What is COPD classification?
In 1997, the Committee of experts for the first time tried to hold COPD classification based on a ratio of FEV-1 (this is the volume for the 1st second of forced expiration). In the outcome document, instructions have been given to chronic obstructive pulmonary disease was divided into stages with indication of treatment and therapeutic activities.
In subsequent years, the disease quite a lot were studied. Were identified pathomorphology, clinical picture, course of the disease. Developed methods of treatment. Was revised and the classification methodology. In reviewing 2007, it was decided to divide the disease into used until now the severity of COPD.
If at the beginning of the study of the disease specialists focused only on the pathology in the lungs, after the revision began to celebrate its extrapulmonary forms. Namely these factors also determine the severity of COPD.
Classification of the disease before 2011
Chronic obstructive pulmonary disease were subdivided into the following stages:
- Easy. The air flow is restricted slightly. The usual symptoms of cough and of sputum are not always. The person himself is even unaware of the fact that the problem starts with his lungs.
- Moderate (COPD moderate). The air flow rate is limited. Comes shortness of breath, increasing during exercise and exertion. Cough and sputum is clearly visible to patients. This stage is a reason to go to the doctor. Usually this is facilitated by constantly evolving respiratory disease or more an exacerbation of the disease.
- COPD severe stage. The speed of the air flow is increasingly restricted. Shortness of breath increases significantly. The ability of physical activity decreased (Fig. Increases overall body fatigue. The exacerbations are repeated more often. All these symptoms together worsen the quality of life of the patient.
- COPD very severe stage. The airflow is very limited (only 30% of what should be). Chronic respiratory failure. This leads to such changes in the heart muscle, such as pulmonary heart (which means failure of the right ventricle).
Depending on the classification treatment.
Classification of COPD in the modern conditions
In 2011, the Committee of experts agreed that the term "stage" is not suitable to determine the status of severity of the disease. This option was based only on FEV-1 that was not sufficient to characterize the disease. Studies conducted in recent years have confirmed that not all cases ofchronic obstructive pulmonary disease is a stages.
Not revealed any evidence that the stages actually exist. But the FEV parameter, it reflects the degree of from mild to very severe, from one state of limitation of the airflow to another.
Reviewing document classification, the experts agreed on the new parameters. She began to consider the severity of the obstruction obtained during the spirometry, and clinical condition of the patient. These include:
- how much for the year of exacerbations of the disease;
- as strongly expressed symptoms in accordance with the conducted specialized assessments (CAT).
To assess the symptoms and their impact on the life of a patient in the Hospital of St. George has developed a special respiratory questionnaire SGRQ, where the scale was used symptoms.
Subsequently, the doctors began to apply in their practice the other evaluation questionnaire - CAT and CCQ. For example, CAT as follows:
|Symptom||Self-assessment of the patient||Symptom|
|Cough no||0||1||2||3||4||5||Persistent cough|
|Phlegm there||-//-||-//-||-//-||-//-||-//-||-//-||Sputum is|
|No squeezing in the chest||-//-||-//-||-//-||-//-||-//-||-//-||Thorax strongly compressed|
|No shortness of breath under load||-//-||-//-||-//-||-//-||-//-||-//-||Severe shortness of breath at the slightest load|
|Household activities are not limited||-//-||-//-||-//-||-//-||-//-||-//-||Household activities are greatly limited|
|Patient confident go out on the street||-//-||-//-||-//-||-//-||-//-||-//-||The patient hesitantly leaves the walls of the house|
|A good night's sleep||-//-||-//-||-//-||-//-||-//-||-//-||A bad dream|
|A lot of energy in the patient||-//-||-//-||-//-||-//-||-//-||-//-||Lack of energy|
The patient fills in the questionnaire by selecting the appropriate score based on your health. The result is evaluated by scoring:
- from 0 to 10 points - chronic obstructive pulmonary disease does not affect the patient's life;
- from 11 to 20 points - the disease affects in moderate limits;
- 21 to 30 points - COPD strongly influences;
- 31 to 40 points - the illness has on the patient's life had an extraordinary influence.
Classification of COPD, taking into account recommendations of experts
The last classification (2011) of the disease represented by the followingparameters:
|Group of patients||Symptoms||The number of annual exacerbations||Scale of dyspnea||Assessing CAT test|
|A||The risk is low when a small number of observed symptoms||≤1||0-1||<10|
|B||The risk is low when a large number of the symptoms observed||≤1||>2||≥10|
|C||The risk is high when a small number of observed symptoms||>2||0-1||<10|
|D||The risk is high when a large number of the symptoms observed||>2||>2||≥10|
The doctor, assessing risk, choose the maximum degree of the speed limit of air. In the edition of the classification document from 2013, it is recommended to refer the case to the high risk if during the previous calendar year patient had only one exacerbation that brought him to the hospital bed.
Considering all the requirements and recommendations of the experts, a patient diagnosed with Chronic obstructive pulmonary disease" with the addition of the following terms:
- severity of bronchial obstruction: I - easy, II - moderate, III - severe, IV - very severe;
- the severity of symptoms of the clinical picture: the expressed, unexpressed;
- the frequency of COPD exacerbations: rare, frequent;
- in the presence of comorbidities.
It related illness play a huge role in COPD. But in the classification of disease has not received worthy attention.
It often happens that the patient is long does not understand that he is really sick and not go to the doctor in a timely manner. Therefore, it is diagnosed the disease is already at the stage when the patient is entitled to a disability. And if he went in the early stages of symptoms, many of the problems could have been avoided.
The treatments are performed depending on what the severity of the disease in the patient. Treatment is divided into two areas - non-pharmacological and pharmacological. The first are the doctor's recommendations for reducing those factors that affect the risk of development of disease. For example, the complete withdrawal from nicotine. To help the patient can come pharmacology with its drugs that reduce the craving for Smoking.
Medical treatment involves taking various drugs, e.g., bronchodilators.