Chronic obstructive ailment legen. COPD (j44)

Chronic obstructive ailment of the disease (COPD) - ailment, as it is possible to get it and lіkuvati, characterized by persistent interconnection of fluidity of the flow, as it evolves to progress and is linked to the development of chronic ignition conditions on the basis of pathogenic areas or gases... In low patients, aggravated and concomitant illnesses can be influenced by the severity of COPD.

Epidemiology

According to the results of mass special education, the population of the great places of the COPD part of the middle of the disease becomes 90%. According to the forecasts, the widening of COPD and the bitterness from it will become worse, which is accompanied by a growing influx of factors in the risik and triviality of the life of the population. The USA has close to 14 million, in the Russian Federation it is transferred close to 11 million. Ailments to COPD, (according to statistics - less than 1 million). The prevalence of COPD in the Russian Federation is close to 10%, 2 times more often sick people are sick. The development of sickness in young people of 20-30 years old is being restructured. Between women who are sick and sick, they become 40-49 years old. Invalidity in COPD will arise in about 10 years after the diagnosis is established, often at the time of the infection - 2-3 degrees of severity of the disease, so as to indicate the disease.

Mortality from COPD tends to grow According to the forecast until 2030, rock won vijde is at the 4th place among the causes of death in the world population. The main vitrages of health protection are close to 80%, they are vitrized at the stationary treatment, of which there is a larger part - 73% for the treatment of important patients.

Ethiology

COPD arises as a result of the infusion of a complex of factors in the risk of a trickle hour

Factories that can be used for the development and progress of COPD

Named factories for riziku

kurnnya tyutyunu

Among the largest factors in the risk of COPD tyutyunopalinnya become 39%. The broadening of the household becomes up to 50% of the middle of the population and up to 11% of the middle; middle school 10 classes 50% and 28% as appropriate. One third of the population is older than 15 years for smoking by the WHO. Tyutyunovy dim is stored in 2 fractions: gas-like (formaldehyde, nitrogen oxide, urethane, vinyl chloride) and fractions of important parts (benzopyrene, nicotine, nitrozonikotin, nickel, cadmium). Ingredinti is injected on the entire body, albeit in the larger world on the bronchopulmonary system, to deduce the bio-transformation of products Tyutyunovy dimu... Toxic dіya nadayut і secondary products. In the first place, there will be highly differentiated cells of mucous bronchial tubes and endothelial cells of dry blood vessels.

Mechanisms to take part in the biological transformation of Tyutyun's dima and їх business

Drinking 15 cigarettes will increase the health of the cigarettes. AM to glaze a part of the untrustworthy particles of Tyutyunov dimu, and it’s too early to die at the prenosological stage of ailment. The development of respiratory symptoms and COPD can be linked to passive women. During the last hour of vaginosity, you can correct the negative infusion on the growth of the fetus and the development of the lungs, and you can press the first antigenic infusion on the immune system.

Professional pollutants (drank and chemistry)

Professionals, such as organic and inorganic saws, chemical agents and diets, cause COPD in 10-20%. There is a great value of intensity and triviality in the flow, after being sent to the houses. Professionals with advancing the development of HOZL: miners, robots of metallurgical enterprises, robots, who are busy at the reworking of the plant, virobnitsy paper and in.

Atmospheric and home pollutant

In the Russian Federation, more than 30 million tons of lustrous voices of industrial wikids can go into the atmosphere, about 20 million tons of wikis by motor transport, which is added to the amount of 400 kg per person per capita. Nearly 735 thousand people live in the minds of the GDK of shkidlivy speeches in the atmospheric twilight 5-10 times. Aeroplutants of industrial smog (solid particles of a saw, sirka dioxid, carbon monoxide, polycyclic carbohydrates) overload the charge. The aeroplutant of the photochemistry can (nitrogen oxide, ozone, aldehyde) re-ferment a lot. Due to the inflow of aeroplutants, the following destruction occurs: activation of AM and phagocytes from the establishment of strong oxidants (oxides of chlorine, water), so that the cell membranes are reduced; approval of new bіlkіv with new antigenic authorities; zapalennya (endobronchit); hyper i-discrimination; collapse of the MCT; vasoconstriction and bronchoconstriction; a decrease in the activity of beta 2-adrenergic receptors, an increase in the activity of cholinergic receptors; stimulation of vasoactive and procoagulant activity (leukotriniv, thromboxanes); ruinuvannya collagen. In the minds of oxidative stress, an antioxidant system (ceruloglobulin, supeoxiddismutase, tocopherols) is seen. Є The number of tributes is significant, which is to indicate those that are difficult to deal with in the midst of the burning of bioorganic fires (wood, pus, straw, vugilla) є An important factor in the development of COPD.

інфекції

The deterioration of COPD can be increased to infectious diseases, however, it has not yet been added to the COPD development. The importance of respiratory infection has been transferred to children, which can be reduced to a decrease in the function of the lungs and the reception of COPD risk in the home. Respiratory and infectious agents of pneumotropic. In COPD ailments, the persistence of viruses in mental health, often in associations (influenza virus, parainfluenza, adenovirus, rinosis virus and in) is indicated. In COPD, the distal appearance of the alveoli is important. Viruses suffer from degenerative-dystrophic diseases and desquamation of bronchial epithelium, destruction of trophies and muscular immune mechanisms, spraying colonization of microbial flora of the lower dikhalnyh nobles, Yaki in the norm sterile. Viruses and some of the components are trivial to be found in the cells of the epithelium and AM, which may cause proteolytic activity and may lead to destruction of the alveoli and mіzhalveolar septa. Viruses with hyperreactivity of bronchial tubes.

Bacteria (pneumococcus, Influenza sticks, Moraxella) are susceptible to sensitization and chronic inflammation. At the same time, neutrophils come on the AM change, as they see proteases. Persistence of bacteria and repeated aggravation to produce antiprotease antiprotection to the depletion, use for ruining the elastic frame of the alveoli and forming the centrilobular emphysemia.

Social and economic status

Є prove that the development of COPD is based on social and economic status.

Internal officials of Riziku

Genetic.

Naybіlsh documentsanym genetic factor of risk є the importance of the lack of alpha-1-antitrypsin - the main inhibitor of serine proteinases in systemic blood flow. For the impairment of the function of the legends, the following genes are linked: the gene for the code of the matrix proteinase 12, the gene for the alpha-nicotin-acetylcholine receptor, the gene for cystic fibrosis, genetically mutated defect in the antioxidant tumor system, cytochrome cytochrome 450.

Rist and development of legends

Growth of the lungs to lay down from the young inflows for the period before the hour of vaginosity and flatness, as well as on the organism in the child and adult. The maximum dosage function of the legends has been reduced in order to improve the development of COPD. Destruction of the processes of ripening to the fetus, low vaga during populations, shkidlivi pour on the child's body, screwed up the legends in the child's life until the development of COPD. Infections of the lower types of the respiratory tract in children destroy the growth of the legends, lead to the change of the legends.

The hypersensitivity and hyperreactivity of the dysfunctional nobles has been discussed.

Bronchial hyperreactivity becomes 15% in the middle of the population factors.

Vіk і become.

The broadening of COPD, for the data of the last few days, however, is the middle of the cholovik and the middle of the women, which is necessary to knit with the chickens of the Tyutyun. A woman who burns less, less choloviks, is less sensitive to the shitty of a Tyutyun dim, more often in a particular childish state. It was established that the prevalence of COPD is more than the middle of the curts, the lower the middle of the non-smokers, the growing number of ailments in the group over 40 years old, in the cholovik more, and less in the women.

інші factories

Installed in the inflow of the disease on the form of COPD. Particularly significant are bronchial asthma, tuberculosis of the lungs.

In such a rank, in COPD development take on the fate of the developmental factor of rizik. We characterize the admission of bureaucrats to the rizik in the children's combinations, key manifestations and іnuvannya іnuvannya phenotypіv obhvoryuvannya.

To carry out the diagnostics process in the classy type of sick person A, I have a lot of respect for those who are a patient who is a senior member, be referred to the category of "evil curses" - index of curts (ІК) 240.

pathogenesis

Firing in the chicks of patients with COPD є key pathogenetic mechanism of COPD .

The physiological role of the firing field in the interdependent diy of the pathogenic substances that was consumed in the inner middle. In case of COPD, an ignition reaction is formed in the form of a trivial injection of an official into a rhizik, a larger world of criminal pathologically abnormal ignition process in spirited nobility among the most dramatic officials. In the ignition process, all cell elements and structures of the respiratory tract are generated. bronchi

Clinical elements and ignition media.

In the chronic ignition process, all the elements of the psychic nobles are drawn into the process, as they interconnect with themselves for additional coverage of cytokines.

neutrophils The key role in the implementation of zapalennya to lay on neutrophils. The structure and the building of the cells are deformed before the flow of currents, so that it becomes difficult to pass through the capillaries, which may have a smaller diameter in the case of neutrophils. There is an accumulation of neutrophils in the distal lungs. Decrease in the expression of adhesion molecules of the endothelial cells. Neutrophils see pro-fired mediators (FAT, LT B4 and in.) Neutrophils see proteases (elastin), acidic radicals, cationic proteins, beta-glucuronidase, which cause tissue destruction of the lung parenchyma, chronic hypersecretion of mucus by bronchial lysalosis.

macrophages accumulate in the destruction of the alveoli . Macrophages are activated to see pro-inflammatory mediators (FNP-alpha, interleukin 8, leukotriene B4), so that neutrophils migrate in the lower direction.

T-lymphocyte Increased presence of cytotoxic CD8+ lymphocytes to be significant in all legene structures. Transferring, seeing CD8+ perforin, granzyme-B and TNF-a, cytolysis and apoptosis of alveolar disease and stimulate inflammation.

eosinophils The role of eosinophils in flaring up in COPD has been clarified.

Epithelial cells of the mucous membrane of the bronchi see pro-burning mediators (eucosanoids, cytokines, adhesion molecules).

Oxidative stress.

Respiratory flow is given to the flow of oxidants, to take place in the morning, to inhale and become endogenous in response to the development of stimuli. One of the factors that play a role in the development of the ignition process in cold paths in COPD is oxidative stress due to the establishment of active forms of acidic-ROS, to which radicals and prooxidants are introduced, create radicals. Tyutyunovy dim is the main initiator of oxidative stress. Dzherelom oxidants є assets of ignited cells, persh for everything, neutrophils and alveolar macrophages. In patients with COPD, there is an increase in the concentration of biological markers of oxide stress - transverse water, 8-isoprostane in the condensate of water, which can be seen, phlegm and systemic blood flow. Kisneví radicals are responsible for the parenchyma of legends, bronchial tubes and legends of the judgment. The synthesis of collagen, elastin, surfactant decreases, the structure of other components in the extracellular matrix, such as hyaluronan... The change in the structure of the blood cells is to lead to the destruction of the immune responses, the activation of the lungs of the smooth muscles of the bronchi, the stimulation of the secretion of the viral secretion, the activation of the blood cells, the increase in the protean of the vertebral penetration, All prices are supervised to the power of the fire.

The regulator, which interconnects the accumulation of highly toxic strong radicals, is the antioxidant system, which is stored in non-enzyme systems (Vitamin E, beta-carotene, Vitamin C, secic acid, bilirubin) and enzyme, neutral antioxidant form of the antioxidant The main antioxidant enzymes are: superoxide dismutase, catalase, glutathione peroxidase, glutathione-S-transferase. In patients with illnesses, it is more difficult to prevent a decrease in the level of endogenous antioxidants with a developmental imbalance in the oxidation-antioxidant system and to increase the level of peroxide oxidation of lipids. A family of antioxidant proteins-peroxidoxins, with a special role in the lungs to superimpose the secretory hydrophilic protein peroxyperidoxin 6 - (Prx6), will remain for an hour. Wine is synthesized in the trachea and bronchi by Clara cells and cells like cells and secreted in the mucus. A fraction of Prx6 from the antioxidant zahyst in the bronchi becomes 70%. In the experimental model of gastrointestinal inflammation and reduction of bronchial tissue oxidation, it is shown that the Prx6 hypothesis in cell-like cells will lead to changes in the oxidative process: decreased markers of peroxidation oxidation. Possibility is observed, but Prx6 is one of the main factors in antioxidative stress and may be the most active of all natural antioxidants in the treatment of adult sickness.

Imbalance of the proteinase-antiproteinase system.

A superb purchase of neutrophils in the dichny paths supervises a high protease activity. With COPD, a number of deciduous proteases appear, which can be established in firing and epithelial cells (neutrophilic elastase, cathepsin G, proteinase-3, metalloproteinases, cathepsin), and it is possible to reduce the potential to hanging antibodies. components of the resulting tissue, and antiproteinases (alpha-1-antitrypsin, secretory inhibitor of leukoproteinases, tissue inhibitors of metaloproteinases). Gnіtyuche dіyu on іngіbіtory proteases nadayut oxidants. Tse to produce up to non-collar structural changes. Elastaza ruin elastin of alveolar stinoks, with the development of emphysemia and reduction of elastic support of the lungs, ruin of bronchial epithelium and viklikal metaplasia of kelikhopodibnykhklitin.

The role of nitrogen oxide and its metabolism in the pathogenesis of COPD.

The role of nitrogen oxide (NO) and its metabolism in the pathogenesis of COPD will remain for an hour. NO is synthesized from arginine for the participation of NO-synthase (NOS) and ionic calcium. There are three forms of NOS: endothelial (eNOS), neuronal (nNOS), and inducible (i NOS). NO molecules can be established as a non-enzymatic path with the renewal of nitrites and nitrates during the acidification of the middle and the transition to a revolting ionization. Injection of NO, which is seen as endothelial cells, gives vasodilating effect on the level of other arteries, neutralizes bronchoconstrictive activity of acetylcholine, and removes thrombosis. Macrophagous NO I give a stimulus to the action on the basis of the diet and the muscle immunity of the dichally nobles. In chickens, the decrease in NO illumination in the dykhalny way can be the result of an increase in the endogenous synthesis on aphids with an excess of NO with a tyutyun dim behind the ringing mechanism. At the same time, the ignition process is accompanied by an increase in the synthesis of NOS and NO. Overwhelmingly the establishment of NO and th metabolites -nitroxyl-anion, perosinitritis is seen as one of the mechanisms of oxidative stress, which is a part in the realization of burning in COPD.

The role of infection in the pathogenesis of COPD

Trial of the analysis of factors in the development of the structure of the respiratory tract opens up the mind for the colonization of mental health by viruses and bacteria. Viruses stimulate the processes of inflammation, tissue proteolysis and destruction of alveoli, disrupt the mechanisms of muscle immunity, and remove bacterial flora. The adhesion of pneumotropic bacteria to mucin, bronchial mucus, epithelial cells, extracellular matrix is ​​adhered through the adhesion receptor for the participation of bacterial invasive factors. The strength of the adhesion receptors is improved during the repair of tissue structures, such as superficial heating. Lack of factors in muscle immunity and secretory IgA, lysozyme and lactoferin bronchial mucus, which is formed by the infusion of chronic diseases of COPD, spirits of colonization of microorganisms of all types of diseases. The persistence of microorganisms stimulates the ignition process, increases the migration and activation of neutrophils, decreases the activity of adrenergic receptors, and causes muscle immunity even more. On aphids, immunodeficiency is attributed to fungal flora. The destruction of the rіvnovagi mіzh microflora and the common mechanisms of the dyshlikh shlakhіv lead to the aggravation of COPD with the improvement of the symptoms of the muscular and systemic inflammation. By such a rank, persistent infection in spontaneous paths, stimulating the activation of cell-effectors, by the mechanism, which leads to inflammation in COPD.

Pathomorphology

Pathomorphological changes are characteristic for COPD to appear in the legacy structures. Chronic changes are characterized by chronic incidents, problems and reparations.

Due to the inflow factors in the risk of deterioration of the power of bronchial mucus, viscosity increases. The metaplasia of the cell-like and mucous cells develops, the hypersecretion of the mucus, which can lead to the production of mucociliary cells.

Structural perebudova dichnyh nobles, growths in the world of progressing illnesses. The taste of bronchial inflammation є bronchial remodeling, Yake is characterized by:

Sweets of the submucosal and adventitious ball for rakhunok nabrya, attachment of collagen and proteinglikans;

Increase in the number and size of mucous and cell-like cells;

Improvement of bronchial microsudine hemispheres;

Hypertrophy and hyperplasia of the muscles in the bronchi.

Structural changes occur in the central, peripheral dichny paths, legion parenchyma and legenevian vessels.

At the central dihalnih Shlyakhov (trachea, bronchi i bronhіoli bіlsh 2 mm dіametrі) vіdbuvaєtsya gіpertrofіya mucous zaloz i kelihopodіbnih klіtin, zmenshennya ciliate klіtin i villi, squamous metaplasia, zbіlshennya Masi gladkoї musculature i spoluchnoї tkanini, degeneratsіya hryaschovoї tkanini, Find our sclerosis stіnki bronchus viyavlyayutsya in 1/3 of the patients. Clinical lesions of the great marauders are characterized by cough and phlegm.

In peripheral dichal paths (other bronchi and bronchial tubes in diameter less than 2 mm), hypertrophy of the muscle fibers, metaplasia of the epithelium, regeneration from the tumors in the place of the collagen are observed. In case of COPD, the changes of other dysfunctional paths to produce up to їх sounding, a decrease in the number of terminal bronchioles and an increase in support. The processes are supervised by progressive deterioration of the function of the new environment.

In the lungs parenchyma (respiratory bronchioles, alveoli, legeny capillaries), the destruction of the alveolar stems develops centrilobular emphysema, dilatation and destruction of respiratory bronchioles. More often, centrilobular emphysema is localized at the upper viddils, in some cases everything is easy. panacinarna emphysema is characteristic of alpha-1-antitrypsin deficiency. Urazhayutsya lower parts, destruction of the alveolar walk, mice and respiratory bronchioles.

Zmini in Legeny vessels are formed at the early stages of COPD. The doom of the Judgment Day will appear. Dysfunction of the endothelium is characteristic in the legs of the legacy artery, which can lead to the formation of legacy arterial hypertension. Adding a vice in the legacy of the artery with the reduction of the capillary channel in the manner of the emfizem of the leg.

Pathophysiology

Processes that lie in the basis of COPD produce up to the formation of typical pathophysiological disorders and symptoms.

Mixing the liquid syrup

Coarse syrup by head pathophysiological mechanism in COPD. It is based on both werewolves and non-negotiable components.

Non-reversible obstruction mechanisms: fibrosis і bronchial ulceration (remodeling), loss of alveolar attachment and rupture of alveolar adhesions to the education of other dysfunctional paths and elastic traction through destructive parenchymal diseases.

Reverse obstruction mechanisms: accumulation of ignition cells, mucus and exudate plasmas in the bronchi, rapid smooth muscles of peripheral and central bronchial tubes, dynamic hyperinflation in case of physical nasal .

legeneva hyperinflation(LGM) - the lungs lightness is shifted.

The basis of LGM lies it's pasta, yaka vinikє in the case of an unconscious vyporozhnenya of the alveoli for an hour vidikh through the loss of elastic traction leg ( static LGM) For as long as the lack of an hour vidikhu in the minds of the twisted interchange of the expiratory flow ( dynamical LGM).

The views of LGM є the promotion of excess lung obstruction (OOL), functional extra lung capacity (FOE), extra lung capacity (OEL). An increase in dynamical hyperinflation is seen in the presence of physical overhaul, as well as at a whole part of the situation, like a short man, and a large part of the legendary obsyagu to be patched on the ridges of the alveoli.

It is not progressively ill, which is characterized by an ignition component, impairment of bronchial passages on the level of distal bronchial tubes and structural changes in the tissues of the lungs and on the vertebrae. Main key signs- cough with the appearance of mucous and gnarial sputum, zaschishka, sagging of the skin cover (cyanosis or erysipelas). Diagnostics is based on the data of spirometry, bronchoscopy, pre-diagnosed blood gases. Treatment including inhalation therapy, bronchodilators

Country houses

Chronic obstructive ailment (COPD) is seen as an independent disease of legends and interdependence in a number of chronic processes dichotomous systems, Which prevent from obstructive syndrome (obstructive bronchitis, secondary emphysemia, bronchial asthma, etc.). It is well known from the epidemiological data that COPD is often the enemy of the population of 40 years, borrowing the leading positions among the causes of disability and 4 months among the causes of lethality in the active and primary part of the population.

cause COPD

Among the reasons for the development of chronic obstructive ailments, 90-95% are introduced. Among the top officials (close to 5%) see viral schooling (inhalation of high-grade gases and particles), respiratory infections of a child's health, bronchopulmonary pathology, and ecology. In men, at least 1% of patients, the basis of COPD is genetic strength, it turns into a deficiency of alpha 1 antitrypsin, which is established in the tissues of the liver and prey on the legacy due to the enzyme elastase.

HOZL є to professional workers of miners, zaliznichniks, budiwelniks, who are in contact with cement, working pulp-paper and metallurgical industries, agricultural workers, who are busy with processing grain. Among the professional schoolchildren, among the reasons for the development of COPD, they lead:

• contacts with cadmium and silicon
• metal scrap
• the role of products is very important, when it comes to fire.

pathogenesis

The factor of the nascent middle age and the genetic strength of the disease is chronically more intense than the inner shell of the bronchial tubes, which leads to the destruction of the muscular bronchial immunity. At the same time, the bronchial mucus is violated, the viscosity grows, and it grows up by ourselves, and for the propagation of bacteria, the destruction of the bronchial passages, the alteration of the alveolar tissue. Progression of COPD leads to the loss of the circulating component (clotting of mucous bronchial tubes, spasm of smooth muscles, secretion of mucus) and the improvement of non-reversible changes, which leads to the development of peribronchial fibrosis and emphysema. Prior to progressive dyshal deficiency in COPD, bacterial acceleration can occur, leading to relapses of legenevirus infections.

The COPD has moved to accommodate the distribution of gas exchange, which appears to reduce O2 and absorb CO2 into the arterial blood, move the grip in line with the Legendary artery and lead to the formation of a legendary heart. chronic Legend's heart a lack of blood circulation and a fatal result in 30% of patients with COPD.

Classification

International experts in the development of chronic obstructive ailments are legally seen in 4 stages. The criterion, we will lay down the basis of the classification of COPD, є the change in the number of FVD (forced vidihu) to FZHEL (forced life of many legends)

• stage 0(The front of the disease). It is characterized by the development of COPD by the development of a rizik, or do not expect to transform in it. appear by coughing and secretion of phlegm with unchanged function of the lungs.
• stage I(Easy to overcome COPD). Insignificant obstructive damage occurs (a forced vidih ​​in 1 sec. - FEV1> 80% of the norm), chronic cough and sputum production.
• stage II(Moderate COPD). Progress obstructive damage (50%
• stage III (An important change in COPD). The build-up of the intermittent flow during vidihu (30%
• stage IV(In the edge of a heavy COPD transition). To appear as an important form of bronchial obstruction, threatening for life (FEV, dysfunctional deficiency, development of the heart of the heart.

COPD symptoms

on early stages Chronic obstructive ailment The disease is not susceptible to failure and does not depend on it all the time. It is characteristic of the clinker to develop, repairing from the moderate stage of COPD.

Overbig COPD is characterized by cough with phlegm and sluggishness. At the early stages of turbulence, an episodic cough with the appearance of mucous phlegm (up to 60 ml per dose); in the world of progression of severity, the cough has become permanent, the zadishka is seen in peace. COPD becomes infected with infection, the nature of the sputum becomes more severe, and the number of infections grows. Overbig COPD can be developed for two types of clinical forms:

• bronchial type... In patients with bronchial type of COPD, it is transmissible manifestations to serve as firing processes in the bronchi, which are superimposed on intoxicating, coughing, and clear sputum. Bronchial obstruction is significant, the legeny emphizma is weak. Quite a group of patients is cleverly called "blue Father" from a glance at the diffuse-blue cyanosis of shkirnykh curvatures. The development of an accelerated and terminal stage begins in a young person.
• emphysematous type... With the development of COPD according to the emematous type, the first plan in the symptomatology is to include an expiratory posture (with complication of vidih). Emphysema of legends overloading the bronchial obstruction. For the characteristic zvnіshny viglyad of paciєntіv (horny-gray color of shkіrnykh crooks, barrel-shaped breast cages, cachexia) they call them "horny pikhtelshikov". Mа bіlsh kindly perebіg, paciєnti, as a rule, live to see the kidnapped vіku.

accelerating

Progresuyuchy perebіg hronіchnoї obstruktivnoї hvorobi legen Mauger uskladnyuvatisya pnevmonієyu, gostroї abo hronіchnoї dihalnoyu nedostatnіstyu, spontaneous pneumothorax, pulmonary fibrosis, vtorinnoї polycythemia (eritrotsitozom) zastіynoї sertsevoї nedostatnіstyu i t. DW vazhkіy i Wkra vazhkogo stage COPD patsієntіv rozvivayutsya legeneva gіpertenzіya i legeneve Serce ... Progressive surges of COPD lead to changes in the activity of patients and a decrease in the quality of life.

diagnostics

It is legendary to raise awareness about the rapid diagnosis of illness, as well as improve the quality of life and improve the triviality of life. When collecting anamnestic tribute, it is necessary to pay respect for the obviousness shkіdlivyh ringtone(Tyutyunopalinnya) and viral factors.

• Doslidzhennya FZD. by the preferred method functional diagnostics to serve spirometry, showing the first signs of COPD. Obov'yazkovoyu є vimіryuvannya shvidkіsnіh and general indicators: life іnstі legen (ZHEL), forced zhitvoi otnosti legen (FZHEL), ob'єmu forced vidihu in 1 sec. (FEV1) і ін. In post-bronchodilator test. Pidsumovannya and spivvidnoshennya cich indicators in allowing diagnosis of COPD.
• Analysis of phlegm. Cytological dosage of sputum in patients with COPD allows assessing the nature and swelling of bronchial inflammation, including oncological alertness. Pose sharpened the character of mucus mucus with re-digestion of macrophages. At the stage of acute chronic obstructive pulmonary disease, the sputum becomes viscous, severe.
• Blood analysis. Clinical prescription of blood in case of COPD appears to be polycetemia (increase in blood counts, hematocrit, hemoglobin, blood viscosity) as an inheritance of the type of hypoxemia in bronchitis. Patients with swelling symptoms of mental deficiencies continue to have a gas storehouse of blood.
• radiography breast cancer. When radiographing the legends, one may become ill with certain clinical manifestations. Patients with COPD on the roentgenogram show a deterioration and deformity of bronchial spines, emphysematous changes of the lung tissue.

The messages that start at the EKG are characterized by hypertrophy of the right type of heart, which is indicative of the development of legacy hypertension. Diagnostic bronchoscopy in COPD is indicated for differential diagnostics, I will look at the mucous bronchial tubes and assessments, I will stand, the fence for the analysis of a secret.

lykuvannya COPD

The goals of therapy for chronic obstructive ailments are the improvement of bronchial obstruction and mental deficiencies, the reduction of periodicity and severity of acute inflammation, improvement of the quality and improvement of the triviality of life. necessary element complex therapyє Usunennya cause sickness (nasamper kurinnya).

COPD treatment is carried out by a pulmonologist and consists of the following components:

• navchannya of the patient with the help of inhalers, spacers, nebulizers, criteria for assessing his own body and self-help navichi;
• the designation of bronchodilators (drugs used to expand bronchodilators);
• the sign of mucolytics (drugs that can develop phlegm and lie down for the first time);
• the sign of inhalation glucocorticosteroids;
• antibiotic therapy for an hour zagostren;
• oxygenation to the body and legacy rehabilitation.

In the case of a complex, methodical and adequately adapted treatment of COPD, it is possible to reduce the rate of development of dyshal deficiencies, to speed up the number of aggravated and prolonged life.

Forecast and prevention

Generally, the prognosis of unpleasantness. It is unhealthy for the progression of COPD to make it impossible. Prior to the prognostic criteria of COPD, the following are considered: the ability to switch off the provoking factor, the patient's recommendations and clinical visits, the social and economic status of the patient. Unwelcoming COPD disruption is made possible in cases of important concomitant ailments, heart and mental deficiencies, lustful patients, bronchial types of illnesses. Quarter of the patients with important forms to push hard to rock. By visits to prevent COPD, to serve as the prevention of high-level factors (from the view of tyutyunopalinnya, to prevent the protection of the work in case of the presence of occupational hazards), prevention of hypertension and other bronchogenic infections.

Chronic obstructive lesions (COPD) -

primordially chronic fired up lungs for exercise distal dykhalny nobles and parenchyma, formations of emphysema, impairment of bronchial passages with development in the general community of circulatory or non-vascular bronchial obstruction, viciklikan pathological inflammation reactions. The ailment develops in sickly individuals and manifests itself as a cough, as a result of phlegm, and a build-up sluggishness, a poorly progressive character, and as a result, in a chronic dysfunctional lack and a legacy heart.

COPD is reported to often occur.

According to the WHO data, the spread of COPD in the middle of the population is to become 9.34: 1000 in the middle of women - 7.33 to 1000.

Russia has close to 1 million ailments on COPD (official data of the Ministry of Health of the Russian Federation), but for the most part, there can be over 11 million people (data from epidemiological reports).

Classification COPD is carried out behind the stage of severity (stages). See 4 stages of COPD.

good luck international recommendations[Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2003]< 70 %, характеризующее ограничение экспираторного воз­душного потока. Разделяющим признаком, позволяющим оценить степень тяжести (стадию) ХОБЛ - легкое (I стадия), среднетяжелое (II стадия), тя­желое (III stage) and in the most important (IV stage) with a stretch, - to serve as the value of the FEV indicator, (which is used for the purpose of bronchodilator drugs).

Stage I: easy overrun of COPD. FEV / FZHEL< 70 %. На этой стадии больной может не замечать, что функция легких у него нарушена. Обструктивные нарушения выражены незначительно - FEV value,> 80% of the available values. Namely, do not worry, COPD is a chronic cough and sputum production. Therefore, only in 25% of the cases of congestion are diagnosed promptly (due to the European Respiratory Partnership), so that COPD is developing at the stage of development.

Stage II: moderate overbig COPD. FEV, / FZhЄL< 70 %. It’s a stage, when a child’s children are medical aid in a ring with a zadishka or zagruzrennya zahvoryuvannya, characterized by a decrease in obstructive damage (50%< ОФВ 1 < 80 % от должных величин). Отмечается усиление симптомов заболевания и одышки, появляющейся при физической нагрузке.

Stage III: important overbig of COPD. FEV / FZhЄL< 70 %. Characterized by a slight increase in the interruption of the flow (30 % < ОФВ, < 50 % от должных величин), нарастанием одышки, частыми обострениями.

Stage IV: vkray important overbig COPD. FEV / FZHEL< 70%. At the first stage, the quality of life can be frustrated, and the fire can be threatening for life. Khvoroba nabuv іnvalidizuyuche perebіg. Characterized by an important bronchial obstruction (FEV,< 30 % от должных величин или ОФВ, < 50 % от должных величин при наличии дыхательной недостаточности). На этой стадии возможно раз­витие легочного сердца.

Ethiology. The main factors in the development of COPD є are:

1) kurіnnya (yak more active, so і passive);

2) an infusion of professional skills (drank, chemistry alcohol, steam of acids and lugs) and industrial pollutants (S0 2, K0 2, black dim, etc.);

3) atmospheric і home (dim from preparation and organic fire);

4) decline in mental strength (most often the deficiency of a g anti-

trypsin);

5) ailments of organs in the early childish, Mala Masa

tila with the people.

Epidemiological development of COPD is the most important factor in the development of COPD. Less than 10% of cases of COPD are linked to other factors of rhizic.

Skin care factors can be independent or in combination one with one.

Pathogenesis. The infusion of tyutyunovy dim and toxic gases produced a multiplying effect on the irritative receptor of the bloody nerve, rosetting in the bronchial epithelium, so that it can lead to the activation of cholinergic mechanisms of vegetative nervous system, Which are realized by bron-hospastic reactions.

As a result of the flow of factors at the first stage of development of the disease, the collapse of the blinking epithelium of the bronchi will collapse even to the rest of the zupinka. Metaplasia of the epithelium develops from the second cell of the instantaneous epithelium and the increase in the number of cell-like cells. The warehouse of bronchial secretion changes (to increase its viscosity and adhesion), which will destroy the meaning of the process. There is a breakdown of mucociliary transport in the bronchi, as a result of the diagnosis of mucostasis, as well as the blockade of other ward nobles and in the farther flap, the optimal mind for the colonization of microorganisms.

With a heady legacy in pouring ethiological officials(Factor_v risiku) є development of a special chronic inflammation, a biomarker of such a є neutrophil. The order of neutrophils in the formulated and realized firing will take on the fate of macrophages and T-lymphocytes. Due to the influx of triggering factors of neutrophils, which circulate in the blood, in great numbers they concentrate in the lungs and are the main source of vital radicals, biologically active speech and enzymes. Neutrophils see a large number of myloperoxidases, neutrophilic elastases, metaloproteases, as well as interleukin and swelling necrosis factor, the main mediators of inflammation in COPD. In the minds of the high concentration of neutrophils in the withers, the balance of the "proteolysis-antiproteolis" and "oxidant-antioxid anti" systems will be destroyed. "Oxidative stress" is developing, and the vision of the great number of violent radicals in everyday life is taking shape. In the case of "oxidative stress", the growth of muscle proteases occurs, and in the order of magnitude of the large number of proteases by neutrophils, to break down the elastic stroma of the alveoli, the process of pulmonary hypertension is developed.

The whole complex of mechanisms ignited before the formation of two main processes characteristic of COPD: impairment of bronchial

nosti and development of centrilobular, panlobular emphysemia. Disruption of bronchial congestion in ailments on COPD is formed for the component of the circulatory system (spasm of smooth muscles, clotting of the mucous membrane and hypersecretion of the mucosa) and non-vascular (formation of the expiratory collapse of other bronchial bronchitis) At the first stages of the development of COPD, bronchial obstruction is formed over the top of the circulating component. In the world of progresuvannya sogvoryuvannya in the damaged bronchial passages become a non-elliptic component.

The main idea of ​​the development of COPD is from HB є those, which emphysema is not slowed down, but a manifestation of ailment, which is formed in parallel with wines, which is seen in spirited ways.

The development of emfizemi should be brought to the reduction of the court hedge in the dylyankas of the legacy fabric, which do not need to be exchanged for gas, as a result of which the rotation of the ventilation-perfusion deterioration occurs. Create a vise for the advancement in the pool of the legendary artery. At the stage of the formation of a legeneva hypertension a further development the legendary heart.

pathological changes, Characteristic for COPD, appear in cartilaginous (more than 2 mm in diameter) and distal bronchi (less than 2 mm) of the 9th-17th generation and acini, which include respiratory bronchioles, alveolar passages, small arteries, alveolar , venules and capillaries. In such a rank, COPD is characterized by the development of a chronic firing process of dichlorocytes, legacular parenchies and sudins, while in other anatomical organs of the disease, there is a number of neutrophilic cells.

Klinichna picture. on I The stage of diagnostic joke reveals the main symptoms of COPD: chronic cough, sputum and / or abnormalities. I have anamnesis, I have great respect for the development of symptoms in the development of COPD (chicken and tyutyunovy dim, promislova drank and chemistry, dim homemade opalescent adjustments and to prepare for the development of the disease) an hour of protection without any clinical symptoms. In the world, the development of COPD disease is characterized by a variety of clinical manifestations and a poorly progressive interruption.

The variability of the main symptoms to be found in the severity of the disease and the phase of overloading is stable or sharpening. The camp will become stable, if progressing illnesses can occur with a trivial dynamic caution for ailments (6-12 m / s), and the frequency of symptoms simply does not change. Sagging is characterized by the degradation of the sick person, it appears to the growth of symptomatology and functional changes, which occurs rapt or stepwise and not less than 5 days.

At the first stage of the diagnostic joke, a retinal analysis of the scarg is carried out, which is presented by the patient. In quiet people, if the patient underestimates his or her body and does not show scarg on its own, the drug, if we are sick, is guilty of actively revealing the appearance of cough and appearance of phlegm.

cough(It is necessary to set the frequency of the diagnosis and the intensity)

I will give life. It is not meant to be a day or to have the character of an intermittent one (it is often held during the day, sometimes at night).

sputum(It is necessary to have a character and a taste), as a rule, it is seen in a small amount of vrants (ridko> 50 ml for dobu), a fatty character. The appearance of gross phlegm and an increase in the amount of sputum are signs of an aggravated disease. The appearance of blood in the sputum gives the suspicion of the cause of the cough (cancer of the lungs, tuberculosis or bronchiectasis);

Chronic cough and excessive production of sputum in a large amount of backward coughs must be overwhelmed by ventilated discharges, so that it can be produced to develop backward.

zadishka(It is necessary to assess the variability, links with physical options) є cardinal acquaintance with COPD and serve as a drive, for which the main mass of ailments are killed before the drug, so that won is the main factor physical activity... To achieve often the diagnosis of COPD arises itself at the stage of becoming ill. It’s a little bit of a cough when you’re physically susceptible to coughing in the middle of 10 years after coughing. In the brink of a rare debut, you can start from the backside. When there is evidence of emphysemia, it can develop in quiet situations, if people are in contact with fine-dispersed (less than 5 microns) pollutants, as well as in case of recessive deficiency of wasps, anti-pancreatitis, it is possible to add

In the world of decreased legacy function, the backwardness is becoming more and more twisted and even more wide-ranging: from the view of marriage due to physical problems to an important mental deficiency. To describe the back of the patient in a simple way: "the growth of zusil at dikhanna", "hardness", "hunger hunger", "dichannia is not difficult." Progression in COPD is characterized by progression-yum (post-growth), post-skin (skin day), improvement in physical infection and in respiratory infections.

Besides, the ailing one can turbuvati rankova head b_l, Sleepiness during the day and sleeplessness at night in cases of hypoxia and hypercapnia, which develop on in different stages getting sick.

In case of taking an anamnesis, it is necessary to respect the factors involved in provoking an aggravated disease (bronchopulmonary infection, disruptions in the infusion of exogenous factors, inadequate physical control of the hospital and in In the world of progresuvannya zhvoryuvannya promіzhki mіzh sharpened flock to short, and with increased severity swells practically persistent character.

Clarify the manifestation of the concomitant ailments (pathology of the heart-vascular system, shlunkovo-intestinal tract), Which is more low in 90% of ailments on COPD and infuses on the severity of COPD and the nature of the complex drug therapy... The effectiveness and tolerability of the therapy started earlier, the regularity of the visit to the patient is maintained.

At the II stage of a diagnostic joke, the most information can be recognized at the stage of unresponsive clinical manifestations of illness and development. At the early stages of illness, clinical symptoms can be seen. Pathological symptoms, which can appear in the world of progressing ailments, lie at the stage of the development of bronchial obstruction, emphysemia and severity of the disease,

flations (over-stretching the leg), the manifestation of such an acceleration, as a dichal lack and chronic legacy in the heart.

Look around the patient, evaluate yogo zovnishniy viglyad, Behavior, reaction of the dichal system to rozmovu, ruh on the cabinet. The lips are taken with a "tube", because they are not supposed to tell us about the importance of COPD protection. Estimate the level of hypoxemia: the central syrian cyanosis is a manifestation of hypoxemia; at the same time, acrocyanosis appears to become an inherited heart failure. Look around the chest, I respect the shape - it is deformed, "barrel-shaped", it is a little dewy in the dyhanna, paradoxically retraction (retracting) of the lower mid-ribbed prominence on the back (the chest of Hoover) and their participation in the act cells in the lower windows - all the signs are important against COPD. With percussion of the chest wall, a boxy percussion sound and lowering of the lower boundaries of the leg (signs of emphizemia) begin. The auscultatory picture of the lungs lies in the presence of anemia and bronchial obstruction. So, with emphysema, the dichotomy is weakened by the vesicular, and in ailments with rotated obstruction, as a rule, it is rough, and the head auscultatory symptom is dry, importantly whistling wheezing, which can be observed in case of forced vidychu, when the back is lumpy.

In case of non-vascular bronchial obstruction, one can experience signs of dichotomous deficiency, an outgrowth of Legenevian hypertension, and a chronic Legenevian heart is forming. Viyaviti signs of a compensated legendary heart in case of physical obsolescence is important, tone the heart to be audible forcibly, a little more to the accent II tone over legendary artery... You can find the pulsation in the epigastric day for the rakhunok of the right duck. In the world of progress, diffuse cyanosis begins. A decompensated legacy heart must form: the oven grows faster, the pastry appears, and then the homosexuals and feet swell.

Patients with medium and heavy interruptions see two key forms COPD - emphіzematous (panacinar emphіzema, "puffy rheum") and bronchial (central hemophysis, "blue puffy"). The main indications of guidance in the table. 5. However, in practice, most often the form of the disease is changed.

Sensitivity of physical (ob'ktivny) methods of treatment of patients in diagnostics of COPD and the significance of the stage of seriousness is small. Smell give orієntiri for false direction diagnostics of the diagnosis of instrumental and laboratory methods.

Stage III of the diagnosis of COPD is the initial stage in the staging of the diagnosis of COPD.

doslіjennya FZD serve as the most important method in the diagnosis of COPD and differentiation from HB. It is necessary for all patients with chronic cough and sputum production, which are evident in the history of factors in the development of the disease when there is a problem with COPD in the early stages of development. The process of pretreatment is not carried out only for the diagnosis, but for the purpose of determining the degree of severity of the disease, the selection of individual therapy, the assessment of the effectiveness, clarifying the prognosis of the overcoming of the disease during the assessment.

COPD (hronіchna obstructive hvoroba legen) - tse zahvoryuvannya, yak rozvivaєtsya vnaslіdok zapalnoї reaktsії on dіyu Pevnyi podraznikіv zovnіshnogo seredovischa, s urazhennyam distal bronhіv i development emfіzemi, i yak proyavlyaєtsya progresuyuchim znizhennyam shvidkostі povіtryanogo flow in legenyah, knots in and takozh urazhennyam іnshih organіv.

COPD borrows another place in the middle of chronic non-infectious diseases and a quarter of the number of causes of mortality, and the indicator is growing unhealthy. In addition, the process of becoming ill is inevitably progressing, it borrows one of the first reasons of disability, so as to bring to the destruction the main function of our body - the function of dichotomy.

The problem of COPD is really good. In 1998, an innovative group of judges launched the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The main staff of GOLD is a wide expansion of information about the disease, systematization of information, clarification of the reasons and emerging visits of prevention. The main idea that I want to convey to the people: COPD is possible for both The whole postulate is to find a fault in a very robust way of diagnosing COPD.

Causes of COPD development

COPD develops with the help of singing officials and provoking agents of the new middle class.

Friendly factories

1. Spadkov's smartness. It has also been reported that the development of a deficiency of some enzymes can lead to the development of COPD. We will explain the family anamnesis of this ailment, as well as the fact that not all of them are sick with great experience.
2. Vіk і become. People older than 40 years of age are more affected by the COPD, however, it is possible to explain both the old organisms and the trivial experience of the home. It is a hint of dania, that at once the disease of the middle of the cholovik and the women may grow up. The reason for this can be the widening of the middle women, and also the sensitivity of the female body to the passive one.
3. be-yaki negative injections, I poured into the development of the organs of the intrauterine periodі an early childish person, to bring the risk of diagnosis of COPD into the future. By itself, physically unappreciated, it is also supervised to change the volume of legends.
4. Інфекції. parts respiratory infections in children, as well as the receptivity to them in the older age.
5. Hyperreactivity of bronchial tubes. If the hyperreactivity of the bronchi is the main mechanism of development, the whole factor is also used as a factor in the risk of COPD.

provocative factors

pathogenesis of COPD

The infusion of tyutyunovy dim and інshh subraznyuyuchih speeches to produce in schilochny individuals until the diagnosis of chronic fumes in the walls of the bronchial tubes. The key is the reduction of distal alveoli (so that they are closer to the legacy parenchymal and alveoli).

As a result, there is a breakdown of normal vision and loss of mucus, blockage of other bronchial tubes, it is easy to get an infection, it is easy to expand on the mucous and mucus balls, to get rid of the clutches. with good cloth(Process of bronchial remodeling). One hour, the ruining of the parenchyma of the fabric of the fabric is seen, the jumper between the alveoli - the growth of the emphysema, that is, the hyperexia of the fabric of the fabric. The lungs, like bi, are inflated by the times, the elasticity changes.

Drobnі bronchi vidikha disgustingly razpravlyayutsya - by force to go out of the emphysematous tissues. The normal gas exchange will break down, so it will change as well. As a result of the diagnosis, the main symptom of all COPD ailments is bad luck, especially when you collapse or walk.

A taint of dyshalal deficiency is an old chronic hypoxia. The guardian sees the whole body. Trivial hypoxia is to bring the enlightenment of the Legendary Sudins to the ringing, yak veda to the expansion of the right views of the heart (to the Legend's heart) and the admission of heart failure.

Why is COPD seen in the vicinity of nosology?

The information about the terms of the disease is low, but the number of patients is great, they are still suffering for those who are ill, I don’t know what the smell of COPD is. Navigate as such a diagnosis and be shown in medical documentation, in case of sick people, as well as those who do not relieve them earlier and "emphizema".

The main warehouses in the development of COPD are effective є chronically inflamedі emphіzema legends. So why is COPD seen in the diagnosis?

In the name of this nosology, the main pathological process is chronic obstruction, so that it is ringing the education of the wicked nobles. Alle the process of obstruction of the presence and in the case of those who are ill.

The incidence of COPD from bronchial asthma is that in case of COPD, obstruction may be more or less non-reversible. The process of spirometry is supported by bronchial infections. at bronchial asthma For bronchodilators, the increase in FEV1 and PSV indicators is higher, lower by 15%. Such obstruction is interpreted as a werewolf. With COPD, the numbers fluctuate slightly.

Chronic bronchitis can be overdue or suprajuvati COPD, ale vin to self-inflicted ailments with clearly defined criteria (trivial cough i), the very term is transmitted to only bronchial tubes. With COPD, all the structural elements of the lungs - bronchi, alveoli, sudini, pleura are affected. Do not become susceptible to chronic bronchitis, superficial obstructive disorders. On the other hand, do not become susceptible to COPD with urgency of the appearance of phlegm. Tobto, in these words, maybe chronic bronchitis without COPD, and COPD is not caused by bronchitis.

Chronic obstructive ailment

In such a rank, COPD at a time is an okremium diagnosis, it has its own criteria, and in any case it is not a diagnosis.

Diagnostic criteria for COPD

COPD can be diagnosed if there is evidence of all the signs that it smells in people over 40 years old:

For the winter patients of COPD є the spirometric indicator of the duration of the sickness of a forced condition 1 s before the forced life of the disease (OFV1 / FZHEL), carried out after 10-15 minutes of the sickness of the bronchial -ipratropium bromide). Indicator value<0,7 подтверждает ограничение скорости воздушного потока и в сочетании с подтвержденными факторами риска является достоверным критерием диагноза ХОБЛ.

Reshta indicators of the spirometry - the high speed of the type, and also the VIMIR OFV1 without the test with bronchodilators can be carried out as screening conditions, the protest does not confirm the diagnosis of COPD.

Among the other methods, which are recognized in case of COPD, in addition to the acute clinical diagnosis, it is possible to refer to the radiography of the legends, the pulse oximeter (the determination of the blood pressure), the dosage of the blood pressure (hypoxemia)

Classification of COPD

The most basic classification of COPD by stages, levels of importance, clinical options.

Classification of the stages of variability of symptoms and data of spirometry:

• Stage 0. Group for Rizik. Inflow of unwelcoming factors (kurinnya). Skarg is mute, the function of the legends is not destroyed.
• Stage 1. Slight overcoming of COPD.
• Stage 2. Moderately severe COPD.
• Stage 3. An important transition.
• Stage 4. Vry important interruption.

In the last additional GOLD (2011 r), the classification for the stages of the the classification behind the degrees of gravity, based on the indicators of FEV1:

For patients with FEV1 / FZHEL<0,70:

• GOLD 1: Light FEV1 ≥80%
• GOLD 2: Medium severity 50% ≤ FEV1< 80%.
• GOLD 3: Vazhka 30% ≤ FEV1< 50%.
• GOLD 4: V-edge important FEV1<30%.

It is imperative that the severity of symptoms does not depend on the degree of bronchial obstruction. Patients with a light step of obstruction can get a bad turn, and they can get sick with GOLD 3 and GOLD 4. To assess the severity of bad health in patients, special caregivers should be asked, the frequency of symptoms in the course of the tests starts in balls. It is also necessary in the assessment of switching over to the frequency of the fire, to the frequency of the acceleration.

In this case, it will be shown on the presentation of the analysis of sub-active symptoms, spirometry data and the risk of aggravating the development of patients on key groups-A, B, C, D.

Practical solutions to see more clinical forms of COPD:

1. Emphysematous variant of COPD. Z skarg for such ailments perevazhaє zadishka. Cough is more likely to develop, sputum may not be present. Hypoxemia, legeneva hypertension occurs rapidly. Such pacinti, as a rule, tend to the low masu tila, the color of the shkirny curves of the horny-gray. They call them “horny pikhtelshikov”.
2. Bronchial option. Such ailments are mainly due to coughing with phlegm, the turbulence of the turbulence is less, they have to grow rapidly in their hearts with a general picture of the heart's inadequacy -synuity, bulging. Such patients are called "blue Father".

Got to emphysematous and bronchial options є to get better, more often to promote changes in form.

In the case of ailments, they see a phase of stable interruption and a phase of sharpening.

aggravation of COPD

The aggravated COPD is called a state of aggravation, if the symptoms of illness go beyond the bounds of an aggravated one. It’s getting better at home, coughing and dying of the sick man’s cough. Zvychayna therapy, as it was earlier, did not assimilate the symptoms to the point of becoming sick, it would be necessary to change the dosage or the scheme of treatment. Call for aggravated COPD requires hospitalization.

Diagnostics of hot spots is primed on the basis of scargs, anamnesis, clinical symptoms, and can also be diagnosed with additional diagnostics (spirometry, remote blood analysis, microscopic examination and diagnostic tests)

The reasons for aggravating the most often are respiratory infections and bacterial infections, and more so are officials (inflow of high-ranking officials in everyday life). It’s a good idea for a patient with a COPD, which significantly reduces the function of the legends, and turning to a wicked camp can take a trivial hour, or the stabilization is going to be on a larger and more difficult step of seizure.

The more often the fire is consumed, the better the forecast is the disease and the more risik is faster.

accelerated COPD

In addition to the fact that patients with COPD are living in the country of persistent hypoxia, they often develop the following acceleration:

lykuvannya COPD

The main principles of clinical and preventive visits for COPD:

1. Vidmova vid kurinnya. At the first glance of simplicity, ale the most important moment.
2. Pharmacotherapy. The earliest ear of basic drug therapy allows for a meaningful change in the life of the patient, change the risk of zagostren and make it more difficult to live.
3. The scheme of the drug therapy for the treatment of individual patients with severe disabilities, sickness of the patient up to trivial drug use, the availability of drugs for the specific skin ailment.
4. We slid proponuvati we get sick from COPD chippings against flu and pneumococcal infections.
5. The positive effect of physical rehabilitation (trenuvan) has been brought. The Danish method is at the stage of development, as long as there are no effective therapeutic programs. The easiest way, which is possible to proponate the patients, is walking with a stretch of 20 minutes.
6. At the time of a difficult interruption, a sickness due to a twisted dysfunctional lack of triviality, an emotional depression because of a palatial help, allows you to polish the camp of the ailing and to continue your life.

Vidmova vid kurinnya

It was reported that the change in the course of the tyutyun was significantly infused into the transition and forecast of COPD. Unimportant to those who have chronic igniting processes that cannot be turned into a turn-on, fixing the course of progress, especially at the early stages of becoming ill.

Tyutyunov's fallowness is a serious problem, as it is not only the patient himself, but also the doctors, but also relatives. Conducted in a special trivial manner, a group of chicks was carried out, in which it was impossible to come in, straightened to fight against a large amount of fallow land (chatter, reconnection, practical joy, psychological response, pointedly). With such vitrates, 25% of patients are willing to see them and see them for an hour. Moreover, what is more and more often conversations are carried out, more and more important and more effective.

Anti-tune programs become state-owned enterprises. The need has come not only to promote a healthy way of living, but to legally secure punishment for health in large communities. Tse can be used to enclose a Skoda hocha b from a passive kurinnya. Especially shkіdlivy tyutyunovy dim for vagіtny women (both more active and passive) and children.

In a part of Tyutyunov's patients, the laziness is similar to that of a narcotic one, and it will be insufficient to carry out conversations in a certain way.

For agitation, there are also medicinal ways to fight the chicken. The price of nikotin-substituting tablets, sprays, zhuvalny gumka, nakirnі plastirі. Also, the effectiveness of antidepressants (bupropion, nortriptyline) in the form of trivial form and form of the disease has been reported.

pharmacotherapy of COPD

Likarska COPD therapy is aimed at reducing symptoms, preventing inflammation and improving the progression of chronic inflammation. Increase zupiniti or vilikuvati destructive processes in the legends, which are unheard of on the current day.

The main drugs that can be used for the treatment of COPD:

bronchodilators

Bronchodilators, which can be used for treating COPD, relax the smooth mucous membranes of the bronchial tubes, and by themselves expand them to educate and lay down the passage of time. It has been reported that all bronchodilators increase the tolerance of physical symptoms.

Before bronchodilator drugs should be taken:

1. Beta-stimulants of a short period ( salbutamol, fenoterol).
2. Beta-stimulants trivaloi dії ( salmoterol, formoterol).
3. Short-acting anticholinergics ( ipratropium bromide - atrovent).
4. Anticholinergics trivaloi diy ( thiotropy bromide - Spirivi).
5. Xanthini ( eufilin, teofilin).

Mayzhe all acute bronchodilators are stagnant in the inhalation form, but in a short way, not just in the middle. Є Various types of inhalers (dosages of aerosol, powder inhalers, inhalers, inhalation activated, small forms for nebulizing inhalers). In important ailments, as well as in those with intellectual disabilities, it is more effective to pass through the nebulizer.

A group of drugs is given, which is the main one in the treatment of COPD, stagnates at all stages of the disease, such as monotherapy, or (in part) in combination with other diseases. For post-mortem therapy, it is more important to get bronchodilators in the trivial diy. If short-range bronchodilators need to be diagnosed, fenoterol and ipratropium bromide (berodual).

Xanthini (euphilin, theofilin) ​​stagnate in tablets and in іn'ktsіy, maybe a lot of side effects, for tricky addiction is not recommended.

Glucocorticosteroid hormones (GCS)

GCS є with tighter anti-firing method. To become stagnant in ailments with an important and in the edge an important step, as well as to be recognized as short courses in case of staggering in a moderate stage.

Naykrashcha form of stasisuvannya - tse іngalyatsіynі GKS ( beclomethasone, fluticasone, budesonide). Stagnation of such forms of corticosteroids minimizes systemic side effects of this group of drugs, which inevitably occur when they are taken in the middle.

Monotherapy of GCS is not recommended for patients with COPD, it is often recognized in combination with beta-agonists of trivial diy. The main combined preparations: formoterol + budesonid (smallcort), salmoterol + fluticasone (seretide).

In case of a serious interruption, as well as in the period of sharpening, systemic GCS may be recognized - prednisolone, dexamethasone, kenalog... Trivial therapy with these diseases is fraught with the development of important side effects (erosive and inferior lesions of the intestinal tract, Isenko-Cushing's syndrome, steroid diabetes, osteoporosis, etc.).

Bronchodilators and glucocorticosteroids (and more often they are available) are the most common ones available, as they are recognized in COPD. The scheme of treatment, dosage and combination of drugs is individualized for a skin ailment. The choice of choice does not mean only the recommended GOLD schemes for small class groups, but the social status of the patient, the type of person and the availability of it for a particular patient, the health before the beginning, the motivation.

Іnshі drugs, which can become stagnant in COPD

mucolytics(Reduction of sputum cough) is recognized for the presence of viscous, difficult to cough up sputum.

Ingibitor phosphodiesterazy-4 roflumilast (Daxas) is an admittedly new drug. Maє prolonged protizapalnu dіyu, є its kind alternative to GCS. To be consumed in tablets of 500 mg once a day in patients with an important stage of COPD. The effectiveness of the drug was brought to the top, ale wasting the drug through the temple, as well as a high dose of medication (nudota, blues, diarrhea, headache).

Є doslіdzhennya, scho drug fenspirid (Erespal) Maє anti-firing effect, we will add the GCS, and we can also recommend such ailments.

The method of intrapulmonary percussion ventilation of the legends: a special apparatus for generating other types of food, which are served in the legends with quick-and-dirty items. As a result of such pneumomassage, there is an expansion of the collapsed bronchi and the improvement of ventilation of the lungs.

Lіkuvannya zagostrennya COPD

Meta lіkuvannya zagostrenny - tse as much as possible kuіruvannya streaming zagostrennya and zapobіgannya vyniknennyu in the future. Regardless of the severity, fire-fighting can be performed on an outpatient basis or in a hospital.

The main principle of using zagostrenny:

• It is necessary to correctly assess the severity of a sick person, to prevent acceleration, as they can mask themselves when a COPD is flagged, and immediately send them to hospital in life-threatening situations.
• In case of aggravated congestion, stagnation of short-range bronchodilators is more painful long-acting. Doses and the frequency of reception, as a rule, increase in proportion to the prevalence. Bazhano vikoristovuvati spaceri or nebulizers, especially for important ailments.
• If there is a lack of bronchodilator efficacy, intravenous administration of euphilin is given.
• Even earlier, monotherapy was used, the combination of beta-stimulants with holinolitics (also short-lived) was used.
• With the appearance of symptoms of bacterial inflammation (the first acquaintance with a є appearance of gnar sputum), antibiotics of a wide range of children are recognized.
• Connection of internal or oral administration of glucocorticosteroids. An alternative to systemic corticosteroids intake is to use Pulmicort through a nebulizer at 2 mg two to one day on the day of ingestion of berodual.
• Dosed oxygen therapy for treatment of patients in hospital through nasal catheter or Ventura mask. Instead of sourness at inhaling madness - 24-28%.
• Інші come in - adjusting the water balance, anticoagulant, treatment of supportive diseases.

Watching for ailments with an important step of COPD

As it is already said, COPD - ill-gotten sickness progresses and will inevitably lead to the development of a dysfunctional deficiency. The fluidity of the process to lay down from the bagatokh officials: the view of the patient from the clinic, the humility to the love, the material capabilities of the patient, his mental health, the availability of medical assistance. Correcting from the medium-heavy stage of COPD, the patients go to the MSEC to reject the group of invalids.

With a very important level of dyshnoy lack of ailments, you cannot win a little bit of a problem, because you can’t get a drop of croquettes. Such ailments will require a steady, third-party glance. Inhalation is important for important ailments to be carried out only behind the aid of a nebulizer. Significantly, the low-flow low-flow Kisneva mill will fall (more than 15 years for doba).

For a variety of purposes, special portable kisnev concentrators. The stench does not vimagayut clean the sour gas station, but concentrate the sour cream right at the start. Oxygen therapy makes life more difficult for such patients.

prevention of COPD

COPD is a disease. It is important that the level of prophylaxis of COPD is not enough to be covered by doctors. The main reason for coming in is guilty of robiti, either the person herself (vidma from the city) or the state (anti-tyunov laws, environmental policy, propaganda and stimulation of a healthy way of life). It has been reported that the prevention of COPD is economically viable for the reduction of the disease and the reduction in the reduction of the primary population.

Video: COPD in the program "Life is healthy"

Video: SHO TAKE HOZL i yak vchasno viyaviti

Pathogenesis (development) of COPD.

The infusion of tyutyunovy dim and toxic gases produced a varied effect on the irritative receptor of the bloody nerve, rostillation in the bronchial epithelium, so that the activation of the cholinergic mechanisms of the autonomic nervous system, the nervous reactivity
As a result of the flow of factors at the first stage of development of the disease, the collapse of the blinking epithelium of the bronchi will collapse even to the rest of the zupinka. Metaplasia of the epithelium develops from the second cell of the instantaneous epithelium and the increase in the number of cell-like cells. The warehouse of bronchial secretion changes (to increase its viscosity and adhesion), which will destroy the meaning of the process. There is a breakdown of mucociliary transport in the bronchi, as a result of the diagnosis of mucostasis, as well as the blockade of other ward nobles and in the farther flap, the optimal mind for the colonization of microorganisms.
The main inheritance of ethiological factors (chinniks in rhizyk) is the development of a special chronic inflammation, a biomarker of which is neutrophil. The order of neutrophils in the formulated and realized firing will take on the fate of macrophages and T-lymphocytes. Due to the influx of triggering factors of neutrophils, which circulate in the blood, in great numbers they concentrate in the lungs and are the main source of vital radicals, biologically active speech and enzymes. Neutrophils see a large number of myloperoxidases, neutrophilic elastases, metaloproteases, as well as interleukin and swelling necrosis factor, the main mediators of inflammation in COPD. In the minds of the high concentration of neutrophils in the withers, the balance of the "proteolysis-antiproteolysis" and "oxidant-antioxid anti" systems will be destroyed. "Oxidative stress" is developing, which is when you see the great number of radicals in everyday life. In the case of "oxidative stress", there is a decrease in muscle protease inflammation, and in the order of the large number of proteases produced by neutrophils to the destruction of the elastic stroma of the alveoli, the process of pulmonary hypersensitivity
The whole complex of mechanisms is ignited until the formation of two main processes characteristic of COPD: destruction of bronchial passage and development of centrilobular, panlobular emphysemia. Impairment of bronchial congestion in COPD ailments is formed for the component of the circulatory system (spasm of smooth muscles, clotting of the mucous membrane - hypersecretion of the mucosa) and non-vascular (the formation of expiratory collapse of other bronchial bronchi, At the first stages of the development of COPD, bronchial obstruction is formed over the top of the circulating component. In the world of progresuvannya sogvoryuvannya in the damaged bronchial passages become a non-elliptic component. The main idea of ​​the development of COPD is from HB є those, which emphysema is not slowed down, but a manifestation of ailment, which is formed in parallel with wines, which is seen in spirited ways.
The development of emfizemi should be brought to the reduction of the court hedge in the dylyankas of the legacy fabric, which do not need to be exchanged for gas, as a result of which the rotation of the ventilation-perfusion deterioration occurs. Create a vise for the advancement in the pool of the legendary artery. At the stage of the stage, the Legenevian hypertension forms with a further development of the Legendary heart.
Pathological changes, characteristic of COPD, appear in the cartilaginous (more than 2 mm in diameter) and distal bronchi (less than 2 mm) of the 9-17th generation and acini, which include respiratory bronchial tubes, alveoli, arteries legenevic arterioles, venules and capillaries. In such a rank, COPD is characterized by the development of the chronic ignition process of the dichlorocytes, the lesions of the parenchymal and the sudins, while in the older anatomical organs of the disease, there is a number of neutrophils, macrophages.