What is COPD the disease and how to treat it?
The disease is a separate pathology, has its own characteristic etiologic characteristics, pathogenesis and clinical picture. It is extremely dangerous as its course and possible complications. Modern air pollution makes this disease is quite common in different parts of the world. The world health Association (who) is working seriously on this issue and clarifies standards for risk analysis and danger. Disease COPD is an important object of study in the medical world, and the methods of its treatment are constantly evolving.
The features of pathology
Chronic obstructive pulmonary disease (abbreviated as COPD) is a pathology that causes a decrease in the flow of air in the respiratory channels, often partly irreversible. The reduction tends to progress and is the result of abnormal inflammation of the lung tissue due to exposure to the components of atmospheric air. Inflammation first appears in bronchial mucosa, where a reaction to the influence of external factors becomes increased production of mucus, worsens the allocation of bronchial secretions. In pathogenic mechanism is activated and the infection that causes a reaction, which, in turn, give rise to atrophic phenomena in the bronchi, bronchioles and alveoli.
After a number of clarifications from the who, in its final form in the list of COPD includes the following diseases: obstructive and purulent obstructive chronic bronchitis, secondary pulmonary emphysema, pulmonary fibrosis, pulmonary hypertension, chronic pulmonary heart. These pathologies have become the special stages of chronic obstructive pulmonary disease.
The reasons of occurrence and development of COPD to date is not fully established, a full etiological mechanism generates an active scientific debate. It was found that the disease is generated by the joint impact of genetic disorders (deficiency of alpha-1-antitrypsin) and secondary factors of respiratory diseases, aggressive environment. To the undisputed reasons for the disease also include excessive Smoking and harmful compounds for professional activities.
The probability of disease sufficiently large, when there are the following risk factors: internal-type - abnormal births, including premature babies, exaggerated bronchial reactivity, genetic predisposition, high level of immunoglobulin E; external-type - air pollution, the crazy lifestyle andpoor diet, passive Smoking (especially for children). Quite likely etiological causes are recognized predisposition in the presence of the second group of blood, infection with adenovirus, a deficiency of vitamin C.
All researchers tend to believe the main precipitating cause of Smoking. On such a claim pushes statistics: smokers account for nearly 80% of all identified patients with COPD, and shortness of breath as a symptom of smokers is found to 39-42 years, 14-16 years earlier than people who are not familiar with tobacco. The second frequency of occurrence of the cause is the inhalation of the dust content of cadmium and silicon. Increased disability due to this disease is found in workers of mining industry, miners, metallurgists, railway workers, workers associated with the cement (concrete) and processing of pulp, wheat and cotton.
The pathogenesis of the disease
The mechanism of the disease is associated with the birth and progression of characteristic processes: inflammatory and oxidative response, imbalance of proteinases and antiproteinases. Chronic inflammation covers a large area of the respiratory system - almost all the organs and pulmonary vessels. The destruction of the tissues is gradually gaining irreversible.
The pathological processes cause a significant accumulation of cells of inflammation - neutrophils, macrophages, T-lymphocytes, which lead to imbalances. Neutrophils stimulate the production of various proteases, macrophages contribute to the appearance of the factor of tumor necrosis, ventilator, and T-lymphocytes cause destruction of epithelial cells of the alveoli. A special role in the pathogenesis of COPD is played by the factor of tumor necrosis and interleukin that destroy lung tissue and stimulate neutrophilic inflammatory response.
Inflammatory and oxidative process produces oxidants that have devastating effects on proteins, fats and nucleic acids and lead to necrosis of cells. Oxidative stress disrupts metabolic processes and increases proteinazy imbalance. Oxidants cause additional bronchial obstruction reversible type.
Chronic progression of the disease leads to the following pathologies:
- Restriction of promotion of the air flow in the respiratory channels. Obstruction of the bronchi creates resistance to the air outlet upon exhalation, hyperinflation leads to a reduction of the amount of inhaled mass, shortness of breath and fast fatigue, and this, in turn,causes contractile dysfunction of the respiratory muscles.
- Violation of the gas balance: the amount of oxygen in the blood decreases, its transportation is deteriorating, increases the concentration of carbon dioxide.
- Hypertrophic secretion of mucus, which accumulates and causes of symptomatic cough.
- The increase in pulmonary pressure (hypertension), which is caused by spasm of small pulmonary arteries and is observed in the later stages of COPD. Increase in pressure leads to atrophy of the right heart ventricle and the formation of pulmonary heart.
- The aggravation of the phenomena of the respiratory type, which is explained by the connection of a viral or bacterial infection, environmental conditions (including air pollution). Acute inflammation, increases the resistance to air flow as a result of increased hyperinflation and the emergence of new pockets of resistance, ventilation imbalance can cause a complicated form of hypoxia. This may occur heart failure, pneumonia.
- Systemic pathology: failure of respiratory rhythm and hyperinflation affect the cardiovascular system and metabolic processes in the body that gives the start to the beginning of other diseases (ischemia, diabetes, depression, etc.) causes a decrease in muscle tone and exhaustion.
Without treatment, COPD leads to morphological changes in the pulmonary structure, bronchial and vascular tissue - metaplasia of the epithelium, necrosis of cilia, degeneration of glands, defeat smooth respiratory muscles. As a result, abundantly accumulated phlegm and mucus disturbed drainage function of the bronchi and narrowing of their lumen. Lose muscle and the deterioration of ventilation of the alveoli cause chronic hypercapnia (carbon dioxide poisoning) and spasms of the vascular system.
The clinical picture of patients with COPD draw the following main symptoms:
- Cough is the main symptom that manifests itself already at the initial stage. Initially has a dry character and is rarely seen, and then becomes constant and sputum.
- Sputum at the initial stage not released or is released in small amounts during exacerbation and connect infection the volume of secretion increases, the appearance of purulent composition.
- Voice tremor occurs when the bronchial obstruction.
- Shortness of breath is an important symptom, characteristic for COPD.
Shortness of breath during the development of the disease largely determines the degree of its severity and progression. These symptoms on the severity are classified into the following stages:
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- Degree 0 (disease not evaluated): shortness of breath may occur only during very fast or long relocation.
- Stage 1 (mild disease): shortness of breath may occur when accelerating or walking Hiking climbing to a considerable height.
- Stage 2 (moderate): due to the shortness of breath has to go slower than usual.
- Stage 3 (severe disease): the walk should be interrupted literally every 120-150 meters.
- Stage 4 (very severe): shortness of breath even when moving around the room, to leave the apartment a problematic and difficult.
An important indicator is the airspeed determined by the method of spirometry. The method allows to determine the forced expiratory volume and lung capacity. Progression of disease these indicators are significantly reduced. In addition, significantly increases the functional residual capacity.
The treatment of the disease
The diagnosis of “COPD” is based on evaluation of history, examination (auscultation, ENT examination, blood tests, ultrasound, spirometry, x-ray, MRI. Given the partial irreversibility of lesions, treatment may not completely restore tissue, so before it aims to stop progression of the disease, eliminate symptoms, improve exercise capacity, prevention of complications, elimination of exacerbations of back disability.
To treat the disease has given stage of its development, depends on the prognosis of cure and the degree of restoration of health.
Main method of treatment of COPD is intensive medical therapy. Treatment is complex, using the following groups of drugs:
- Bronchodilators that expand the bronchial lumen, which increases the flow of air (Atrovent, Spiriva), M-holinoblokatory beta-2 agonists (Salmeterol, Formoterol).
- Corticosteroids local and system function; relief of overt respiratory failure is with prednisone.
- Antibiotics in the form of injections, tablets, inhalation, used for the removal of infectious component and the exclusion of complications in the form of bronchitis, pneumonia, etc. (penicillins, protected clavulanic acid, cephalosporins), with obvious bacterial infection - respiratory fluoroquinolones group.
- Mucolytics to liquefy and remove mucus drugs of indirect action (Bromhexine, Ambroxol) or direct impact (Trypsin, Chymotrypsin).
- Inhibitors of proinflammatory mediators - for replacement of corticosteroids with the intolerances (Erespal, Fenspiride).
Surgical treatment is carried out in special cases and is limited to a few indications forto such intervention. It is most common to remove large lesions, bullous type of emphysema is manifested when the symptom of hemoptysis. Sometimes there are surgeries to reduce the lung volume at difficult for emphysema.
Prevention of COPD
Prevention of COPD includes Smoking cessation, a major cause of pathology. In addition, it is crucial to treat bronchitis in the chronic form or pneumonia. As a rehabilitation measure, the doctor may prescribe physical exercises. Special aerobic activities help to normalize the functioning of the respiratory system.