Internal illnesses. Chronic obstructive pulmonary disease (COPD) (most important)

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Internal illnesses. Chronic obstructive pulmonary disease (COPD) (most important)

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33. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Chronic obstructive pulmonary disease is a heterogeneous group of pulmonary diseases that are combined by a disorder of the function of external respiration of the lungs according to the obstructive type.

They are diagnosed at late stages, when progression becomes inevitable, despite the use of modern treatment programs.

COPD includes chronic diseases of the respiratory system: chronic obstructive bronchitis (88-90%), severe bronchial asthma (8-10%), emphysema (1%).

In the US and UK, the COPD group also includes cystic fibrosis, bronchitis obliterans, and bronchiectasis. With generalized obstruction, differential diagnosis is carried out.

Pathogenesis, clinic, diagnosis and treatment of individual nosological forms of COPD are described independently.

Management in an outpatient setting. Early identification of patients is necessary (for mild and moderate cases of the disease), early prescription of adequate basic therapy (for mild COPD, 3-week therapy with Atrovent is required with the possible addition of mucolytics, further prescription of bronchodilators according to indications (meteorological conditions, nature of work, bad habits), with Moderate and severe COPD requires long-term (constant) use of bronchodilators (Atrovent, Berodual 2 doses 3-4 times a day), if necessary, Saltos, Teopec, Theodur, etc. are added, for mucostasis - mucolytics; bronchodilators can be discontinued when stabilization of the subjective state and persistent stabilization of peak expiratory flow rates for 3 months). Monitoring is carried out for patients after ARVI or influenza with a long-lasting cough, non-productive, spastic in nature, not controlled by taking antitussive drugs (prescribing Atrovent for 3 weeks).

Etiology. The reasons for the status may be resistance to sympathomimetics and other bronchodilators, rapidly developing total pulmonary obstruction, the development of hypoxia and hypercapnia.

Clinic. There are 3 stages of flow.

At stage 1, there is a discrepancy between distant noises and auscultatory data, tachycardia, a tendency to increase pressure, resistance to cardiac glycosides, accent and splitting of the II tone over the pulmonary artery, anxiety, tension, asthenia, pale cyanosis.

In stage 2, respiratory failure, tachypnea, oligopnea increase, the sonority and number of dry rales decrease, their disappearance is possible, the formation of a "silent" lung, hypotension, decompensated respiratory acidosis and hypercapnia.

In stage 3, there is pronounced diffuse cyanosis, loss of consciousness with the participation of all reflexes, "silent" lung syndrome, frequent and small pulse, sonorous heart sounds, hypotension, collapse, hypoxic coma is formed.

Treatment. Treatment consists of avoiding b2-agonists, glucocorticoids (up to 1500 mg per day of prednisolone) are administered parenterally and orally, rehydration therapy (up to 3 liters of fluid per day), epidural anesthesia, artificial ventilation with bronchoalveolar therapeutic lavage.

Author: Myshkina A.K.

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