Causes, symptoms, stages and diagnosis of COPD disease
Definition of chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is an independent progressive disease characterized not only by an inflammatory component, but also by structural changes in blood vessels and lung tissue. In addition, it should be mentioned about serious violations of bronchial obstruction. Such obstruction is localized in the region of the distal bronchi. This disease is delimited from a number of typical chronic processes of an important respiratory system.
It has been proven that chronic obstructive pulmonary disease most often affects men over 40. She occupies a leading position among all causes of disability. Moreover, the risk of mortality is high even among the working-age population.
With an increase in the production of bronchial mucus and an increase in its viscosity, the most favorable conditions are created for the rapid growth of bacteria. In this case, the patency of the bronchi is disturbed, the lung tissue and alveoli change. The progression of the disease directly leads to edema of the bronchial mucosa, mucus secretion and spasms of smooth muscles. Often in COPD bacterial complications join and relapses of pulmonary infections occur.
It happens that the course of chronic obstructive pulmonary disease is greatly aggravated by serious disorders of gas exchange, which are manifested by a significant decrease in oxygen in the blood and an increase in blood pressure. Such conditions provoke circulatory failure, which leads to death in about 30% of patients with this diagnosis.
The main reason is considered to be tobacco smoking. Among other factors that cause the development of chronic obstructive pulmonary disease, there are respiratory infections in childhood, industrial hazards, concomitant bronchopulmonary pathologies, as well as a depressing state of the environment. In a small number of patients, the disease is based on a genetic predisposition, which is expressed by a deficiency of the alpha-1-antitrypsin protein. It is he who is formed in the tissues of the liver, protecting the lungs from serious damage.
As a rule, chronic obstructive pulmonary disease is considered an occupational disease of many railway workers, miners, construction workers, as well as workers who come into contact with cement. Often, this disease occurs among specialists in the metallurgical and pulp and paper industries. Genetic predisposition and environmental factors cause chronic inflammatory processes of the inner lining of the bronchi, which significantly reduces local immunity.
COPD symptoms and stages
There are several classifications of chronic obstructive pulmonary disease. At stage zero, the disease is manifested by a strong secretion of sputum and a constant cough against the background of unchanged lung function. The first stage is characterized by chronic cough, sputum production, and minor obstructive disorders. In moderate conditions, various clinical symptoms can be observed, which intensify with a certain load. In this case, pronounced obstructive disorders progress.
In the third stage of the disease, when you exhale, the airflow restriction increases. An increase in exacerbations and an increase in shortness of breath can be noted. In extremely severe conditions, severe forms of bronchial obstruction appear that can threaten human life. Cor pulmonale develops and dangerous respiratory failure is diagnosed.
It should be mentioned that in the very early stages, chronic obstructive pulmonary disease can be secretive. Often, the characteristic clinic of the disease manifests itself in moderate conditions. COPD is characterized by severe cough with shortness of breath and phlegm. Sometimes in the early stages there is an episodic cough, accompanied by the release of a large amount of mucous sputum. During this period, shortness of breath with intense exertion also worries. The cough becomes permanent only as the disease progresses.
With the onset of a particular infection, dyspnea at rest is observed, and the sputum becomes purulent. The course of chronic obstructive pulmonary disease develops either by emphysematous or bronchial type. Many patients with bronchial types of the disease complain of cough, profuse sputum production. Intoxication, cyanosis of the skin and dangerous purulent inflammation in the bronchi can also be noted, as well as a significant expression of obstruction with mild pulmonary emphysema.
Patients with the emphysematous type of COPD are characterized by expiratory dyspnea, which is characterized by difficulty in exhaling. In this case, pulmonary emphysema strongly prevails over typical bronchial obstruction. The patient's skin is gray-pink, and the rib cage is barrel-shaped. It should be mentioned that with a favorable benign course, all patients survive to old age.
In most cases, the progressive development of the disease is complicated by acute respiratory failure and pneumonia. Sometimes spontaneous pneumothorax, secondary polycythemia, pneumosclerosis, and congestive heart failure are diagnosed. In very severe stages, some patients may develop cor pulmonale or pulmonary hypertension. In absolutely all cases, the disease leads to a decrease in the quality of life and activity.
Timely diagnosis of chronic obstructive pulmonary disease can increase the life expectancy of patients and significantly improve the quality of their existence. When collecting anamnestic data, modern specialists always pay attention to production factors and the presence of bad habits. The main method of functional diagnostics is spirometry. She reveals the initial signs of the disease.
Also important is the measurement of volumetric and speed indicators. These include the vital capacity of the lungs, forced capacity, and the volume of one forced expiration per second. For diagnosis, the ratio and summation of the identified indicators is sufficient. To assess the severity and nature of bronchial inflammation, a cytological method for examining the sputum of patients is used. In the exacerbation phase, sputum always has a viscous and at the same time purulent character.
Clinical blood tests help to identify polycetomy, which is possible due to the development of dangerous hypoxemia only with a bronchial type of ailment. The number of erythrocytes, hemoglobin, hematocrit and blood viscosity is determined. The main symptoms of respiratory failure are the gas composition of the shelter. To exclude other similar diseases, chest x-rays are shown. COPD is characterized by deformation of the bronchial walls, as well as changes in the lung tissue of an emphysematous nature.
An ECG can reveal the development of pulmonary hypertension, and diagnostic bronchoscopy is necessary to assess the state of the mucous membranes of the bronchi and take the analysis of their secretions.
The main goal of therapy for the disease is considered to slow down all progressive processes, remove obstructions and exclude respiratory failure. This is exactly what is needed to increase the duration and quality of life of patients. Eliminating the cause of the disease, such as smoking or industrial factors, is a necessary treatment in complex therapy. Treatment begins with teaching the patient how to use spacers, inhalers and nebulizers, as well as self-assessment.
At the same time, mucolytics and bronchodilators are prescribed to dilute sputum and expand the lumen of the bronchi. Then inhaled glucocorticosteroids are usually prescribed, and antibiotic therapy is administered in exacerbations. If necessary, pulmonary rehabilitation and oxygenation of the body are prescribed. A decrease in the rate of development of COPD is possible only with a methodical complex treatment, which is selected adequately for each individual patient.
As a rule, the prognosis is favorable relative to the complete recovery of patients. With the steady progression of the disease, they speak of disability. It should be noted that the main prognostic criteria include the exclusion of provoking factors, and most importantly, patient compliance with treatment measures and all recommendations.
Prevention of COPD
Preventing the further development of chronic obstructive pulmonary disease is the most important preventive measure. Abstaining from smoking is the main requirement for disease progression. Secondhand smoke is also considered unacceptable. An integrated approach against the disease will guarantee an increase in life expectancy.
You should also pay special attention to other respiratory infections that can trigger COPD recurrence. For the prevention of exacerbations, long-term use of special mucolytics, which have antioxidant activity, is considered promising.
Since COPD is an incurable disease, it is necessary to lead a proper lifestyle, control symptoms, due to which it is possible to significantly slow down the development of the disease. The correct preventive criteria will allow the patient to return to quality living conditions.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".