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Patients with shortness of breath, chronic cough, and sputum production are tentatively diagnosed with COPD. What is this disease? This abbreviation stands for "chronic obstructive pulmonary disease". This disease is associated with an increased inflammatory response of the lung tissue to the action of inhaled particles or gases. The disease is characterized by progressive, irreversible (in the final stages) violation of bronchial patency.

Its distinctive feature is the progressive limitation of the air flow rate, which is confirmed only after spirometry - an examination that allows you to assess the state of pulmonary ventilation. Index FEV1(forced expiratory volume in the first minute) is an objective criterion for bronchial patency and the severity of obstruction. By size FEV1 evaluate the stage of the disease, judge the progression and evaluate the treatment.

Chronic obstructive pulmonary disease (COPD), what is it, how does it occur and what processes underlie it? Restriction of the airflow velocity is caused by damage to the small bronchi (bronchial constriction develops -) and destruction of the parenchyma (occurs over time). The degree of predominance of these two processes in the lung tissue is different in different patients, but one thing is common - namely chronic inflammation terminal airway causes these changes. The general code for this disease according to ICD-10 is J44 (Other chronic obstructive pulmonary disease).

COPD develops in adults and most patients complain of shortness of breath, cough, and frequent winter colds. There are many reasons that cause this disease. One contributory cause is congenital lung disease and chronic inflammatory lung disease that begins in childhood, continues into adolescence, and progresses to COPD in adults. This disease in adults is the leading cause of death, so the study of this pathology is of great importance.

The knowledge and teaching about COPD is constantly changing, the possibilities of the most effective treatment and increasing life expectancy are being studied. The problem is so urgent that in 1997 the International COPD Expert Group decided to create the Global COPD Initiative (GOLD). In 2001, the first report of the working group was published. Since then, the reports have been supplemented and republished annually.

The Global COPD Initiative monitors the disease and provides physicians with documents that form the basis for diagnosing and treating COPD. The data is useful not only for doctors, but also for students studying internal medicine. It is especially necessary to rely on this document if a history of COPD is being written, since the document fully presents the causes of the disease, all stages of its development, and diagnosis. The medical history for therapy will be written correctly, since the document presents the clinic of the disease, the formulation of the diagnosis is proposed and detailed clinical recommendations for treatment are given. different groups patients depending on the severity of the disease.

Almost all documents of the Global COPD Initiative are available on the Internet in Russian. If there are none, then on the official website of GOLD you can find and download the document COPD recommendations gold 2015. The development of exacerbations is characteristic of chronic obstructive pulmonary disease. Gold 2015 defines: “COPD exacerbation is an acute condition characterized by worsening respiratory symptoms. This necessitates a change in the treatment regimen.”

An exacerbation aggravates the patient's condition and is the reason for seeking emergency help, and frequent exacerbations lead to a long-term deterioration in respiratory function. Taking into account possible causes, the presence of an exacerbation, the severity of the disease and an unspecified pathology with severe respiratory failure and chronic cor pulmonale, the COPD code for ICD-10 has several subgroups: J 44.0, J 44.1, J 44.8, J 44.9.

COPD pathogenesis

The pathogenesis is represented by the following mechanisms:

• irritating factors cause inflammation of the bronchopulmonary system;
• there is an enhanced response to the inflammatory process, the mechanisms of which are not sufficiently elucidated (may be genetically determined);
• the pathological response is expressed in the destruction of the lung tissue, which is associated with an imbalance between proteinases and antiproteinases (in the lung tissue there is an excess of proteinases that destroy the normal parenchyma);
• increased collagen formation (fibrosis), structural changes in the small bronchi and their narrowing (obstruction), which increases airway resistance;
• airway obstruction further prevents air from escaping during exhalation (created "air traps"), develops (increased airiness of the lung tissue due to incomplete emptying of the alveoli during exhalation), which in turn also leads to the formation of "air traps".

In patients with COPD, an increase in the concentrations of oxidative stress markers in sputum and blood is found. Oxidative stress increases with exacerbations. As a result of it and an excess of proteinases, the inflammatory process in the lungs is further enhanced. The inflammatory process continues even when the patient stops smoking. The severity of inflammation in the small bronchi, their fibrosis and the presence of exudate (sputum) are reflected in the degree of reduction in forced expiratory volume in the first second and the ratio FEV1/FZhEL.

Airflow limitation adversely affects the work of the heart and gas exchange. Disturbances in gas exchange lead to hypoxemia and hypercapnia . transport of oxygen and carbon dioxide worsens as the disease progresses. The basis of exacerbations and progression of the disease is an inflammatory reaction. It begins with damage to the cells of the respiratory tract mucosa. Then specific elements are involved in the process (macrophages, neutrophils, activated interleukins , tumor necrosis factor, leukotriene B4 ). Moreover, the more pronounced the severity of the disease, the more active the inflammation, and its activity is a factor predisposing to exacerbations.

COPD classification

The international GOLD program of 2014 proposed a spirometric classification that reflects the severity (or stage) of obstruction.

But spirometric assessment is not enough, a clear assessment of symptoms and the risk of exacerbation in this patient is also necessary. In 2011, a comprehensive classification was proposed that takes into account the severity of symptoms and the frequency of exacerbations. In this regard, all patients in the international GOLD program are divided into 4 categories:

• A - low risk of exacerbation, no symptoms, less than one exacerbation per year, GOLD 1-2 (according to spirometric classification).
• B - low risk of exacerbation, more symptoms than in the previous group, less than one exacerbation per year, GOLD 1–2 (spirometric classification).
• C - high risk of exacerbations, more than two exacerbations per year, GOLD 3-4.
• D - high risk of exacerbations, more symptoms than in group C, more than two exacerbations per year, GOLD 3-4.

The clinical classification presents in more detail the clinical signs of the disease, which determine the severity.

In this classification, moderate severity corresponds to category B.

The course of the disease has the following phases:

• Remission.
• Aggravation.

A stable state (remission) is characterized by the fact that the severity of symptoms practically does not change for a long time (weeks and months).

An exacerbation is a period of deterioration in the condition, which is manifested by an increase in symptoms and a deterioration in the function of external respiration. Lasts 5 days or more. Exacerbations can begin gradually or rapidly with the development of acute respiratory failure.

COPD is a disease that combines many syndromes. To date, two phenotypes of patients are known:

• Emphysematous type (dyspnea predominates, patients have panacinar emphysema, according to appearance they are defined as "pink puffers").
• Bronchitis type (cough with sputum and frequent respiratory infections predominate, in patients with a study, centroacinar emphysema is determined, and in appearance these are “bluish edema”).

These types are isolated from patients with moderate to severe course. The selection of these forms is important for the prognosis. With the emphysematous type, cor pulmonale develops at a later date. AT recent times further study of the disease made it possible to identify other phenotypes: “female”, “COPD in combination with bronchial asthma”, “with rapid progression”, “with frequent exacerbations”, “α1-antitrypsin deficiency”, “young patients”.

The reasons

The etiology (causes and conditions of the onset of the disease) is still being studied, but today it is well established that COPD develops through the interaction of genetic factors and adverse environmental factors. Among the main reasons are:

• Prolonged smoking. Most often, the incidence is directly dependent on this factor, but under equal conditions, the genetic predisposition to the disease matters.
• Genetic factor associated with severe hereditary deficiency α1-antitrypsin . deficit α1-antitrypsin causes destruction of lung tissue and the development of emphysema.
• Atmospheric air pollution.
• Air pollution in residential areas (heating with wood and bio-organic fuels in rooms with poor ventilation).
• Exposure to occupational factors (organic and inorganic dust, gas, smoke, chemicals, steam). In this regard, COPD is considered as an occupational disease in these patients.
• Bronchial asthma and chronic bronchitis in smokers, which increase the risk of developing COPD.
• Congenital pathology of bronchopulmonary structures. Intrauterine damage to the lungs, their improper development increases the risk of developing this disease in adults. Hypoplasia of the lungs along with other malformations of bronchopulmonary structures (sequestration of the lungs, malformations of the wall of the trachea and bronchi, lung cysts, malformations of the veins and arteries of the lungs) are the cause of constant bronchopulmonary inflammation and the basis for chronic inflammatory process. Lung hypoplasia - underdevelopment of the lung parenchyma, a decrease in the number of bronchial branches in combination with their defective wall. Lung hypoplasia usually develops at 6-7 weeks of embryo development.
• Cystic fibrosis. The disease manifests itself at an early age, proceeds with purulent bronchitis and severe respiratory failure.

Risk factors include: family history, frequent respiratory tract infections in childhood, low birth weight, and age (aging of the airways and parenchyma resembles the processes that occur in COPD).

Symptoms of COPD

Chronic obstructive pulmonary disease is manifested by progressive shortness of breath, cough with sputum. The severity of these symptoms can change from day to day. The main symptoms of COPD in an adult are shortness of breath and feeling short of breath. It is shortness of breath that is the main cause of disability in patients.

Signs such as a persistent cough and sputum are often the first manifestations of the disease. Chronic cough with sputum may appear many years before the development of bronchial obstruction. However, bronchial obstruction can develop without a previous chronic cough.

Auscultation reveals dry rales that occur on inhalation or exhalation. At the same time, the absence of wheezing does not exclude the diagnosis. Cough is most often underestimated by patients and is considered a consequence of smoking. At first, it is present periodically, and over time - every day and almost constantly. Cough in COPD may be without sputum, and its appearance in in large numbers indicates bronchiectasis. With exacerbation, sputum becomes purulent.

In severe and extremely severe cases, the patient develops fatigue, weight loss, lack of appetite, depression and anxiety. These symptoms are associated with the risk of exacerbations and have an unfavorable prognostic value. With a strong cough, coughs may appear, which are associated with a rapid increase in intrathoracic pressure when coughing. With a strong cough, ribs may occur. Swelling of the lower extremities is a sign of the development of cor pulmonale.

The clinic allocates different types: emphysematous and bronchitis. Emphysematous type - These are patients with reduced nutrition and they do not have cyanosis. The main complaint is shortness of breath and increased work of the respiratory muscles. The patient breathes superficially and exhales air through half-closed lips (“puffs”). The patient's posture is characteristic: in a sitting position, they tilt their torso forward and rest their hands on their legs, thereby facilitating their breathing. The cough is minor. Examination revealed emphysema. The gas composition of the blood is not very changed.

Bronchitis type - due to severe hypoxemia, patients are cyanotic and edematous due to heart failure ("cyanotic edema"). Shortness of breath is minor, and the main manifestation is coughing up sputum and signs of hypercapnia (tremor, headache, confused speech, constant anxiety). Examination reveals cor pulmonale.
Exacerbation of COPD is provoked by a bacterial or viral infection, adverse environmental factors. It is manifested by an increase in all symptoms, a deterioration in spirographic parameters and severe hypoxemia. Each exacerbation aggravates the course of the disease and is an unfavorable prognostic sign.

Analyzes and diagnosis of COPD

Diagnosis of the disease begins with a survey of the patient and the collection of complaints. Below are the main points to look out for and signs of the disease.

Instrumental and functional studies

• . This is an important examination to determine the obstruction and its severity. Spirometry and post-bronchodilation spirometry are necessary to diagnose the disease and determine the severity. An FEV1/FVC ratio of less than 0.70 after administration of a bronchodilator (post-bronchodilation spirometry) confirms bronchial obstruction and the diagnosis. Spirometry is also a health assessment tool. Based on a threshold of 0.70, spirometric classification distinguishes into 4 degrees of severity of the disease.
• Plethysmography. Patients with this disease are characterized by air retention in the lungs (increased residual volume). Plethysmography measures total lung capacity and residual volume. As bronchial obstruction increases, hyperinflation develops (the total lung capacity, characteristic of emphysema, increases).
• Pulse oximetry. Shows the degree of saturation of hemoglobin with oxygen, after which conclusions are drawn about oxygen therapy.
• Chest X-ray. Conducted to eliminate lung cancer , . With exacerbation of COPD, this research method is carried out to exclude all possible complications: pneumonia , pleurisy with effusion , pneumothorax . In mild COPD, x-ray changes are often not detected. As the disease progresses, emphysema (flat diaphragm, x-ray transparent spaces - bullae).
• Computed tomography is usually not performed, but if there is doubt about the diagnosis, the study reveals bullous changes and their prevalence. Carrying out CT is necessary to resolve the issue of surgical intervention (decrease in lung volume).

The differential diagnosis of the disease depends on age. In children and young adults with exclusion infectious diseases occurring with respiratory symptoms, the likely disease is bronchial asthma . In adults, COPD is more often observed, however, differential diagnosis in them should be carried out with bronchial asthma, which differs in clinical manifestations, anamnesis, but the main difference is the reversibility of bronchial obstruction in bronchial asthma. That is, the bronchodilation test during spirometry is positive. The main differential diagnostic signs are given in the table.

COPD treatment

Chronic obstructive pulmonary disease occurs with periods of remission and exacerbations. Depending on this, the treatment will be different. Treatment is selected individually, and it differs in the main groups of patients (groups A, B, C, D, discussed above). The use of drugs reduces the severity of symptoms, reduces the frequency of exacerbations, reduces their severity, improves the general condition of the patient. As a result of treatment, exercise tolerance increases.

How and how to treat COPD? All drugs in the treatment of COPD can be divided into main groups:

• Bronchodilators. They increase the forced expiratory volume and change other indicators of spirometry. This is due to the relaxation of the muscles of the bronchi, which eliminates the obstacle to the removal of air. Bronchodilators can be used as needed or regularly. They are represented by different groups of drugs - β2-agonists (short-acting and long-term). Inhaled short-acting β2-agonists are lifesaver drugs used for relief, while long-acting inhalants are used for long-term control of symptoms. Short-acting dosage preparations: (metered dose inhaler 100 mcg dose), (metered dose inhaler 100 mcg dose), Terbutaline (powder inhaler 400 mcg dose). Long-acting: formoterol (, Atimos , ), salmeterol ( sereventer ). Anticholinergic drugs: short acting based on ipratropium bromide (, Ipratropium Aeronative ) and long-acting with the active substance thiotripium bromide (, Spiriva Respimat ). Combination of β2-agonists and M-anticholinergics:, Berodual N , Ipramol Steri-Neb , Ultibro Breezhaler . Methylxanthines (tablets and capsules, Teopec , ).
• Inhaled glucocorticosteroids:,.
• Inhalers with a combination of β2-agonists + glucocorticosteroids:, Zenhale .
• α1-antitrypsin replacement therapy. Young adults with severe α1-antitrypsin deficiency and established emphysema are candidates for replacement therapy. But this treatment is very expensive and not available in most countries.
• Mucolytic and antioxidant agents. The widespread use of these drugs is not recommended, however, patients with viscous sputum show improvement with the use of mucolytics (carbocysteine ​​and N-acetylcysteine). There is evidence that these drugs may reduce the frequency of exacerbations.

The most important points in the appointment of bronchodilators:

• Long-acting inhaled bronchodilators (both β2-agonists and M-anticholinergics) are the main drugs for maintenance treatment. The list of long-acting drugs is expanding to include 12-hour drugs ( Serevent , Atimos , Bretaris Genuair ) and 24-hour ( , Striverdi Respimat , Spiolto Respimat - combined).
• In the absence of the effect of monotherapy, a combination of a β2-agonist (short-acting or long-term) and an M-anticholinergic is prescribed.
• Inhaled bronchodilators are more effective than tablet forms and have fewer adverse reactions. has low efficiency and causes side effects, so it is used in cases where it is not possible to purchase expensive long-acting inhaler drugs. Many drugs are available for the nebulizer in the form of solutions. In patients with low inspiratory flow rates, the use of a nebulizer has advantages.
• Combinations of bronchodilators with different mechanisms of action are more effective in dilating the bronchi. Combined drugs: Berodual N , Spiolto Respimat , Ultibro Breezhaler , Anoro Ellipta , Duaklear Genuair , Spiolto Respimat .

When prescribing glucocorticoids, the following are taken into account:

• Limit the use of systemic glucocorticosteroids during an exacerbation to 5 days (dose 40 mg per day).
• The phenotype of COPD-asthma and the presence of eosinophils in sputum is a group of patients in which the use of corticosteroids (systemic and inhaled) is highly effective.
• An alternative to taking hormones orally during an exacerbation are inhaled forms of glucocorticosteroids. Long-term use of inhaled corticosteroids is not recommended, as they are less effective than the combination of β2-agonists + glucocorticoids: salmeterol / fluticasone ( Seretide , Salmecort , ), formoterol/budesonide ( , SymbicortTurbuhaler ), formoterol/beclomethasone (), formoterol/mometasone ( Zenhale ) fluticasone/vilanterol ( Relvar Ellipta - over long-acting).
• Long-term treatment with inhaled glucocorticoids is acceptable in severe or extremely severe form, frequent exacerbations, provided there is insufficient effect from long-acting bronchodilators. Long-term treatment with inhaled hormonal drugs is prescribed only according to indications, since there is a risk of side effects (pneumonia, fractures).

The following treatment regimens for patients of various groups are proposed:

Patients in group A have mild symptoms and a low risk of exacerbations. Such patients are not indicated for the appointment of bronchodilators, however, sometimes they may need to use "on demand" short-acting bronchodilators.

In patients of group B, the clinical picture is of moderate severity, but the risk of exacerbations is low. They are prescribed long-acting bronchodilators. In a particular patient, the choice of one or another drug depends on the effectiveness and relief of the condition after taking it.

With severe shortness of breath, they proceed to the next stage of treatment - a combination of long-acting bronchodilators of different groups. It is also possible to treat in combination short-acting bronchodilator + theophylline .

Group C patients have few complaints but a high risk of exacerbations. For the first line, inhaled hormonal drugs + long-acting β2-agonists (long-acting M-anticholinergics) are used. An alternative regimen is a combination of long-acting bronchodilators of two different groups.

Group D patients have a detailed picture of the disease and have a high risk of exacerbations. In the first line in these patients, inhaled corticosteroids + long-acting β2-agonists or long-acting M-anticholinergics are used. The second line of treatment is a combination of their three drugs: inhaled hormonal drug + β2-agonist (long-acting) + M-anticholinergic (long-acting).

Thus, in the moderate (II) stage, severe (III) and extremely severe (IV), one of the drugs is selected sequentially for regular use:

• M-anticholinergic short-acting -, AtroventH, Ipratropium Air .
• M-anticholinergic long-acting -, Incrus Ellipta , Spiriva Respimat .
• short-acting β2-agonists.
• Long acting β2 agonists: Atimos , Formoterol Easyhaler , sereventer , Onbrez Breezhaler , Striverdi Respimat .
• M-anticholinergic + β2-agonist.
• M-anticholinergic long-acting + theophyllines.
• Long-acting β2-agonists + theophyllines.
• Triple regimen: M-anticholinergic + inhaled β2-agonist + theophyllines or inhaled hormonal drug + β2-agonist (long-acting) + M-anticholinergic (long-acting).
• A combination of long-acting drugs, which are used constantly, and short-acting drugs - “on demand” are allowed if one drug is not enough to control dyspnea.

A forum dedicated to the topic of treatment is visited by patients with a disease of varying severity. They share their impressions about drugs and come to the conclusion that the selection of a basic effective drug is a very difficult task for the doctor and the patient. Everyone is unanimous in the opinion that the winter period is very difficult to endure, and some do not go out at all.

In severe cases, during exacerbations, a combination of a hormone and a bronchodilator () is used three times a day, inhalation. Many note that the use of ACC facilitates sputum discharge and generally improves the condition. The use of an oxygen concentrator during this period is mandatory. Modern hubs are small in size (30-38 cm) and weight, suitable for stationary use and on the go. Patients choose to use a mask or a nasal cannula.

During remission, some take Erakond (alfalfa plant extract - a source of iron, zinc, flavonoids and vitamins) and many do breathing exercises according to Strelnikova in the morning and evening. Even patients with the third degree of COPD tolerate it normally and notice an improvement.

Treatment for exacerbation of COPD

Exacerbation of COPD is regarded as an acute condition, which is characterized by worsening respiratory symptoms. Exacerbation in patients can be caused by viral infections and bacterial flora.

The systemic inflammatory process is assessed by biomarkers - the level of C-reactive protein and fibrinogen. Predictors of the development of frequent exacerbations in a patient are the appearance of neutrophils in the sputum and a high content of fibrinogen in the blood. Three classes of drugs are used to treat exacerbations:

• Bronchodilators. Of the bronchodilators during exacerbation, the most effective are short-acting inhaled β2-agonists in combination with short-acting M-anticholinergics. Intravenous administration of methylxanthines is the second line of treatment and is used only when short-acting bronchodilators are not effective enough in this patient.
• Glucocorticosteroids. In case of exacerbation, it is used in tablets in a daily dose of 40 mg. Treatment is carried out no more than 5 days. Tablet form is preferred. An alternative to taking hormones orally can be nebulizer therapy, which has a pronounced local anti-inflammatory effect.
• Antibiotics. Antibacterial therapy is indicated only for infectious exacerbation, which is manifested by increased shortness of breath, an increase in the amount of sputum and the appearance of a purulent sputum. Initially, empiric antibiotics are prescribed: aminopenicillins with clavulanic acid , macrolides or tetracyclines. After receiving the responses of the analysis to the sensitivity of the flora, the treatment is adjusted.

Antibiotic therapy takes into account the age of the patient, the frequency of exacerbations for Last year, FEV1 index and the presence of concomitant pathology. In patients under 65 years of age with an exacerbation frequency of less than 4 times a year and FEV1> 50%, either a macrolide is recommended ().

Azithromycin in the neutrophilic variant affects all components of inflammation. Treatment with this drug reduces the number of exacerbations by almost three times. If these two drugs are ineffective, the alternative is respiratory fluoroquinolone inside.

In patients over 65 years of age with exacerbations more than 4 times, with the presence of other diseases and with an FEV1 of 30-50% of the norm, a protected aminopenicillin () or a respiratory fluoroquinolone () or a second-generation cephalosporin are offered as the drugs of choice. If a patient received antibiotic therapy more than 4 times in the previous year, the FEV1 indicator<30% и постоянно принимал кортикостероиды, рекомендуется внутримышечно, или в высокой дозе levofloxacin , or a b-lactam antibiotic in combination with an aminoglycoside.

A new class of anti-inflammatory drugs (phosphodiesterase-4 inhibitors) is represented by roflumilast ( Daxas ). Unlike GCS, which only affect the level of eosinophils in sputum, Daxas also affects the neutrophil link of inflammation. A course of treatment of four weeks reduces the number of neutrophils in sputum by almost 36%. In addition to the anti-inflammatory effect, the drug relaxes the smooth muscles of the bronchi and suppresses fibrosis. Some studies have shown efficacy in reducing the number of exacerbations. Daxas is prescribed to a certain group of patients who have the maximum effect: with frequent exacerbations (more than twice a day) and with a bronchitis type of the disease.

Long term treatment roflumilast within a year, it reduces the frequency of exacerbations by 20% in the "COPD with frequent exacerbations" group. It is prescribed against the background of treatment with long-acting bronchodilators. The number of exacerbations can be significantly reduced with the simultaneous administration of corticosteroids and roflumilast. The more severe the course of the disease, the greater the effect in reducing the number of exacerbations against the background of such combined treatment.

The use of ACC Fluimycin and other drugs with the active substance acetylcysteine ​​also has an anti-inflammatory effect. Long-term therapy for a year and high doses (two tablets per day) reduces the number of exacerbations by 40%.

Treatment of COPD with folk remedies at home

As monotherapy treatment folk remedies will not bring results, given that COPD is a serious and complex disease. These funds must be combined with drugs. Basically, drugs with anti-inflammatory, expectorant and restorative effects are used.

In the initial stages of COPD, treatment with bear bile and bear or badger fat is effective. According to the recipe, you can take badger or pork internal fat (0.5 kg), aloe leaves crushed in a blender (0.5 kg) and 1 kg of honey. Everything is mixed and heated in a water bath (the temperature of the mixture should not rise above 37 C, so that the healing properties of honey and aloe are not lost). The mixture is taken in 1 tbsp. l. before meals three times a day.

Benefits will bring cedar resin, cedar oil and infusion of Icelandic moss. Icelandic moss is brewed with boiling water (a tablespoon of raw materials per 200 ml of boiling water, infused for 25-30 minutes) and taken 0.25 cups three times a day. The course of treatment can last up to 4-5 months with two-week breaks. In patients, sputum is easier to expectorate and breathing becomes freer, it is important that appetite and general condition improve. For inhalation and ingestion, decoctions of herbs are used: coltsfoot, plantain, oregano, marshmallow, St. John's wort, mint, calamus, thyme, St. John's wort.

The doctors

Medications

• Bronchodilators: Atimos , Incrus Ellipta , sereventer , Atrovent N , Ipratropium Air , Spiriva Respimat , Berodual N , Fenipra .
• Glucotricoids and glucocorticoids in combinations:, Salmecort , Symbicort , Turbuhaler , Zenhale , Relvar Ellipta .
• Antibiotics: / clavulanate , .
• Mucolytics:, Mukomist .

Procedures and operations

Pulmonary rehabilitation is a mandatory and integral part of the treatment for this disease. It allows you to gradually increase physical activity and its endurance. Various exercises improve well-being and increase the quality of life, have a positive effect on anxiety and often occur in patients. Depending on the condition of the patient, this may be:

• daily walking for 20 minutes;
• physical training from 10 to 45 minutes;
• training the upper muscle group using an ergometer or doing resistance exercises with weights;
• inspiratory muscle training;
• breathing exercises that reduce shortness of breath and fatigue, increase exercise tolerance;
• transcutaneous electrical stimulation of the diaphragm.

At the initial stage, the patient can exercise on an exercise bike and do exercises with light weights. Special breathing exercises (according to Strelnikova or Buteyko) train the respiratory muscles and gradually increase the volume of the lungs. A pulmonologist or a specialist in physical therapy should advise gymnastics, and you can also watch a video of breathing exercises for COPD.

Oxygen therapy

Short-term oxygen therapy is prescribed for a period of exacerbation of the disease, or in cases where there is an increased need for oxygen, for example, during exercise or during sleep, when hemoglobin oxygen saturation decreases. It is known that prolonged use of oxygen (more than 15 hours daily, including at night) increases the survival of patients with respiratory failure and hypoxemia at rest. This method remains the only one that can reduce mortality in the extremely severe stage. Long-term oxygen therapy is indicated only for some groups of patients:

• who are permanently hypoxemic PaO2 less than 55 mmHg Art. and there are signs of cor pulmonale;
• hypoxemia PaO2 less than 60-55 mm Hg. Art. and hypercapnia PaCO2 more than 48 mm Hg. Art. with the presence right ventricular hypertrophy and low breathing rates.

At the same time, clinical manifestations are also taken into account: shortness of breath at rest, cough, asthma attacks, lack of effectiveness from treatment, sleep disturbance, poor exercise tolerance. Oxygen delivery devices are: nasal cannula and Venturi masks. The latter are more acceptable oxygen devices, but they are not well tolerated by patients.

The gas flow is selected and changed by the doctor based on the saturation of the blood with oxygen. The duration of the sessions is determined by the principle "the longer the better" and they are necessarily held at night.

Oxygen therapy reduces shortness of breath, improves sleep, general well-being, hemodynamics, and restores metabolic processes. Holding it for several months reduces polycythemia and pressure in the pulmonary artery.

Ventilation support

Patients with extremely severe COPD require non-invasive ventilation, and a combination of long-term oxygen therapy and NIV (in the presence of daytime hypercapnia) is also possible. Ventilatory support increases survival but does not affect quality of life. For this purpose, devices with constant positive pressure during inhalation and exhalation are used.

Surgery

Lung volume reduction surgery is performed to reduce hyperinflation, improve lung function, and reduce shortness of breath. This operation also increases the elastic recoil of the lungs, increases the speed of exhaled air and exercise tolerance. It is indicated for patients with upper lobe emphysema and low exercise tolerance. Removal of the bulla, which does not take part in gas exchange, promotes the expansion of the nearby lung tissue. This type of surgery is palliative.

Diet

Diet therapy is aimed at:

• reduction of intoxication;
• improved regeneration;
• decrease in exudation in the bronchi;
• replenishment of losses of vitamins, proteins and mineral salts;
• stimulation of gastric secretion and improvement of appetite.

With this disease, it is recommended or. They fully provide the body's need for protein, fats and carbohydrates, activate immunological protection, increase the body's defenses and resistance to infections. These are diets with a high energy value (3000-3500 kcal and 2600-3000 kcal, respectively), they have an increased protein content - 110-120 g (more than half are proteins of animal origin - these are complete proteins).

This is due to the fact that the chronic purulent-inflammatory process is accompanied by the release of exudate, which contains protein in large quantities. The resulting loss of protein with sputum is eliminated by its increased consumption. In addition, in the course of the disease, many patients develop a lack of weight. The content of carbohydrates in diets is within the normal range. With an exacerbation, carbohydrates are reduced to 200-250 g per day. Diets are varied in terms of a set of products, they do not have special restrictions on cooking, if this is not dictated by the concomitant pathology of the gastrointestinal tract.

An increased content of vitamin products is provided. In the nutrition of such patients are important, FROM , AT Therefore, the diet is enriched with vegetables, juices, fruits, decoctions of wild rose and wheat bran, brewer's yeast, sea buckthorn, currants and other seasonal berries, vegetable oils and nuts, liver of animals and fish.

Vegetables, fruits, berries, juices, meat and fish broths help improve appetite, which is so important for patients with severe disease. You can eat all foods with the exception of fatty pork, duck and goose meat, refractory fats, hot spices. Salt restriction to 6 g reduces exudation, inflammation and fluid retention, which is important in cardiovascular decompensation.

Reducing the amount of fluid provides for cardiovascular decompensation. The diet must include foods with calcium (sesame seeds, milk and sour-milk products). Calcium has an anti-inflammatory and desensitizing effect. Especially necessary if patients receive hormones. The daily content of calcium is 1.5 g.

In the presence of severe shortness of breath, take light food in small portions. In this case, the protein should be easily digestible: cottage cheese, sour-milk products, boiled chicken or fish, soft-boiled eggs or scrambled eggs. If you are overweight, you need to limit simple carbohydrates (sweets, sugar, pastries, cookies, cakes, jams, etc.). The high standing of the diaphragm with obesity makes it difficult to already difficult breathing.

COPD prevention

With this disease, there is a specific prevention and prevention of complications that occur during the course of the disease.

Specific prevention:

• To give up smoking.
• Taking steps to improve the air quality in the workplace and at home. If it is impossible to achieve this under production conditions, patients must necessarily use personal protective equipment or decide on rational employment.

Prevention of complications:

• It is also important to stop smoking, which aggravates the course of the disease. In this, the strong-willed decision of the patient, the persistent recommendations of the doctor and the support of loved ones are of decisive importance. However, only 25% of patients can refrain from smoking.
• Prevention of exacerbations of the disease consists in vaccination against influenza and pneumococcal infection, which significantly reduces the risk of infectious diseases of the respiratory tract, which are the main factor provoking an exacerbation. It is recommended that every patient be vaccinated, which is most effective in the elderly and patients with severe forms of the disease. Influenza vaccines containing killed or inactivated live viruses are used. Influenza vaccine reduces mortality in COPD exacerbations by 50%. It also affects the reduction in the frequency of exacerbations against the background of the incidence of influenza. The use of pneumococcal conjugate vaccine (according to Russian specialists from Chelyabinsk) reduces the frequency of exacerbations by 4.8 times per year.
• Immunocorrective therapy, which reduces the time of exacerbation, increases the effectiveness of treatment and prolongs the period of remission. For the purpose of immunocorrection, drugs are used that contribute to the production of antibodies against the main pathogens: IRS-19 , . IRS-19 and Imudon - local preparations that are in contact with the mucous membranes of the upper respiratory tract for a short time. Broncho-Vaxom has a strong evidence base of effectiveness in the prevention of exacerbations of COPD. For prophylactic purposes, the drug is taken for a month, one capsule on an empty stomach. Then three courses are held for 10 days each month, with a break of 20 days. Thus, the entire prevention scheme lasts five months. The number of exacerbations of COPD is reduced by 29%.
• An important aspect remains pulmonary rehabilitation - breathing exercises, regular physical activity, hiking, yoga, and more.
• Exacerbations of COPD can be prevented by complex measures: physical rehabilitation, adequate basic treatment (taking a long-acting beta-blocker or long-acting M-anticholinergic) and vaccination. Despite the fact that the patient has a pathology of the lungs, he should be encouraged to physical activity and perform special exercises. Patients with COPD should lead as active a lifestyle as possible.

Consequences and complications of COPD

The following complications of the disease can be distinguished:

• Acute and chronic.
• Pulmonary hypertension . Pulmonary hypertension usually develops in the late stages due to hypoxia and the resulting spasm of the arteries of the lungs. As a result, hypoxia and spasm lead to changes in the walls of small arteries: hyperplasia (enhanced reproduction) intima (the inner layer of the vessel wall) and hypertrophy muscular layer of blood vessels. In small arteries, an inflammatory process is observed, similar to that in the respiratory tract. All these changes in the vascular wall lead to an increase in pressure in the pulmonary circle. Pulmonary hypertension progresses and eventually leads to right ventricular enlargement and right ventricular failure.
• Heart failure .
• Secondary polycythemia - an increase in the number of red blood cells.
• Anemia . It is registered more often than polycythemia. Most of the pro-inflammatory cytokines, adipokines, acute phase proteins, serum amyloid A, neutrophils, monocytes that are released during pulmonary inflammation play a role in the development of anemia. Significant in this is the inhibition of the erythroid germ, the violation of iron metabolism, the production of hepcidin by the liver, which inhibits the absorption of iron, deficiency in men, which stimulates erythropoiesis. Medications are important theophylline and ACE inhibitors inhibit the proliferation of erythroid cells.
• Pneumonia . The development of pneumonia in these patients is associated with a severe prognosis. The prognosis worsens if the patient has a cardiovascular pathology. At the same time, pneumonia, in turn, often leads to cardiovascular complications in the form of arrhythmia and pulmonary edema.
• Pleurisy .
• Thromboembolism .
• Spontaneous pneumothorax - accumulation of air in the pleural cavity, due to rupture of the lung tissue. In patients with COPD, the severity of pneumothorax is determined by a combination of processes: lung collapse, emphysema, and chronic inflammation. Even a slight collapse of the lung leads to a pronounced deterioration in the patient's condition.
• Pneumomediastinum - accumulation of air in the mediastinum, resulting from the rupture of the terminal alveoli.

Patients with COPD develop comorbidities: metabolic syndrome muscle dysfunction, lungs' cancer , depression . Comorbidities have an impact on mortality rates. Inflammatory mediators circulating in the blood exacerbate ischemic heart disease , anemia and diabetes .

Forecast

It is assumed that COPD by 2020 will come out on the 3rd place among the causes of death. The increase in mortality is associated with an epidemic of smoking. In patients, a decrease in airflow limitation is associated with an increased number of exacerbations and a reduced life expectancy. Because each exacerbation reduces lung function, worsens the patient's condition and increases the risk of death. Even one exacerbation almost halves the forced expiratory volume in the first second.

In the first five days of an exacerbation of the disease, the risk increases significantly arrhythmias , acute coronary syndrome , and sudden death. The number of subsequent exacerbations increases rapidly, and the periods of remission are significantly reduced. If between the first and second exacerbation five years can pass, then in the future between the eighth and ninth - about two months.

It is important to predict the frequency of exacerbations, as this affects the survival of patients. Due to respiratory failure, which develops with severe exacerbations, the mortality rate increases significantly. The following relationship has been traced: the more exacerbations, the worse the prognosis. Thus, exacerbation is associated with a poor prognosis and it is important to avoid it.

How long do patients with this diagnosis live? Life expectancy in COPD is affected by severity, comorbidities, complications, and the number of exacerbations of the underlying disease. The age of the patient is also important.

How long can you live with stage 4 COPD? It is difficult to answer this question unequivocally, and all of the above factors must be taken into account. You can refer to the statistics: this is an extremely severe degree of the disease and with an exacerbation 2 times a year, mortality within 3 years occurs in 24% of patients.

At grade 3, how long do patients with this disease live? Under the same conditions, mortality within 3 years occurs in 15% of patients. Even in the absence of frequent exacerbations, GOLD 3 and GOLD 4 patients are at greater risk of death. Concomitant diseases aggravate the course of the disease and often cause death.

List of sources

• Zinchenko V. A., Razumov V. V., Gurevich E. B. Occupational chronic obstructive pulmonary disease (COPD) is a missing link in the classification of occupational lung diseases (a critical review). In: Clinical aspects of occupational pathology / Ed. Doctor of Medical Sciences, Professor V. V. Razumov. Tomsk, 2002, pp. 15–18
• Global strategy for the diagnosis, treatment and prevention of chronic obstructive pulmonary disease (revised 2014) / Per. from English. ed. A. S. Belevsky.
• Chuchalin A. G., Avdeev S. N., Aisanov Z. R., Belevsky A. S., Leshchenko I. V., Meshcheryakova N. N., Ovcharenko S. I., Shmelev E. I. Russian Respiratory Society . Federal clinical guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease // Pulmonology, 2014; 3:15–54.
• Avdeev S. Systemic effects in patients with COPD // Vrach. - 2006. - No. 12. - P. 3-8.

Chronic obstructive:

• respiratory disease NOS
• lung disease NOS

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to contact medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

ICD code 10: what is COPD?

The ICD-10 COPD code is J44. So decipher chronic obstructive pulmonary disease. This is an inflammatory disease of a non-allergic nature. In this case, the respiratory system suffers. Violations occur due to various irritations of the lungs by harmful substances. With this ailment, lesions extend to the bronchi and parenchyma of the lungs.

COPD in ICD-10

In any industry there is a classification, including in healthcare. The International Classification of Diseases (ICD-10) has been developed. This document is considered normative and basic. It contains an alphabetical index, instructions, and the classification itself. The document contains 21 classes. Codes consist of an alphanumeric set. ICD-10 is revised every 10 years, so there are always various updates and additions. ICD-10 is intended to create favorable conditions for the collection, processing, storage and analysis of information on mortality and disease.

Section J44 refers to other pulmonary diseases of a chronic obstructive nature. This includes all chronic forms of ailments, as well as an obstructive, emphysematous type of disease. In addition, blockage of the respiratory channels, asthma, tracheobronchitis and bronchitis are taken into account. But at the same time, asthmatic bronchitis, chronic bronchitis, tracheitis of a simple or purulent-mucous type, bronchiectasis, as well as emphysema and tracheobronchitis, which are caused by external stimuli, are excluded from the section.

COPD according to the classifier Mkb-10.

Code J44.0 refers to chronic obstructive pulmonary disease that occurs together with an acute respiratory infection in the lower respiratory system. At the same time, the course of lung disease along with the flu is excluded here. Moreover, under this number only a viral disease is taken into account.

Number J44.1 is an unspecified obstructive pulmonary disease of a chronic type with an exacerbation. Code J44.8 suggests other chronic obstructive pulmonary problems, and these should be specified. This mainly concerns the emphysematous and bronchitis type, and the course of the disease is quite severe. The patient has respiratory failure. In some cases, there is also heart failure.

If the disease is still not specified, but is also obstructive and chronic, then the number J44.9 is set. The course of the disease is also severe. There is also a second or third degree of congestive heart failure and a third degree of respiratory failure.

Symptoms and stages of COPD

As a rule, COPD is suspected in people who constantly cough. In addition, shortness of breath, the appearance of sputum, are considered characteristic symptoms. Such symptoms are not diagnostic in nature, but their presence increases the likelihood of just such a diagnosis.

It is a chronic cough that is considered the first symptom of a lung disease. As a rule, people believe that smoking is a natural reaction of the body. Or the cough is caused by air pollution. In fact, the cough is periodic at first, and then becomes constant. So this is not a natural reaction of the body, but a symptom of the disease. By the way, it can be dry, that is, without sputum.

Another main symptom that this disease has is shortness of breath, which manifests itself during physical exertion. The patient feels heaviness in the chest. There is suffocation, feels the lack of air. It takes effort to breathe properly.

According to the classification of the disease, COPD has 4 stages:

At this stage of the development of the disease, the patient does not yet notice any pathologies or abnormalities in himself. Occasionally, a cough appears, which gradually becomes chronic. As for organic changes, they are not determined, so it will not be possible to establish a diagnosis of COPD.

1. Second stage.

The course of the disease cannot be described as severe, but at this stage the patient already goes to the hospital with complaints of a regular cough. In addition, with any, even the lightest, physical exertion, shortness of breath appears. The intensity of the cough increases.

Now the course of the disease is quite severe. The flow of air into the respiratory ducts is limited, so that shortness of breath already appears not only during exertion, but also in the calm state of the patient.

1. The fourth stage is considered the most difficult.

The symptoms of COPD are already life threatening. The bronchi become blocked, resulting in cor pulmonale. As a rule, at this stage, patients receive disability.

Causes and mechanism of development of COPD

COPD can appear for various reasons. The mechanism of development of the disease is as follows. At first, changes in the lungs relate only to emphysema. The lungs swell, which leads to rupture of the walls of the alveoli. Then an irreversible bronchial obstruction is formed. Due to the fact that the walls of the bronchi thicken, it is difficult for the passage of air through them. In addition, respiratory failure becomes chronic and gradually increases.

Video about COPD disease:

The airways become inflamed for many reasons. The chronic form of the disease develops due to irritation from cigarette smoke, dust and harmful gases. As a result, lung tissue is gradually destroyed, which leads to emphysema. The natural mechanisms of protection and recovery are violated. The degeneration of the fibrous nature of the small bronchi begins. Due to such changes, the work of the entire respiratory system is disrupted. The airflow speed is greatly slowed down.

The most common cause that leads to such disorders is smoking. In addition, it is smoking that is a factor that provokes not only pulmonary, but also heart failure. The worst effect is achieved only when smoking is combined with the frequent use of industrial aerosols. In this case, the most severe form of the disease develops.

ICD-10 has codes for all pathologies, including lung diseases.

For chronic obstructive pulmonary disease, the number is J44. This disease is a consequence of constant irritation of the tissues of the human respiratory system by various toxic substances, including gas and dust. As the disease progresses, the patient develops shortness of breath and cough, which gradually only increase, especially during physical exertion. ICD-10 helps doctors and other professionals to clearly identify the disease through this classification and facilitates this process.

Bronchitis code (acute, chronic, obstructive) according to ICD-10

Knowledge of the classification of bronchitis, proposed in the International Classification of Diseases of the Xth revision, is necessary for any doctor to maintain statistical records and correctly register diagnoses. However, it has some drawbacks. In particular, the approaches to categorizing the disease are such that the applicability of the classification in the daily activities of a medical practitioner is rather controversial.

Bronchitis is an inflammatory disease of the mucous membrane covering the bronchial tree. Unlike pneumonia, with bronchitis there is a diffuse lesion of the bronchi, there are no focal infiltrative changes. According to the International Classification of Diseases, Injuries and Causes of Death X Revision (ICD-10), there are:

• acute bronchitis;
• Chronical bronchitis.

Acute bronchitis (AB) is an acute widespread inflammation of the mucous membrane of the bronchial tree, accompanied by increased production of bronchial mucus and sputum formation. Often associated with upper respiratory tract infections. Bronchitis code according to ICD-10 - J20.

Chronic bronchitis (CB) is a long-term widespread inflammation of the mucosa lining the bronchial tree. The disease tends to progress. It is characterized by a gradual persistent change in the mechanisms of secretory activity of the bronchial mucosa, the development of mucociliary clearance disorders. Chronic bronchitis is considered in the presence of a cough with sputum for two years or more. Moreover, each year the duration of coughing is at least three months. Encoded by characters J40, J41, J42.

Some people with CB develop obstructive disorders. Obstruction - a decrease in the lumen of the bronchi, accompanied by a violation of the exhalation mechanism, its lengthening.

As a result of expiratory disturbances, there is always a residual volume of air in the lungs that exceeds normal values ​​(air traps). Emphysema of the lungs is formed - a pathological condition characterized by an increase in the airiness of the lungs.

The occurrence of obstruction is also possible with OB, but in this case it is reversible.

Chronic obstructive pulmonary disease (COPD) is a very common pathology in smokers. Encoded with J44 characters. At the present stage, it is unacceptable to use the wording "chronic obstructive bronchitis complicated by pulmonary emphysema" when making a diagnosis. Both of these concepts are included in the term chronic obstructive pulmonary disease.

The classification of bronchitis is designed for both children and adults. For OB, the main classification criterion is the etiology of the disease. In most cases, AB is a viral infection. However, the definition of the pathogen in clinical practice is extremely rare. The disease is most often assigned the code J20. 9.

Acute bronchitis can be caused by:

• J20. 0 - M.pneumoniae;
• J20. 1 - H.influenzae;
• J20. 2 - streptococcus;
• J20. 3 - Coxsackie virus;
• J20. 4 - parainfluenza virus;
• J20. 5 - respiratory syncytial virus;
• J20. 6 - rhinovirus;
• J20. 7 - echovirus;
• J20. 8 - other specified agents;
• J20. 9 - other unspecified agents.

J40 bronchitis, unspecified (acute or chronic), not otherwise classified.

Chronic bronchitis is classified according to the nature of the sputum:

• J41. 0 - simple HB;
• J41. 1 - mucopurulent HB;
• J41. 8 - mixed HB.

Nonspecific CP J42 may be called chronic tracheitis or chronic tracheobronchitis.

COPD is divided depending on the period of the disease (exacerbation / remission):

• J44. 0 - COPD with acute respiratory infection of the lower respiratory tract;
• J44. 1 - COPD with exacerbation, unspecified;
• J44. 8 - other specified COPD;
• J44. 9 - COPD, unspecified.

Diseases of the lung tissue caused by external agents (chemicals, dust, etc.) do not belong to bronchitis and are considered in other headings - J60-J70. The term "allergic bronchitis" is also not used. It is completely replaced by the concept of bronchial asthma (code J45).

In everyday practice, to make a diagnosis, Russian doctors resort to the domestic classification. In accordance with it, acute bronchitis (obstructive or non-obstructive), chronic is distinguished. Chronic obstructive pulmonary disease is considered separately.

The classification of inflammatory diseases of the bronchi according to ICD-10 with its etiological approach in Russia is of little practical importance. It is mainly used as a source of statistical data.

All information on the site is provided for informational purposes only. Before using any recommendations, be sure to consult your doctor.

Full or partial copying of information from the site without an active link to it is prohibited.

Chronic obstructive bronchitis: symptoms and treatment in adults and children, ICD code 10

Obstructive bronchitis (OB) is a serious disease of the upper respiratory tract. It begins with inflammation of the lining of the bronchi, then a spasm joins the inflammation, in which all the mucus accumulates in the organs of the respiratory system. In most cases, breathing with these symptoms is difficult.

The most serious symptom of such bronchitis is acute obstruction (most often found in children) - a slow narrowing of the bronchial lumen. Abnormal wheezing occurs.

ICD-10 disease code

According to the international classification of diseases, it belongs to class 10. It has the code J20, J40 or J44. Class 10 are diseases of the respiratory system. J20 is acute bronchitis, j40 is bronchitis as unspecified, chronic or acute, and j44 is other chronic obstructive pulmonary disease.

Symptoms and Risk Factors

Obstructive bronchitis can be divided into two types:

• Primary, it is in no way associated with other diseases;
• Secondary is associated with concomitant diseases. These include kidney disease (renal failure) and diseases of the cardiovascular system; other diseases of the respiratory tract;

Risk factors for primary obstructive bronchitis:

• Smoking (also passive);
• Contaminated air;
• Profession (work in a dusty, poorly ventilated area, work in a mine or quarry);
• Age (children and the elderly are most often affected);
• Genetic predisposition (if such a disease has occurred in the family history, it occurs mainly in women).

The main ones are the following: Haemophilus influenzae, it occurs in half of the cases, pneumococcus, it accounts for about 25%, as well as chlamydia, mycoplasma, Staphylococcus aureus and Pseudomonas aeruginosa, they account for 10% of cases.

Acute and chronic symptoms

Chronic bronchitis is classified according to the nature of sputum:

Catarrhal bronchitis passes in the mildest form and is characterized by a diffuse inflammatory process, in which the tissues of the bronchi and lungs are not affected. Light sputum contains only mucus.

Catarrhal-purulent - when examining sputum in mucus, purulent discharge occurs.

Purulent obstructive bronchitis - a patient coughs with purulent exudate. When examining sputum, purulent discharge will be present in large quantities.

• In the first 2-3 days of illness, a dry cough is observed;
• Approximately for 3-4 days, the cough becomes wet, and, depending on the degree of mucus obstruction in the bronchial mucosa, it is divided into obstructive and non-obstructive;
• Headache;
• The temperature rise is not higher than 38 degrees;
• Dyspnea;
• Violation of the respiratory function.

Symptoms of the chronic form:

• Relatively satisfactory condition;
• Isolation of a small amount of mucopurulent and purulent sputum;
• The period of exacerbation is most often winter;
• Mostly adults over the age of 40 are affected.

Acute bronchitis often develops in children in the first year of life, since children at this age are predominantly in a horizontal position.

In connection with this position of the body, when a child begins to have an ARVI accompanied by a runny nose, the mucus cannot properly go out and descends into the bronchi.

A child at this age cannot cough up sputum, which complicates the process of treatment and recovery. In most cases, acute bronchitis is caused by a virus.

Obstructive bronchitis occurs in children from about 2 to 3 years old, this is due to the physiology of the child. Children at this age have a narrow lumen of the bronchi. Signs of the disease can develop as early as the first day of SARS (earlier than with acute bronchitis).

Symptoms of acute bronchitis:

• Fever 2–3 days;
• General weakness;
• Cough;
• The nasolabial triangle turns blue;
• Dyspnea;
• Bloating of the chest;

Chronic obstructive bronchitis affects adults and only rarely children. This disease proceeds for several years and only worsens over the years, the period of remission becomes shorter, and the course of the exacerbation becomes more and more difficult. Some symptoms, such as shortness of breath, do not go away and remain with the patient permanently.

Diagnosis of the disease

Usually, examination and analysis of physical data is sufficient to confirm the diagnosis. As mentioned above, in a patient with a disease such as obstructive bronchitis, the chest will be enlarged, when viewed with a phonendoscope, whistling and buzzing sounds will be heard in the lungs.

But for reliability, it is worth conducting a sputum analysis in order to exclude asthma, whooping cough or a foreign body in the bronchi. For completeness of the data, it will be necessary to donate blood to see the ESR and leukocyte indicators, with a viral infection, these indicators will be increased.

Treatment

Treatment of obstructive bronchitis usually takes place on an outpatient basis, with the only exception being children under 3 years of age in severe cases. During treatment, it is necessary to exclude all types of irritants (dust, perfumes, cigarette smoke, household chemicals).

The room where the patient is located should be well ventilated and humidified. Rest and rest are also indicated in this disease. Mucolytic and bronchodilator drugs are prescribed for sputum discharge.

To avoid complications and the transition from an acute to a chronic state, the main therapy will be the use of antiviral drugs. The use of antibiotics is justified only if there is no visible improvement and pneumonia is suspected.

Medical treatment

Bronchodilatory therapy is in most cases the main method of treating obstructive bronchitis, since it allows you to restore airway patency. There are drugs with an action of 12 to 24 hours, which greatly facilitate the life of patients.

But the truth is, when more intensive bronchodilatory therapy is needed, they are not suitable, since there is a risk of overdose. In such cases, more "controlled" drugs are used, for example, Berodual.

It is a symbiosis of two bronchodilators (Fenoterol and Ipratropium bromide). Relaxing blood vessels and smooth muscles of the bronchi, helps prevent the development of bronchospasm.

Berodual also releases mediators from inflamed cells, has the properties of stimulating respiration, and also reduces the secretion of bronchial glands.

Mucolytic therapy is aimed at thinning sputum in the bronchi and removing it from the patient's body.

There are several groups of mucolytics:

1. Vasicinoids. Vasicinoids and mucolytics these drugs do not have side effects like the previous groups. They can be used in pediatrics.

Vasicinoids are represented by ambroxol and bromhexine.

Bromhexine is a derivative of vasicin, created synthetically, providing a mucolytic effect. Ambroxol is a new generation medicine that is allowed for nursing mothers and pregnant women.

Enzymatic. This group of drugs is not recommended for use in pediatrics, since damage to the lung matrix is ​​possible. Because they have a long list of side effects such as coughing up blood and allergies.

Thiol-containing. The thiol-containing drug acetylcystiine is able to cleave the disulfide bonds of mucus.

But its use in pediatrics is also impractical due to the possibility of bronchospasm and suppression of the actions of ciliated cells that protect the bronchi from infections.

Mucolytics are mucoregulators. A representative of mucolytics - mucoregulators are derivatives of carbocysteine, having both mucolytic (reduce the viscosity of mucus) and mucoregulatory effect (reduce mucus production).

In addition, this group of drugs contributes to the restoration of the bronchial mucosa, its regeneration.

Another group of drugs that are prescribed to patients with obstructive bronchitis are corticosteroids. I prescribe them only when smoking cessation and bronchodilatory therapy do not help.

The ability to work is lost, and airway obstruction remains severe. Drugs are usually prescribed in tablet form, less often injections.

Bronchodilatory therapy remains the main one, corticosteroids are the emergency help in this disease. The most common drug in this group is Prednisolone.

Speaking of traditional medicine, you should not completely rely on it and self-medicate, but as an auxiliary therapy with the main treatment prescribed by a doctor, it can be used.

Here are some tips for treatment:

• To stop the beginning cough, you need to drink warm milk with propolis dissolved in it (15 drops).
• Black turnip and honey are excellent in expelling sputum. Take a turnip, wash it well, cut out the middle and put a spoonful of honey there.

When the turnip gives juice, which mixes with honey, the infusion is ready. You need to drink it 3-4 times a day, a teaspoonful.

Antibiotics for obstructive bronchitis

As mentioned above, antibiotics are prescribed only for bronchitis caused by a bactericidal infection.

In all other cases, the use of antibiotics is unjustified and can lead to the opposite effect - dysbacteriosis, development of resistance to this drug, decreased immunity and allergic reactions. Therefore, it is worth taking antibiotics only as prescribed by the doctor and the dosage and regimen prescribed by him.

Urgent care

Broncho-obstructive syndrome is a common symptom complex that includes violations of bronchial patency, which is based on occlusion or narrowing of the airways.

To alleviate this syndrome, it is better to inhale with a nebulizer and Berodual's solution, this will help to quickly restore respiratory function. If there is no nebulizer at hand or the ability to use it, then you can use this drug in the form of an aerosol.

Prevention

An important role in the prevention of obstructive bronchitis is smoking cessation. And also it is worth saying about the room where a person works and lives, it must be ventilated, humidified and clean.

For people with a weakened immune system, it is worth taking immunomodulators so as not to catch an infection, which in turn can lead to a relapse of the disease.

Chronic obstructive bronchitis

ICD-10 code

Related diseases

Titles

Description

Cough for at least 3 months a year, for at least 2 years in a row. With the exclusion of other diseases in which cough is characteristic - chronic bronchitis.

In Russia, according to estimates using epidemiological markers, there should be about 11 million patients with chronic obstructive bronchitis. However, in official medical statistics there are about half a million patients with chronic obstructive bronchitis, i.e., there is a diagnosis in the late stages of the disease, when the most modern treatment programs are not able to slow down the steady progression of the disease. This is the main cause of high mortality in patients with chronic obstructive pulmonary disease. Although these estimates require clarification, there is no doubt about the socioeconomic significance of this widespread disease.

The reasons

Smoking% of cases of chronic obstructive bronchitis.

Deficiency of α1-antitrypsin (α1 - AAT) Is currently the only well-studied genetic pathology leading to chronic obstructive bronchitis and chronic obstructive pulmonary disease (alpha 1 antitrypsin is detected in less than 1% of cases).

The acute impact of air pollution on humans.

Risk of professional nature (cadmium, silicon). Professions with an increased risk of developing chronic obstructive bronchitis:

Construction workers associated with cement;

Workers in the metallurgical industry (hot metal processing);

Workers engaged in the processing of grain, cotton and paper production;

Office workers associated with printing on laser printers (laser printers emit harmful substances and fine dust into the air, toner powder also contains toxic substances).

Due to the summation of environmental risk factors and genetic predisposition, an inflammatory process develops, which involves all the morphological structures of the bronchi of different calibers, interstitial (peribronchial) tissue and alveoli. The main consequence of the action of risk factors is inflammation, which develops according to the classical canons of pathophysiology. But the localization of inflammation and the features of triggering factors determine the specifics of the pathological process. Schematically, the entire chain of events developing in COB patients can be divided into primary and secondary mechanisms.

The etiological environmental factors form "oxidative stress", i.e., contribute to the release of a large number of free radicals in the airways.

Under the influence of risk factors, there is a violation of the movement of cilia up to a complete stop, metaplasia of the epithelium with the loss of cells of the ciliated epithelium, an increase in the number of goblet cells. The composition of the bronchial secretion changes: the sol phase becomes smaller, being replaced by the gel phase, which disrupts the movement of significantly thinned cilia. This contributes to the occurrence of mucostasis, causing blockade of the small airways. The latter always leads to a violation of ventilation-perfusion ratios.

Also, in the bronchial secretion, the content of nonspecific components of local immunity with antiviral and antimicrobial activity decreases: interferon, lactoferin and lysozyme.

Thick and viscous bronchial mucus with reduced bactericidal potential is a good breeding ground for various microorganisms (viruses, bacteria, fungi). This whole complex of inflammation mechanisms leads to the formation of two main processes characteristic of chronic obstructive bronchitis:

Violation of bronchial patency;

Development of centrilobular emphysema.

Violation of bronchial patency in patients with chronic obstructive bronchitis is conditionally divided into two components: reversible and irreversible.

The presence of a reversible component gives individuality to chronic obstructive bronchitis and allows it to be distinguished into a separate nosological form. As the disease progresses, patients with chronic obstructive bronchitis gradually (FEV1 - forced expiratory volume in 1 second) lose the reversible component.

The reversible component consists of spasm of smooth muscles, edema of the bronchial mucosa and mucus hypersecretion, which occur under the influence of a wide range of pro-inflammatory mediators. Violation of bronchial patency in chronic obstructive bronchitis is quite persistent, not subject to daily changes by more than 15%.

The loss of the reversible component of bronchial obstruction is conventionally considered to be the situation when, after a 3-month course of adequate therapy, the patient did not improve FEV1 (forced expiratory volume in 1 second).

Symptoms

The first symptoms for which patients usually seek medical attention are cough and shortness of breath, sometimes accompanied by wheezing with sputum production. These symptoms are most pronounced in the morning. The earliest symptom, appearing by 40-50 years of age, is a cough. By the same time, in the cold seasons, episodes of a respiratory infection begin to occur, which are not initially associated with one disease. Shortness of breath, initially felt on exertion, occurs on average 10 years after the onset of cough.

Sputum is secreted in a small amount (rarely more than 60 ml / day) in the morning, has a mucous character and becomes purulent only during infectious episodes, which are usually regarded as exacerbations.

As chronic obstructive bronchitis progresses, the intervals between exacerbations become shorter.

The results of a physical examination of patients with chronic obstructive bronchitis depend on the severity of bronchial obstruction, the severity of pulmonary hyperinflation and physique. As the disease progresses, wheezing is added to the cough, most noticeable with accelerated exhalation. Often, auscultation reveals dry rales of different timbres. Shortness of breath can vary over a very wide range: from feeling short of breath during standard physical exertion to severe respiratory failure. As bronchial obstruction progresses and hyperinflation of the lungs increases, the anteroposterior size of the chest increases. The mobility of the diaphragm is limited, the auscultatory picture changes: the severity of wheezing decreases, the exhalation lengthens.

The sensitivity of physical methods for determining the severity of chronic obstructive pulmonary disease is low. Classical signs include wheezing and prolonged expiratory time (>5 sec), which may indicate bronchial obstruction.

Diagnostics

A physical examination is not enough to establish a diagnosis of a disease, it only provides guidelines for further direction of a diagnostic study using instrumental and laboratory methods.

Conventionally, all diagnostic methods can be divided into mandatory minimum methods used in all patients ( general analysis blood, urine, sputum, chest x-ray, external respiration function test (EPF), ECG), and additional methods used according to special indications.

For everyday clinical work with patients with chronic obstructive bronchitis, in addition to general clinical tests, it is recommended to study the function of external respiration (FEV1, forced vital capacity or VC), a test with bronchodilators (b2-agonists and anticholinergics), chest x-ray. Other research methods are recommended to be used according to special indications, depending on the severity of the disease and the nature of its progression.

Of great importance in the diagnosis of chronic obstructive bronchitis and an objective assessment of the severity of the disease is the study of respiratory function (RF). Due to its good reproducibility and ease of measuring forced expiratory volume in 1 second (FEV1), it is now a generally accepted indicator for assessing the degree of obstruction. Based on this indicator, the severity of chronic obstructive bronchitis is also determined.

Mild severity - FEV1> 70% of the due values;

Severe - less than 50%.

In everyday practice, in patients with chronic obstructive bronchitis, tests with bronchodilators (b-agonists and / or anticholinergics) are used, which to a certain extent characterize the ability for rapid regression of bronchial obstruction, in other words, a reversible component of obstruction.

An increase in FEV1 during the test by more than 15% from baseline is conventionally characterized as reversible obstruction.

So, the diagnosis of chronic obstructive bronchitis is carried out in the presence of:

Clinical signs, the main of which are cough and expiratory dyspnea;

Violations of bronchial patency (decrease in forced expiratory volume FEV1) in the study of the function of external respiration (RF). An important component of diagnosis is the progression of the disease. A prerequisite for diagnosis is the exclusion of other diseases that can lead to similar symptoms.

Treatment

1, Smoking cessation and limitation of action external factors risk. The first required step. The patient should be well aware of the harm caused to him by smoking. A specific program is being drawn up to limit and stop smoking. In cases of nicotine dependence, it is advisable to use nicotine replacement drugs. Perhaps the involvement of psychotherapists, acupuncturists.

2, Patient education. Relatively new stage. The patient should be well aware of the nature of the disease and the features of its course. He must be an active, conscious participant in the treatment process. At this stage, the doctor develops an individual treatment plan. It is very important that when drawing up a treatment plan, realistic, feasible goals are set, taking into account the severity of bronchial obstruction, the significance of its reversible component and the nature of the progression of the disease. The setting of impossible tasks causes disappointment in the patient, reduces the belief in the expediency of the treatment program and, ultimately, violates the patient's willingness to follow the recommendations of the attending physician. The patient must be taught the correct use of drugs, as well as the basic rules of self-control, including the use of peak flow meters. At the same time, he must be able to objectively assess his condition and, if necessary, take measures to provide himself with emergency assistance. The educational program should also include information and the adoption of measures to limit the harmful effects of the ecology of the home. Such, for example, as the reduction or exclusion from the use of household cleaners containing chlorine and other harmful chemicals.

Nowadays, maintaining cleanliness in our house without chemicals is a reality. To clean the apartment, you can use cleaning wipes made of ultramicrofiber. These wipes have excellent cleaning properties, are durable in use, and allow you to reduce the use of chemicals by 85%. Cleaning wipes include a terry scraper, a universal scraper, a scrubber scraper, and a scraper for optics. To clean the apartment, you can also use mops with special nozzles for dry and wet cleaning, also made of ultramicrofiber. To reduce the release of chlorine from tap water, filters must be used. For example: Rainshaw shower filter, Vitalizers.

3, Bronchodilatory therapy.

Since bronchial obstruction is considered one of the central mechanisms for the occurrence of chronic obstructive bronchitis, bronchodilatory drugs (anticholinergics, beta-two-agonists, methylxanthines) are the basic therapy.

For bronchodilation, Microhydrin is a good helper - the most powerful antioxidant currently known, neutralizes and neutralizes free radicals that are formed in the body during its life.

Microhydrin is able to structure water and body fluids. It reduces the surface tension of water, making it bioavailable, which promotes cell and tissue hydration, which is important for increasing overall cell function and health.

Microhydrin is a universal and absolutely safe stimulator of energy production in the body. When microhydrin is taken in cells, active synthesis of ATP occurs - a molecule that provides energy for all biochemical processes occurring in cells.

4, Mucoregulatory therapy.

The improvement of mucociliary clearance is largely achieved with a targeted effect on bronchial secretions using mucoregulatory drugs (ambroxol, N-acetylcysteine, bromhexine).

Alternative drugs are:

Herb Set No. 3 (Combination Three). One dose (1 tablet) contains: calcium carbonate 110mg. , herbal collection (brown elm bark, pleural root, mullein leaves, thyme herb, Californian eriodictyon) 425 mg. (Young elm bark - has astringent, blood-purifying, analgesic and anti-inflammatory effect. Pleural root - expectorant, antispasmodic, diaphoretic, anti-inflammatory agent. Thyme - expectorant, antiseptic, antispasmodic, sedative and diuretic effect. It contains thymol, which has antiseptic, disinfectant and bactericidal action.Mullein - analgesic, antispasmodic, mucolytic and astringent effect.Eriodiction Californian - expectorant and antimicrobial agent, relieves spasm of smooth muscles of the bronchi.).

Licorice Root. One dose (1 tablet) contains: Licorice root 490 mg. , calcium carbonate 55 mg. , cellulose, maltodextrin, stearic acid, magnesium stearate.

5, Anti-infective therapy.

In official medicine, during exacerbations, it is customary to prescribe antibiotics, with the manifestation of clinical signs of intoxication and purulent elements in the sputum.

As an alternative, you can use:

Garlic (garlic). One dose (1 capsule) contains: garlic oil 3 mg. , soybean oil, gelatin, glycerin, water. It has antibacterial, anti-inflammatory, antioxidant and antitumor properties, reduces blood cholesterol levels, the risk of developing cardiovascular diseases, helps strengthen the immune system and improve the body as a whole.

6, Treatment of dysbacteriosis.

During inflammatory processes in the body, a violation of the quantitative and qualitative ratio of the microflora of the body develops, which further aggravates the disease process.

Coral Probiotic is a synbiotic that is a unique combination of probiotics (Lactobacillus and Bifidobacterium longum) and prebiotics (inulin). Provides comprehensive protection of microflora, having a positive effect on dysbacteriosis, intoxication, violation of microflora after a course of antibiotics.

7, Nutrition of the body.

For a better recovery of the body, there must be good nutrition at the cellular level.

Shark liver oil - strengthening the immune system, quick recovery from past illnesses, stress.

Activin - Contains: Grape seed extract, soy sprouts, vitamin E, royal jelly, red seaweed dunaliella, muira puama, eleutherococcus senticosus, milk thistle, ginkgo biloba, green tea extract, vitamin C, probiotic blend (lacto- and bifidobacteria), chelated minerals: zinc, germanium, manganese, molybdenum, chromium, copper, selenium. Increases endurance and accelerates the healing process.

VitAloe is an excellent general tonic for conditions such as weakened immunity, recovery of the body after illnesses, viral, bacterial infections.

Green gold is a natural combined product. It has a tonic effect on all body systems, a pronounced immunostimulating effect, an antioxidant effect.

Calcium Medzhik is the most important macronutrient in the human body, necessary for everyone. It is necessary in the rehabilitation period after injuries, operations, diseases.

Tactics during remission:

1, Maintaining water balance.

One of the most important tasks for maintaining health is maintaining water balance. It is necessary to drink pure structured water 30 ml. per kg. body weight per day.

Coral mine is a mineral composition for purification and enrichment of drinking water with easily accessible vital microelements. Coral Mine eliminates excess acidity and restores the necessary acid-base balance to the body.

2, Cleaning programs.

Herb Set No. 7 - consists of garlic, black walnut leaves and cassia leaves.

Black walnut leaves - antihelminthic, antibacterial, anti-inflammatory.

It also makes sense to conduct deeper cleansing programs:

Lax - Max - binds and removes toxins from the body, restores beneficial microflora.

Colo-Vada Plus - detoxification of the body, antihelminthic, antimicrobial action, strengthens the body and has an antioxidant effect.

The International Classification of Diseases (ICD) in the tenth version was developed by the World Health Organization in 1989 to systematize all known diseases and pathological conditions. In accordance with the ICD-10, chronic obstructive disease goes under 4 codes:

• J44. 0 - COPD with acute respiratory infection of the lower respiratory tract;
• J44. 1 - COPD with exacerbation, unspecified;
• J44. 8 - Other specified obstructive pulmonary disease;
• J44. 9 - COPD, unspecified.

Definition of disease, ICD-10 code, classification

Let's see what it is - COPD,? Chronic obstructive pulmonary disease is a chronic inflammatory disease characterized by irreversible or only partially reversible changes in the lower respiratory tract. The nature of these changes causes a partial restriction of the air flow entering the lungs.

For all varieties of COPD, the progression of the disease is characteristic, with time the condition of patients worsens. The disease mainly affects smokers, and if the patient does not limit his bad habit, then throughout his life he needs medical care. Even a complete cessation of smoking cannot fully restore the affected tissues.

The term "COPD" most often implies a combination of chronic bronchitis and secondary pulmonary emphysema - expansion of the air spaces of the distal bronchioles, leading to a number of negative irreversible changes and impaired breathing.

Causes

The main reasons why pathological changes in the lower respiratory tract begin are constant irritating factors. These most often include polluted air or the influence of pathogenic microflora.

The most common causes of the onset and development of COPD include:

• Tobacco smoking. Substances contained in tobacco smoke irritate the respiratory mucosa and cause inflammation. Pneumocytes (lung cells) are damaged. Long-term smokers are more likely to develop emphysema. COPD can also occur with passive smoking;
• Professional hazards. Long-term air pollution is another of the most common causes of COPD. High-risk professions include: miners, builders (working with cement), metallurgists, railway workers, workers employed in the processing of grain and cotton;
• Genetic disorders. They are not so common, but can be a decisive factor in the occurrence of COPD;
• Frequent SARS and acute respiratory infections. Infections of the lower respiratory tract suffered in childhood are one of the causes of changes in lung function at an older age, under the influence of environmental factors. The causes of frequent colds in adults are described in.

To date, up to 90% of COPD deaths occur in countries with a low social level, where measures to control and prevent the onset of the disease are not always available.

Symptoms

The most important symptom that indicates pathological changes is the presence of a cough. Initially periodic, gradually the symptom becomes permanent, accompanied by shortness of breath. Lack of air is also progressive. Appearing during physical exertion, shortness of breath is accompanied by heaviness in the chest, the inability to take a full breath.

In accordance with the classification, there are 4 stages of the disease:

1. It is characterized by the absence of any significant symptoms, except for the occasional cough. Gradually, this symptom becomes chronic;
2. The intensity of the cough increases, it is already permanent. The patient is forced to consult a doctor, because even minor physical exertion causes shortness of breath;
3. At this stage, the patient's condition is diagnosed as severe: the flow of air into the respiratory organs is limited, so shortness of breath becomes a constant phenomenon even in a calm state;
4. This stage of the disease already poses a threat to the patient's life: the lungs become clogged, and shortness of breath appears even when changing clothes. At this stage, the patient is assigned a disability.

In the early stages, COPD is treatable and it is possible to reverse the process of impaired ventilation. However, later detection of pathology dramatically reduces the patient's chances of recovery and is fraught with a number of serious negative consequences.

Possible Complications

The chronic course of the disease leads to a constant progression of symptoms and, in the absence of proper medical care, to the occurrence of serious complications in the patient's health:

• Acute or chronic respiratory failure;
• congestive heart failure;
• Pneumonia;
• Pneumothorax (penetration of air into the pleural cavity as a result of rupture of the altered lung tissue);
• Bronchiectasis (deformation of the bronchi, as a result of which their functionality is impaired);
• Thromboembolism (blockage of a vessel by a thrombus with circulatory disorders);
• Chronic pulmonary heart (thickening and expansion of the right parts of the heart as a result of increased pressure in the pulmonary artery);
• Pulmonary hypertension ( high blood pressure in the pulmonary artery);
• Atrial fibrillation (abnormal heart rhythm).

Any of the above complications can significantly disrupt the quality of life, which is why early diagnosis and timely medical care are of particular importance.

How to treat adults

The following methods can be used to diagnose COPD at the earliest stages:

• Spirometry;
• Sputum examination;
• Blood test;
• Radiography of the lungs;
• Bronchoscopy.

A method that allows you to establish an accurate diagnosis can be spirometry, which determines the rate of entry and exit of air from the lungs, as well as its volume. These same studies can give an idea of ​​the severity of the disease.

Medical treatment

Drug treatment of COPD can be divided into stages depending on the patient's condition.

In case of exacerbation, funds from the following groups are used:

Price from 140 rubles.

• Bronchodilators: Salbutamol, Fenoterol, Serevent, Oxys. Not only eliminate shortness of breath, but also positively affect a number of pathogenesis links;
• Glucocorticosteroids: Prednisolone (systemic), Pulmicort (inhalation). Systemic drugs provide a more stable effect with long-term use, however, inhaled ones have fewer side effects due to local effects;
• Antibiotics: Amoxicillin, Amoxiclav, Levofloxacin, Zinnat. The choice of drug depends on the severity of the patient's condition and can only be made by the attending physician;
• Mucolytics:, Acetylcysteine. They are prescribed in the presence of viscous sputum during an exacerbation. As a rule, in a stable state are not used;
• Influenza vaccines. To prevent exacerbation during influenza outbreaks, it is recommended to vaccinate in the autumn with killed or inactivated vaccines;
• pneumococcal vaccine. It is also used for prophylactic purposes, the use of bacterial vaccines orally is considered preferable: Ribomunil, Bronchomunal, Bronchovax.

In the later stages of the disease with inefficiency drug treatment oxygen therapy, non-invasive and invasive ventilation can be used. In some cases of emphysema, surgery may be the only acceptable solution.

In complex treatment, a mandatory item should be a reduction in risk factors: smoking cessation, preventive actions designed to minimize the impact of industrial hazards, atmospheric and household pollutants (harmful chemicals).

One of the areas of treatment is the implementation of educational programs on topics: smoking cessation, basic information about COPD, general approaches to therapy, specific issues. Also read about whether it is possible to do inhalation with pneumonia.

Folk remedies - home treatment without pharmaceutical preparations

To normalize breathing during the period of remission, drugs according to folk recipes are used as an additional remedy:

• Make a mixture of chamomile, mallow and sage in a ratio of 2: 2: 1. One tablespoon of the collection is poured with 200 ml of boiling water. Insist, filter and take twice a day for 0.5 cups for 2 months, after which they change the medicine;
• Grind on a grater one beet root and black radish. Boiled water is added and infused for 6 hours. Infusion take 4 tbsp. l. three times a day for 30 days, after which they take a week break;
• A teaspoon of anise seeds is infused in a thermos, pouring 200 ml of boiling water for 15 minutes. After that, the infusion is cooled and drunk 50 g before meals 4 r. in a day;
• At night every day they drink boiled milk (slightly cooled) with 1 tsp. any internal fat: pork, goat;
• Mix birch sap with fresh milk in a ratio of 3: 1, add a pinch of flour per glass and drink 1 glass of the mixture at a time. The course of treatment is 1 month;
• Pour a glass of boiling water 1 tbsp. l. dried heather, insist, filter and drink during the day in several doses;
• Washed and crushed nettle roots are rubbed with sugar in a ratio of 2: 3, after which they are infused for 6 hours. The resulting syrup is taken in 1 tsp. several times a day.

The use of folk remedies should be carried out only after consulting the attending physician, taking into account the individual characteristics of the patient's health.

Prevention of chronic obstructive pulmonary disease

To prevent the onset or development of COPD, the following preventive actions can be taken:

• To give up smoking;
• Wearing respirators in hazardous industries;
• Timely treatment of pulmonary diseases;
• Protecting children from tobacco smoke as passive smokers;
• Immunity strengthening: full fortified nutrition, gradual hardening, sports, long walks, stable psycho-emotional state.

Video

This video will explain what COPD is.

conclusions

The prognosis for the development of the disease is extremely unfavorable. Therefore, if there are any symptoms or suspicions, it is necessary to undergo a thorough examination. If the disease is detected in the early stages, then it is likely, subject to the recommendations of the doctor and maintaining a healthy lifestyle, to stabilize the condition for many years.

An effective preventive measure is also timely vaccination against pneumonia and influenza, which can protect against the development of most serious complications of infectious diseases. Is it possible to cure pneumonia with folk remedies, find out at.

Severe inflammation of the respiratory system obstructive bronchitis develops due to untimely or improper treatment acute stage of the disease.

The disease is accompanied by structural changes and impaired respiratory function of the bronchi.

At an early stage of the chronic process, changes can be completely cured.

In advanced cases, the pathological process becomes irreversible.

- diffuse inflammation of the bronchial tree, characterized by persistent mucosal edema and increased sputum production.

Accumulating inside the bronchial tract, sputum blocks the path of air.

The acute form of the disease develops as a result of inadequate treatment of acute respiratory viral infections. or with prolonged exposure to polluted air on the bronchi.

Ineffective treatment of acute obstructive bronchitis provokes its transition to a chronic form.

According to ICD 10, chronic bronchitis refers to obstructive pulmonary diseases, therefore it has the same code J44 with COPD.

WHO experts consider a form of bronchitis chronic if the disease lasts more than 2 months with an exacerbation more than 2 times a year.

Stages of development of the chronic form

The disease in its development goes through several stages:

The result of the constant filling of the respiratory tract with sputum is structural changes in the walls of the airways.

The serous glands that produce bronchial secretion are hypertrophied. At the last stage, the “bald bronchus” syndrome develops, caused by the complete death of bronchial cilia.

Violation of gas exchange in the lungs due to blockage of the bronchial canals gradually leads to the development of pneumosclerosis.

Classification

The development of the disease is classified according to severity. The classification is based on the volume of the formed breath - FEV:

• light: FEV 70% of the norm of a healthy respiratory system;
• average: from 50 to 69%;
• heavy: 50% or less.

By the nature of the disease formed in the bronchi of sputum, the disease is divided into the following types:

1. catarrhal- the mildest form with diffuse inflammation.
2. Catarrhal-purulent- inflammation is accompanied by the formation of pus.
3. Purulent obstructive- The patient has purulent sputum.

In the later stages, the inflammatory process affects the deep tissues of the bronchi and lungs, structural changes in tissues become irreversible, and the disease develops into COPD.

Causes of inflammation

The medical history includes primary and secondary causes. Primary serve as an impetus to inflammation, secondary - contribute to the progression of the disease:

Primary reasons:

Secondary causes that contribute to the development of inflammation under the influence of irritating substances are associated with the state of human health and the conditions of his life.

Predisposing factors that accelerate the development of the disease are:

• tendency to allergic reactions;
• weakened immunity;
• genetic predisposition;
• frequent colds;
• living in adverse climatic conditions.

Video consultation: Causes of obstructive bronchitis.

Dr. Komarovsky will list the causes of obstructive bronchitis. Recommendations, conclusions, advice.

Symptoms

The main sign of the development of the disease is a slowly progressive obstruction with gradually increasing respiratory failure.

The pathological process reaches its peak by about 40-50 years.

At this time, the narrowing of the bronchi is no longer amenable to the usual effects of bronchodilators.

COB occurs with periodic exacerbations and remissions. Symptoms during an exacerbation:

• headache;
• cough with purulent-mucous sputum;
• chills, fever;
• nausea, dizziness.

During remission, the following clinical manifestations are observed:

In the later stages of COB, visual signs appear that are noticeable even to a non-specialist:

• respiratory muscle movements
• swelling of the veins in the neck;
• swollen chest;
• blue skin;
• horizontal arrangement of ribs.

Oxygen starvation causes damage to other organs and the development of concomitant symptoms:

1. Pressure surges, heart rhythm disturbances, cyanosis of the lips with damage to the cardiovascular system;
2. Pain in the lower back, swelling of the legs with damage to the urinary system;
3. Disturbances of consciousness, absent-mindedness, memory loss, hallucinations, blurred vision - evidence of CNS damage;
4. Loss of appetite, pain in the epigastric region in violation of the digestive tract.

IMPORTANT! Chronic hypoxia leads to further deterioration of the body, gradually developing chronic diseases of the liver, kidneys, circulatory system.

Diagnostics

Diagnosis and treatment of COB is carried out by local therapists or pulmonologists.

The diagnosis is based on the examination of the patient and the analysis of complaints about the state of the body.

The main method of making an initial diagnosis is listening to the lungs with special instruments.

Signs confirming the diagnosis:

• the sound when tapping the lungs is boxy;
• hard breathing at the beginning of the disease, whistling in the lungs as inflammation develops;
• symmetrical voice trembling in the initial stages, weakening of the voice in the later stages.

To confirm the diagnosis, the doctor prescribes the following studies:

• inhalation tests - inhalation of a bronchodilator to determine the reversibility of obstruction;
• blood test for acid-base balance and gas composition;
• chest x-ray;
• spirometry - measurement of lung volume by drawing up a schedule of inhalation and exhalation;
• bronchography;

To assess the degree, a study of the function of external respiration is carried out - FVD.

Before the examination, smoking patients are offered to give up bad habits for a day, the patient is also forbidden to drink coffee, strong tea and alcohol and avoid physical exertion.

30 minutes before the procedure, the patient should be in a state of complete physical and psychological rest.

Measurements are carried out with a special device - a spirometer.

The patient is seated in a chair with armrests and offered to exhale into the device after a deep breath.

A decrease in performance with each exhalation indicates the presence of chronic obstructive bronchitis.

Treatment

COB treatment is complex, it consists of medication, physiotherapy and breathing exercises.

Mild to moderate disease is treated on an outpatient basis.

The patient is issued a sick leave for a period of 15 to 30 days. A severe stage of exacerbation requires hospitalization of the patient.

Medically

The main group of medicines for the treatment of COB are bronchodilators:

• Ipratropium bromide, "Salmeterol", "Formoterol" - preparations for inhalation, restoring the mucous membrane;
• "Fenoterol" ("Salbutamol", "Terbutaline") is used during periods of exacerbations to relieve inflammation.

An important part of therapy is the use of expectorants.. The components of the drugs thin the sputum, promote the regeneration of mucosal cells.

The most popular drugs in this group:

• "Carbocysteine";
• "Fluimucil";
• "Lazolvan";
• "Bromhexine";
• "Herbion".

In the acute stage, inflammation is removed with antibiotics of the macrolide group, cephalosporins or penicillins.

In some cases, patients are prescribed antiviral drugs: Acyclovir, Cernilton, Arbidol.

To maintain immunity, the medical complex includes immunomodulators: Immunal, Imudon, Bronchomunal, IRS-19, Echinacin.

IMPORTANT! During the period of remission, saline air has a beneficial effect on the state of the respiratory system of patients. Therefore, patients with bronchitis are recommended an annual trip to the seashore, as well as procedures in salt chambers (halotherapy).

Physiotherapy

Physiotherapeutic procedures in the treatment of bronchitis are aimed at stimulating sputum discharge and correcting respiratory function.

The following methods are applied:

The set of procedures and the duration of the course depends on the stage of the disease and the general condition of the patient.

Folk methods

Alternative methods of treatment of chronic bronchitis supplement the intake of medications, help to speed up recovery.

According to patients, the following folk remedies are most effective:

Prevention

The main conditions for preventing the development of a chronic form of obstructive bronchitis are the timely treatment of acute respiratory infections and the acute form of the disease, as well as minimizing risk factors for a negative impact on the respiratory system.

To give up smoking, hardening, maintaining a healthy lifestyle, a balanced diet is the basis for the prevention of the disease.

People with a weak respiratory system should pay attention to living and working conditions.

Indoors, it is recommended to do daily wet cleaning and airing.

Maintain optimal humidity levels.

If inflammation of the bronchi provokes environment or working conditions, it is worth changing the place of residence and work.

Chronic obstructive pulmonary disease (COPD) is prolonged and progressive inflammation of the respiratory organs.

The disease is caused by violations of bronchial patency due to increased viscosity of bronchial mucus and structural changes in the lung tissue and blood vessels.

Over time, lung function is inhibited more and more, which leads to irreversible processes and a rather high mortality process: 6% of total deaths.

Phenotypes and types of COPD, ICD code 10

The concept of the COPD phenotype implies a combination of observable certain clinical features.

According to this principle, the disease differs in two main types: bronchitis, which developed against the background of chronic bronchitis, and emphysematous - against the background of chronic emphysema.

According to ICD 10, bronchitis and emphysematous types of COPD are indicated by the code J44.8 under the wording "Other specified chronic obstructive pulmonary disease".

Chronic obstructive bronchitis

Prolonged often recurrent inflammation of the bronchi with difficulty in ventilation of the lungs due to mucous congestion. Long-term systematic exposure to causative factors in the bronchial tree causes a number of pathological structural and functional changes, which results in:

• mucus hypersecretion;
• atrophy and metaplasia of the epithelium;
• goblet cell hyperplasia;
• mucosal edema;
• reduced production of immunoglobulin A.

Constantly inflamed mucous membrane provokes reflex spasms of the bronchi and significant disturbances in the synthesis of surfactant. As a result of the inflammatory process, obliteration of the bronchioles occurs (pathological closure of the excretory lumen) and collapse of the small bronchi. The drainage function of the bronchial tree is irreversibly impaired and cannot be treated.

Photo 1. This is how healthy bronchi look like (picture below) and with chronic obstructive bronchitis (top).

According to the relevance of the negative influence etiological factors are arranged in the following order:

1. Smoking active and passive.
2. Severe congenital deficiency of α1-antitrypsin.
3. Industrial emissions, exhaust fumes and elevated levels of dust.

The main characteristic symptoms of the disease are: painful hacking cough with the release of purulent sputum (often with streaks of blood) of increased viscosity and constant shortness of breath. Over time, additional signs of general intoxication appear: subfebrile temperature, fatigue and constant weakness.

In the ICD 10 classification, pathology is indicated by the same code as COPD - J44.8

Emphysema

Pathological deformation of the lung tissue with excessively dilated distal bronchioles, impaired gas exchange and respiratory failure. The alveolar walls are destroyed, the voids in the alveoli are filled with air, the lungs swell and increase abnormally in size. In ICD 10, emphysema is assigned J43 code.

The disease is very common a serious consequence of chronic obstructive bronchitis. In addition, pulmonary emphysema develops against the background of advanced pneumonia, tuberculosis, silicosis, anthracosis and bronchial asthma.

No less significant causal factors are: long-term smoking, toxic industrial air pollution and congenital deficiency of α1-antitrypsin.

The primary signs by which emphysema is diagnosed are:

• severe shortness of breath;
• cyanosis (bluish hue) of the lips, nails and tongue due to acute oxygen starvation of tissues;
• smoothing of the supraclavicular region;
• expanded intercostal spaces;
• significantly expanded chest.

Bronchitis type

Clinical form of COPD caused by chronic bronchitis with frequent relapses for at least two years.

Chronic bronchitis means extensive diffuse inflammation of the bronchial mucosa. As a result, pathological changes occur in the organs of the respiratory system in the form of protective, secretory and cleansing dysfunction.

As a result, hypersecretion leading to mucostasis (stagnation of viscous sputum), epithelial hyperplasia and hyperfunction of the bronchial glands.

The main risk group for the development and progression of the disease are smokers. Other important reasons include work in hazardous industries, bacterial and viral infections, hereditary predisposition, and weakened immunity.

A patient with chronic bronchitis is characterized by a bluish tint of the skin, a barrel-shaped chest and, often, increased body weight to the point of obesity. The main symptom is a paroxysmal cough., which is accompanied by abundant secretions of purulent sputum. Additionally, there is increased sweating, general weakness and subfebrile condition. In the future, bronchial obstruction is manifested by wheezing, swollen jugular veins on expiration, expiratory dyspnea and an unproductive whooping cough.

According to the results of research in the diagnostic process, it is found thickening of the walls of the bronchi, the air flow is extremely weak and only partially penetrates the lungs, which indicates bronchial obstruction.

Attention! Despite the fact that bronchodilatory, antibacterial and expectorant therapy, as a rule, gives a positive response, it is the bronchitis type of COPD has a high mortality rate.

Emphysematous form

Develops due to chronic emphysema. The characteristic difference of this type is destruction of the interalveolar septa and formation of air cavities (bull). A spirometry study fixes hyperventilation: a pathological condition when oxygen enters the lungs, but does not penetrate into the blood.

Photo 2. This is how a person looks like with emphysematous (left) and bronchitis (right) type of COPD.

The patient's quality of life is significantly reduced. The appetite is weak, in connection with which the weight is reduced to the limit of a dangerous value, the chest is deformed, as if in a state of deep inspiration. Swollen veins are clearly visible on the patient's neck. Cough in some cases is either completely absent, or manifests itself slightly and without sputum.

Breathing is weak, accompanied by a noisy distant wheezing. The capacity and residual volume of the lungs are significantly increased. Their transparency is increased, the X-ray fixes the low standing of the diaphragm and the “drip” heart. The skin color is unnaturally pink, and shortness of breath of varying degrees of intensity is often present even at rest.