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Chronic Obstructive Pulmonary Disease (COPD) - Symptoms and Treatment


Chronic Obstructive Pulmonary Disease (COPD) - Permanent airway obstruction caused by emphysema or chronic bronchitis.

Emphysema - an increase in tiny air bubbles of the lungs (alveoli) and the destruction of their walls. Chronic bronchitis is a disease accompanied by chronic cough, sputum production and not associated with another disease, such as a malignant tumor of the lungs. In chronic bronchitis, the bronchial glands are enlarged, which leads to excessive mucus production.

There are two causes of airway obstruction in chronic obstructive pulmonary diseases. The first is emphysema. Normally, the groups of alveoli associated with the small airways (bronchioles) represent a rather rigid structure, and this does not allow them to subside. With emphysema, the walls of the alveoli are destroyed, so that the bronchioles lose support. As a result, when a person exhales, the bronchioles subside and the airways become narrowed.

The second reason for impaired patency is inflammation of the small airways in chronic bronchitis. The result is fibrosis of their walls, swelling of the mucous membrane, partial blockage of their lumen by mucus, and spasm of smooth muscles. Edema, mucus obstruction, and smooth muscle spasm are different in severity at different stages of the disease and decrease under the influence of bronchodilators. The inflammatory component of airway obstruction is partially reversible.

Chronic obstructive pulmonary disease is the second cause of disability after heart disease, which causes people to stop working, and the fourth most common cause of death. More than 95% of all deaths due to chronic obstructive pulmonary disease occur in people over the age of 55. These diseases affect men more often than women, and more often lead to death. This also applies to people with a low material standard of living. In the United States, about 14 million people suffer from chronic obstructive pulmonary disease. In Russia, official statistics mention 1 million patients with chronic obstructive bronchitis, but the real figure is probably close to 11 million people.

To chronic obstructive pulmonary diseases, apparently, there is a hereditary predisposition. Working in an environment contaminated with chemical fumes or dust increases the risk of chronic obstructive pulmonary disease. However, smoking increases this risk much more than occupational hazards.

Chronic obstructive pulmonary diseases develop in 10-15% of smokers. Those who smoke cigars and pipes develop more often than non-smokers, but not as often as cigarette lovers. The latter have higher mortality rates from chronic bronchitis and emphysema than non-smokers. With age, smokers' lung function deteriorates much faster than non-smokers. The more cigarettes a person smokes, the faster lung function decreases.

  • chronic cough is usually the first symptom to prevent shortness of breath. It occurs at first sometimes, over time - it bothers daily, more often - during the day, less often - at night. It may be unproductive, without sputum secretion, in some cases it is absent,
  • sputum is usually observed in a small amount, mucous membrane, after coughing,
  • shortness of breath - progressive (gradually increases over the years), persistent (bothers the patient daily), occurs or worsens with physical exertion, contributing to its poor tolerance.

In the future, it occurs at rest and significantly limits vital activity, increases during respiratory infections, can be defined by patients as the need for additional effort when breathing, respiratory discomfort, chest compression, frequent breathing.

In severe COPD, weight loss, anorexia, hemoptysis (with respiratory tract infections), depression and / or anxiety, anxiety are possible, with ankle pulmonale - ankle swelling.

The goals of treatment are: reducing the rate of progression of diffuse damage to the bronchi, leading to an increase in bronchial obstruction and respiratory failure, reducing the frequency and duration of exacerbations, increasing exercise tolerance and improving the quality of life.

The indicated strategic directions are the main reference point for individual work with the patient. In determining the treatment strategy for a particular patient, the goal of treatment should be real and sufficient. Early and consistent therapy is needed at all stages of the development of COPD. The implementation of strategic goals is usually carried out through a series of individualized organizational and therapeutic measures (treatment tactics):

1. Smoking cessation and limitation of external risk factors.

2. Patient education.

3. Bronchodilation therapy.

4. Mucoregulatory therapy.

5. Anti-infective therapy.

6. Correction of respiratory failure.

7. Rehabilitation therapy.

When forming the treatment strategy and tactics for treating COPD patients, it is crucial to distinguish 2 treatment regimens: treatment without exacerbation (maintenance therapy) and treatment of exacerbation of COPD.

The vast majority of patients should be treated on an outpatient basis, according to an individual program developed by the attending physician.

Hospitalization of such patients is indicated only with exacerbation of COPD, which is not controlled on an outpatient basis, with an increase in hypoxemia, the occurrence or increase of hypercapnia, decompensation of the pulmonary heart.

Our clinic specializes in the treatment of chronic obstructive pulmonary disease. Figures:

  • 19 years successful work
  • 3245 cured man
  • 2596abandoned inhalers
  • 1298came to us on the recommendation

COPD is an abbreviation of the disease, which stands for Chronic Obstructive Pulmonary Disease. Chronic obstructive pulmonary disease is a disease that is characterized by a restriction in airflow due to obstruction. Obstruction is associated with the presence of an inflammatory process in the lungs. COPD is considered a progressive disease that has a more severe course in the absence of proper therapy.

COPD is divided into 4 stages. The first stage of the disease is considered the easiest. There are no particular symptoms at this stage. Usually only a chronic cough is present, but patients do not particularly notice it. That is why COPD, most often, is not diagnosed on time, because there are no specifically disturbing symptoms. The second stage is assigned the moderate severity of the disease. The patient complains of coughing and shortness of breath, which appears during physical exertion.
The third stage is characterized by severe COPD. Shortness of breath occurs even with minimal physical exertion, the general condition of the patient suffers greatly.

The fourth stage is an extremely difficult stage of the course of COPD. Dyspnea disturbs even at rest. The fourth stage is extremely dangerous for human life and requires urgent intervention of specialists.

If you suspect COPD, or there has been such a diagnosis for a long time, while any therapy does not bring the desired effect, then you just need to contact a qualified specialist. You can find just such a specialist by contacting the ENT-Asthma clinic. It is here that you will receive the treatment that will allow you to forget about the disease!

Causes of COPD

COPD Causes Associated with Negative Exposure environmental factors, and also with bad habits of a person. The causes of COPD include:

  • Smoking is the main factor of the disease!
  • Polluted indoor air.
  • Polluted air.
  • Hereditary predisposition.
  • Occupational hazards (contact with cadmium, silicon, work with metals, which is why COPD is often found in miners, railway workers, builders).
  • Frequent respiratory infections or chronic diseases (bronchial asthma, chronic bronchitis).

Remember, although COPD can be treated, but the disease is much easier to prevent!

Give up bad habits, protect the upper respiratory tract from dust and respiratory infections, spend more time in the fresh air, follow the right lifestyle - and you will never know what COPD is.

COPD Symptoms

COPD symptoms are similar to many othersthat bother with various diseases of the respiratory system. Cough comes to the fore. More often it bothers in the morning, accompanied by sputum production. With the progression of the disease, the cough becomes permanent, and patients suffer from it for a whole day.

In addition to coughing, a common symptom of COPD is shortness of breath. Shortness of breath does not appear immediately. It develops gradually and begins to appear with significant physical exertion. Later, it intensifies and already disturbs the patient even with normal physical exertion. If the disease does not begin to be treated, then shortness of breath progresses and appears even with slight physical exertion. For this, the patient does not have to go through 2 flights of stairs, just take a few steps around the apartment, reaching the kitchen, and shortness of breath makes itself felt.

In addition to the symptoms characteristic of damage to the respiratory system, with COPD, there are also common symptoms: fatigue, weakness. Due to respiratory failure, in severe stages, limb cyanosis can be observed.

COPD treatment

COPD treatment in our ENT-Asthma clinic begins with accurate diagnosis of the disease. For the diagnosis and subsequent treatment of COPD in our clinic, special methods are used to determine the severity of the disease. High-quality diagnosis allows you to prescribe an effective and safe treatment.
Many argue that COPD cannot be cured completely. But it is worth noting that therapy should be aimed at preventing possible complications, alleviating the general condition of the patient and reducing the severity of symptoms, as well as creating long-term remission.

With the right and effective treatment, all of the above can be achieved. In this case, the patient will feel almost healthy, and the symptoms will remind themselves extremely rarely. This is precisely the goal of the doctors at the Lor-Asthma clinic who treat patients with COPD.

Do not forget, early detection of COPD plays a significant role. That is why, if you notice such symptoms of COPD as sputum discharge and a prolonged cough, we strongly advise you to consult a pulmonologist for advice without delay. Contact the clinic "ENT-Asthma". Only here doctors will do everything possible and impossible so that the patient is satisfied, and most importantly, he feels absolutely healthy!

Cost of treatment

NameCost, rub.
1Initial appointment with a doctor, doctor of medical sciences2400
2Procedures as prescribed by the doctor:
UV Ozone Remediation350
Laser photoreactive therapy1600-2400
Microcompress application in the nasal cavity600
Application of gum-propolis suspension on the mucous membranes500
3The final examination of the doctor according to the results of treatmentis free

Questions from users on our site about chronic obstructive pulmonary disease

Alexander Puryasev,
Doctor of Medical Sciences, head doctor of the clinic:Given the age of the patient and the severity of the disease, it is difficult to give a prognosis without seeing the patient. I can promise that we will try! It may not be possible to cure, but given the effectiveness of our treatment in such cases, relief and reduction of suffering is possible. Contact!

Alexander Puryasev,
Doctor of Medical Sciences, head doctor of the clinic:COPD is treated with a very good result! The course of treatment can take from 10 -15 days, the cost of the course from about 20 tr. the disease is chronic, then most likely plan to come for preventive treatment 2 times a year for at least 2 years.

Alexander Puryasev,
Doctor of Medical Sciences, head doctor of the clinic:Of course there are. Come to us, treat your bronchi, you will be satisfied.

Alexander Puryasev,
Doctor of Medical Sciences, head doctor of the clinic:You can do without surgery. After my inspection, the cashier administrator will be able to calculate you.

Alexander Puryasev,
Doctor of Medical Sciences, head doctor of the clinic:I am waiting for you at the reception, I will prescribe treatment for you.

Definition of the disease. Causes of the disease

Chronic Obstructive Pulmonary Disease (COPD) - a disease that is gaining momentum, advancing in the ranking of the causes of death of people older than 45 years. Today, the disease is in 6th place among the leading causes of death in the world, according to WHO forecasts in 2020, COPD will already take 3rd place.

This disease is insidious in that the main symptoms of the disease, in particular when smoking, appear only 20 years after the start of smoking. For a long time, it does not give clinical manifestations and can be asymptomatic, however, in the absence of treatment, airway obstruction imperceptibly progresses, which becomes irreversible and leads to early disability and a reduction in life expectancy in general. Therefore, the topic of COPD seems to be especially relevant these days.

It is important to know that COPD is a primary chronic disease in which early diagnosis in the initial stages is important, as the disease tends to progress.

If a doctor diagnoses Chronic Obstructive Pulmonary Disease (COPD), the patient raises a number of questions: what does it mean, how dangerous is it, what does it change in lifestyle, what is the prognosis of the course of the disease?

So, chronic obstructive pulmonary disease or COPD - This is a chronic inflammatory disease with damage to the small bronchi (airways), which leads to respiratory failure due to narrowing of the lumen of the bronchi. Over time, emphysema develops in the lungs. This is the name of a condition in which the elasticity of the lungs decreases, that is, their ability to contract and expand during breathing. At the same time, the lungs are constantly in a state of inspiration, they always, even during exhalation, have a lot of air, which disrupts normal gas exchange and leads to the development of respiratory failure.

Causes of COPD are:

  • exposure to harmful environmental factors,
  • smoking
  • occupational hazards (dust containing cadmium, silicon),
  • general environmental pollution (car exhaust, SO2NO2),
  • frequent respiratory infections
  • heredity,
  • deficiency α1antitrypsin.

Symptoms of chronic obstructive pulmonary disease

COPD - A disease of the second half of life, often develops after 40 years. The development of the disease is a gradual, long process, often invisible to the patient.

Appeared to see a doctor dyspnea and cough - the most common symptoms of the disease (shortness of breath is almost constant, cough is frequent and daily, with sputum discharge in the morning).

A typical patient with COPD is a 45-50 year old smoker who complains of frequent shortness of breath during physical exertion.

Cough - one of the earliest symptoms of the disease. It is often underestimated by patients. In the initial stages of the disease, the cough is episodic, but later becomes daily.

Sputum also a relatively early symptom of the disease. In the first stages, it is excreted in small quantities, mainly in the morning. The character is slimy. Purulent profuse sputum appears during an exacerbation of the disease.

Dyspnea occurs in the later stages of the disease and is initially observed only with significant and intense physical exertion, increases with respiratory diseases. In the future, shortness of breath is modified: the feeling of lack of oxygen during normal physical exertion is replaced by severe respiratory failure and increases over time. It is shortness of breath that becomes a frequent reason to consult a doctor.

When is COPD suspected?

Here are some questions from the COPD early diagnosis algorithm:

  • Do you cough several times every day? Does it bother you?
  • Does sputum or mucus occur during coughing (often / daily)?
  • Do you have shortness of breath faster / more often than peers?
  • Are you over 40?
  • Have you smoked and had to smoke before?

With a positive answer to more than 2 questions, spirometry with a bronchodilation test is necessary. With an FEV test score1/ FVC ≤ 70 suspected COPD.

Pathogenesis of chronic obstructive pulmonary disease

With COPD, both the respiratory tract and the tissue of the lung itself, the pulmonary parenchyma, suffer.

The disease begins in the small airways with blockage of their mucus, accompanied by inflammation with the formation of peribronchial fibrosis (connective tissue tightening) and obliteration (cavity overgrowth).

With the formed pathology, the bronchitis component includes:

  • hyperplasia of the mucous glands (excessive neoplasm of cells),
  • mucous inflammation and edema,
  • bronchospasm and airway obstruction by secretion, which leads to a narrowing of the airways and an increase in their resistance.

The emphysematous component leads to the destruction of the final sections of the respiratory tract - the alveolar walls and supporting structures with the formation of significantly expanded air spaces. The absence of a tissue skeleton of the airways leads to their narrowing due to a tendency to dynamic decline during exhalation, which causes an expiratory collapse of the bronchi.

In addition, the destruction of the alveolar-capillary membrane affects the gas exchange processes in the lungs, reducing their diffuse capacity. As a result, there is a decrease in oxygenation (oxygen saturation of the blood) and alveolar ventilation. Excessive ventilation of insufficiently perfused zones occurs, leading to increased ventilation of the dead space and impaired removal of carbon dioxide CO2. The alveolar-capillary surface area is reduced, but may be sufficient for gas exchange at rest, when these anomalies may not occur. However, during exercise, when the need for oxygen increases, if there are no additional reserves of gas exchanging units, then hypoxemia occurs - a lack of oxygen in the blood.

Emerging hypoxemia with prolonged existence in patients with COPD includes a number of adaptive reactions. Damage to the alveolar-capillary units causes a rise in pressure in the pulmonary artery. Since the right ventricle of the heart under such conditions should develop greater pressure to overcome the increased pressure in the pulmonary artery, it hypertrophies and expands (with the development of heart failure of the right ventricle). In addition, chronic hypoxemia can cause an increase in erythropoiesis, which subsequently increases blood viscosity and enhances right ventricular failure.

Classification and stages of development of chronic obstructive pulmonary disease

COPD stageCharacteristicName and frequency
proper research
I. lightChronic cough
and sputum production
usually, but not always.
FEV1 / FVC ≤ 70%
FEV1 ≥ 80% due
Clinical examination, spirometry
with bronchodilation test
Once a year. During COPD -
general blood test and radiography
chest organs.
II. medium heavyChronic cough
and sputum production
usually, but not always.
FEV1 / FVC ≤ 50%
FEV1 80% due. The low peak expiratory flow rate, which varies slightly with bronchodilators, also favors COPD. With the first diagnosed complaints and changes in the parameters of the FVD, spirometry is repeated throughout the year. Obstruction is defined as chronic if it is fixed at least 3 times per year (regardless of the treatment), and COPD is diagnosed.

FEV monitoring1 - an important method of confirming the diagnosis. Spirometric measurement of FEV1 carried out repeatedly over several years. FEV annual fall rate1 for people of mature age is within 30 ml per year. For patients with COPD, a characteristic indicator of such a drop is 50 ml per year or more.

Bronchodilator test - initial examination, which determines the maximum FEV1, the stage and severity of COPD is established, and bronchial asthma is excluded (with a positive result), the tactics and volume of treatment are selected, the effectiveness of therapy is evaluated and the course of the disease is predicted. It is very important to distinguish COPD from bronchial asthma, since these common diseases have the same clinical manifestation - bronchial obstruction syndrome. However, the approach to treating one disease is different from another. The main distinguishing feature in the diagnosis is the reversibility of bronchial obstruction, which is a characteristic feature of bronchial asthma. It has been established that in people diagnosed with CO BL after taking a bronchodilator, the percentage of increased FEV 1 - less than 12% of the initial (or ≤200 ml), and in patients with bronchial asthma, as a rule, it exceeds 15%.

Chest x-ray has an auxiliary value, since changes appear only in the late stages of the disease.

ECG can detect changes that are characteristic of the pulmonary heart.

Echocardiography necessary to identify symptoms of pulmonary hypertension and changes in the right heart.

General blood analysis - it can be used to evaluate hemoglobin and hematocrit (can be increased due to erythrocytosis).

Determination of oxygen level in the blood (SpO2) - pulse oximetry, a non-invasive study to clarify the severity of respiratory failure, as a rule, in patients with severe bronchial obstruction. Blood oxygen saturation of less than 88%, determined at rest, indicates severe hypoxemia and the need for oxygen therapy.

Treatment of chronic obstructive pulmonary disease

COPD treatment contributes to:

  • reduction of clinical manifestations,
  • increased exercise tolerance,
  • prevention of disease progression,
  • prevention and treatment of complications and exacerbations,
  • improving the quality of life,
  • mortality reduction.

The main areas of treatment include:

  • weakening the degree of influence of risk factors,
  • educational programs,
  • drug treatment.

Weakening the degree of influence of risk factors

Quitting smoking is required. This is the most effective way that reduces the risk of developing COPD.

Industrial hazards should also be controlled and their impact mitigated by adequate ventilation and air cleaners.

Educational programs

Educational programs for COPD include:

  • basic knowledge of the disease and general treatment approaches encouraging patients to stop smoking,
  • training on how to use individual inhalers, spacers, nebulizers,
  • the practice of self-monitoring using peak flow meters, the study of emergency self-help measures.

Patient education occupies a significant place in the treatment of patients and affects the subsequent prognosis (level of evidence A).

The peak flowmetry method allows the patient to independently control the peak volume of forced expiration on a daily basis - an indicator that closely correlates with the value of FEV1.

Patients with COPD at each stage are shown physical training programs in order to increase the tolerance of physical activity.

Drug treatment

Pharmacotherapy for COPD depends on the stage of the disease, the severity of symptoms, the severity of bronchial obstruction, the presence of respiratory or right ventricular failure, and concomitant diseases. Drugs that fight COPD are divided into means for relieving the attack and for preventing the development of the attack. Preference is given to inhaled forms of drugs.

To stop rare attacks of bronchospasm, inhalations of short-acting β-adrenostimulants are prescribed: salbutamol, fenoterol.

Preparations for the prevention of seizures:

  • formoterol
  • tiotropium bromide,
  • combined preparations (berotek, beravent).

If the use of inhalation is impossible or their effectiveness is insufficient, then theophylline may be necessary.

With a bacterial exacerbation of COPD, antibiotic connection is required. Can be used: amoxicillin 0.5-1 g 3 times a day, azithromycin 500 mg three days, clarithromycin CP 1000 mg 1 time a day, clarithromycin 500 mg 2 times a day, amoxicillin + clavulanic acid 625 mg 2 times a day, cefuroxime 750 mg 2 times a day.

Glucocorticosteroids, which are also administered by inhalation (beclomethasone dipropionate, fluticasone propionate), also help relieve symptoms of COPD. If COPD is stable, then the appointment of systemic glucocorticosteroids is not shown.

Traditional expectorant and mucolytic agents give a weak positive effect in patients with COPD.

In severe patients with partial oxygen pressure (pO2) 55 mmHg Art. and less at rest, oxygen therapy is indicated.

Forecast. Prevention

The prognosis of the disease is affected by the stage of COPD and the number of repeated exacerbations. Moreover, any exacerbation negatively affects the general course of the process, therefore, as early as possible diagnosis of COPD is extremely desirable. Treatment of any exacerbation of COPD should begin as early as possible. It is also important to have a full-fledged therapy of exacerbation, in no case is it permissible to transfer it “on the feet”.

Often people decide to consult a doctor for medical help, starting from the II moderate stage. In stage III, the disease begins to have a rather strong effect on the patient, the symptoms become more pronounced (increased shortness of breath and frequent exacerbations). At stage IV, a marked deterioration in the quality of life occurs, each exacerbation becomes a threat to life. The course of the disease becomes disabling. This stage is accompanied by respiratory failure, the development of the pulmonary heart is not excluded.

The prognosis of the disease is affected by patient compliance with medical recommendations, adherence to treatment and a healthy lifestyle. Continued smoking contributes to the progression of the disease. Quitting smoking slows down the progression of the disease and slows down the decline in FEV1. Due to the fact that the disease has a progressive course, many patients are forced to take medicines for life, many require gradually increasing doses and additional funds during exacerbations.

The best means of preventing COPD are: a healthy lifestyle, including good nutrition, tempering the body, reasonable physical activity, and eliminating the effects of harmful factors. Quitting smoking is an absolute condition for the prevention of exacerbation of COPD. Existing occupational hazards, when diagnosing COPD, are a good reason to change jobs. Preventive measures are also the avoidance of hypothermia and the limitation of contacts with patients with acute respiratory viral infections.

In order to prevent exacerbations, patients with COPD are shown annual influenza vaccination. People with COPD aged 65 and over and patients with FEV1 The author of the article: