Stories of COPD. Classification of COPD. Chronic lung diseases

Currently, diseases of the respiratory system are occurring more often. This state of affairs, of course, worries doctors. They recommend people to take their health more seriously.

Four degrees COPD

International experts in the progression of COPD distinguish several stages:

- Degree 0 (not yet a disease). This is the initial stage, where there is a high risk of COPD, but fears are not always justified. A person often coughs and coughs up phlegm. On this classification of COPD only begins. What next?

- Degree I (moderate course of the disease). It is characterized by small obstructive changes, persistent cough and expectoration of sputum.

- Degree II (moderate course of the disease). Obstructive changes are progressing. A person suffocates when walking, and clinical signs also appear, which increase during physical activity.

- Degree III (severe course of the disease). The airflow restriction increases when a person exhales. The patient is even more panting at physical exertion, and exacerbations occur more often. At this stage of the disease, the respiratory system of a person can be very dangerous.

- Degree IV (very severe course of the disease). Characterized by a complex form of bronchial obstruction, which is often threatened with death. There is a respiratory insufficiency, there is a pulmonary heart.

Treatment of COPD

Therapy for the disease is determined by the degree of its complexity. It should be clearly understood that drug treatment can only slow down the progress of the disease, and also make its course stable. If you do not exclude factors that contribute to the progression of the disease (for example, cigarettes), then therapy may not bring the desired results. The list of medications, their number and the possibility of combining with other pharmacological agents is determined by the doctor. On pulmonary diseases, a pulmonologist specializes. In particular, he knows the classification of COPD, he also knows how to treat these ailments.

Therapy of a moderate ailment

With noticeable signs of shortness of breath, the patient may resort to the help of inhaled bronchodilators. The doctor can prescribe the following medicines: Salbutamol, Ventolin, Berotek, Terbutalin, Fenoterol. But they can not be taken by those with tachyarrhythmia, CHD, decompensated diabetes mellitus, glaucoma, myocarditis, aortic stenosis, and thyrotoxicosis. The patient can take medication no more than four times a day. Do not do this more often. Disease COPD, the treatment of which is carried out until the death of the patient, requires a responsible attitude.

It is necessary to make an inhalation properly. If you have been prescribed this treatment for the first time, you should perform the initial procedure together with the doctor, so that he can report possible misconduct. The medication should be inhaled into the mouth (inject) exactly at the level of the entrance: so it will reach the bronchi, and not just fall into the throat. At the end of the procedure, it is necessary to hold your breath on inhalation and sit for 5-10 seconds.

What if you have a moderate degree of disease?

Here you can not get by with medications prescribed for moderate COPD. In addition to them, you need to take medications that dilate the bronchi and last long. It is necessary to buy them. Broncho-pulmonary diseases usually require high costs.

In particular, the drug "Serevent" is prescribed. It is produced in the form of a metered-dose inhaler. The optimal daily dose for adults is 50-100 μg twice a day. Inhalation should be carried out in compliance with all rules.

Also, doctors prescribe Formoterol. It is produced in capsules, where the inhalable powder is located. The procedure is inserted using a device handyhaler. Usually doctors prescribe 12 mcg twice a day. It should be noted that the treatment of lung diseases does not always give the desired effect. It's sad, but it's true.

Severe disease

At this stage, a person needs continuous anti-inflammatory therapy. The moderate and large doses of glucocorticosteroids for inhalation are prescribed. The following medicines are prescribed: Beklazon, Benacort, Fliksotid, Bekotid, Pulmicort, etc. They are manufactured in the form of metered inhalation aerosols or solutions injected into the throat by means of a nebulizer. By the way, this is a very convenient device. If you have lung disease (COPD), you can buy it.

In addition, mixed medications can be prescribed at this stage of the disease, including long-acting drugs that dilate the bronchi and a corticosteroid for inhalation. The doctor can prescribe the drugs "Symbicort" or "Seretid." Mixed drugs are considered to be the most effective medicines for the treatment of pulmonary diseases of this stage. They really deserve attention. Chronic lung disease can stop its development when used.

Very severe COPD: what to do?

In addition to drugs prescribed at a severe stage of the disease, oxygen therapy (inhaling air containing a lot of oxygen, carried out regularly) is added. For this procedure, in stores where medical products are sold, or in large pharmacies, you can buy both fairly large devices for self-use, and small cans. The latter can be taken to the street and applied when there is a shortage of air. Asthma is COPD, and it threatens life, so you should always carry a balloon.

If a person is not yet very old and is in a satisfactory shape, surgery can be performed. If the patient is in critical condition, it may be necessary to use mechanical ventilation.

How to prevent the development of COPD?

Prevention of diseases of the respiratory system is very important. The first and most serious action aimed at preventing lung diseases is the exclusion of cigarettes from their lives. This measure is effective both for the prevention of the disease, and for stopping the development of the already begun pathology. If your profession is associated with any production, where there is always a lot of metal aerosol or industrial dust, always resort to protective equipment. But the most effective measure of disease prevention is dismissal from harmful work. With chronic ailments of the respiratory system, you should go to the doctor from time to time and be examined.

An example of a history of ailment

For those who are interested in COPD, the medical history of the therapy may also seem curious. Let's look at an example.

I. Information from the passport

1. Full name of the patient: Sergeev Vladimir Kuzmich.

2. Sex of the patient: male.

3. Age: 53 years.

4. Place of residence: Omsk, ul. The Red Way, 18/7.

5. Specialty: unemployed.

6. The number and time of arrival in the hospital: 19.02.2014 at 14:55.

7. Date of leaving the hospital or transfer to another clinic: -.

8. Who sent the patient: brought by the ambulance.

9. Diagnosis made by the institution that delivered the patient: right-side out-of-hospital low-floor pneumonia.

10. The disease on admission: respiratory insufficiency of the first stage. Right-sided out-of-hospital low-floor pneumonia.

II. The main complaints of the patient

The patient reports that his body temperature reaches 39.5 ° C. He also coughs all the time and complains of serous sputum, which can be difficult to expect. This may be a sign of a respiratory system.

III. Secondary complaints of the patient

The patient is concerned about the decline of strength, malaise, trembling of the body, the inability to properly perform their work, sweating, migraine.

Response to the respiratory system

Shortness of breath: appears with physical activity, has a combined character.

Cough: does not stop throughout the day, in mild quantities mucus sputum is allocated. It can be difficult to expect.

Sputum: available, slimy, hard coughing up, ¼ cup per day, it does not depend on the patient's condition, the smell is unremarkable (as many diseases of the respiratory system manifest themselves).

IV. Disease history

The illness began unexpectedly on February 13, 2014 after a long stay in the cold, when the patient's temperature rose to 39.5 ° C and a dry cough appeared. The patient did not drink any medicines. After two days, the cough was already wet, and the sputum hardened. The temperature remained unchanged for four days. On February 19, 2014, the patient called an ambulance and was taken to the Omsk City Central Clinical Hospital. He was diagnosed with right-side out-of-hospital low-floor pneumonia. The patient was not on the register. He reports that previously he had no ailments of the respiratory system, except for acute respiratory viral infection. This completes the history of COPD of moderate severity.

V. Patient's life

Sergeev Vladimir Kuzmich was born in 1961 in the city of Omsk. He was the first child of his parents. His weight after the birth was 2700 g. The patient's mother at the time of his birth was 20 years old, and his father - 28. The sick were breast-fed. In the first class he entered when he was 6 years old. He studied mainly on the four. After school I entered a technical school. I studied at the builder.

Information about the profession. The patient got a job at 22, he became a builder. Dangerous factors: work on the street, dust, physical and emotional overload. Not so long ago, he quit his job.

Housing conditions are normal. In the patient's property is a three-room apartment in a brick building. Before the onset of the disease of the respiratory system, he lived there quietly and did not expect trouble.

Than hurted or was ill; was sick in the childhood, does not remember. He reports that he once suffered an acute respiratory viral infection. He claims that he does not suffer from tuberculosis, STD, AIDS, or viral hepatitis.

VI. Study of the body

The general condition of the patient can be called moderate, his position is active, and consciousness - nothing obscured. The facial expression is normal, there is no manifestation of paranoia and schizophrenia. The gait is light. The constitution is satisfactory. According to the constitution, it is a normostenic. The size of the neck, arms and legs is proportional to the length of the body. Height - 165 cm, weight - 73 kg. The patient has too much body weight, soon obesity can develop.

System of visible mucous membranes and skin

Skin of light pink shade, mucous membranes, accessible to inspection (eye, lips, nose, mouth), of the same color. Painful pigmentation was not found. The skin is quite elastic. There is a turgor. The moisture of the skin is normal. During the study, general edema was not found. On the body, there are no rashes, no scars, no peeling, no shedding through the skin.

Chest Examination

The thorax refers to the normostenic type. Epigastric angle is straight. Tightly pressed to the chest of the scapula. The course of the ribs is straight. Are visible gaps between them. The clavicles are also well expressed, the pits above and below them are slightly visible. On the surface of the breast there are neither asymmetrical bulges nor concavities. Scoliosis is not detected.

Surface abdominal palpation

With superficial palpation, the patient does not have any unpleasant sensations, the abdomen is soft, no strained muscles, no hernial bulges. Symptom Shchetkin-Blumberg is not confirmed. The inguinal and umbilical ring is normal.

Appearance of the abdomen when the patient lies on the back

The abdomen seems large due to fatty subcutaneous fat, its shape is normal, it is symmetrical, it rises when breathing. There was no noticeable peristalsis. There is a venous net under the skin along the sides of the abdomen and near the navel. The divergence of the rectus muscles, as well as hernias, was not found. The navel is retracted.

VII. Presumptive diagnosis

Based on the patient's story, the history of the disease, information about life, as well as an objective study of the patient, the following presumptive diagnosis can be made: pneumonia of the lower part of the right lung, which is out-of-hospital. The disease is moderately severe. There is also a complication, namely the respiratory insufficiency of the first stage. In addition, a number of important findings can be drawn from the history of COPD.

VIII. Sequence of examination of the patient

1. General analysis of blood.

2. Ultrasound examination of organs located in the abdominal cavity.

3. Blood test for biochemistry (protein, urea, glucose, creatinine).

4. General examination of urine.

5. Blood on Wasserman's reaction.

6. Electrocardiogram.

7. X-ray of organs located in the thorax.

8. Feces for the presence of worms.

9. Bacteriological examination of sputum.

XI. The final diagnosis and its explanation

Based on the patient's story, the history of the disease, instrumental and laboratory tests, the patient can be diagnosed as follows: pneumonia of the lower part of the right lung, which is out-of-hospital. The disease is moderately severe. There is a respiratory insufficiency of the first stage.

XII. Necessary therapy

1. Feverish period requires strict bed rest.

2. The patient needs to drink a lot and adhere to the diet No. 15 according to Pevzner.

3. Etiotropic therapy - reception of antibiotics according to the type "feverish period + 5-7 days".

Another example of a history of COPD

Let's consider one more medical history, it is no less interesting. It will be useful for an aspiring physician to read and analyze it.

I. Personal Information

1. Full name of the patient: Ivanov Petr Ilyich.

2. Sex of the patient: male.

3. Year of birth: 1958 (56 years).

4. Specialty: mason.

5. Education: secondary special.

6. Place of residence: Omsk, ul. Marx, 23/2.

7. The number and time of arrival in the hospital: 15.04.2014 at 20:15.

8. Diagnosis: exacerbation of chronic bronchitis. Respiratory failure of the first stage.

9. Other diseases: arterial hypertension, grade I, risk II.

II. Information about the patient's work

Total length of service - 40 years, work on specialty - 27.

Description of working conditions. The working day lasts 8 hours, the break is 60 minutes. The patient can go on vacation on time. The main specialty is a mason.

III. The patient's story about his condition

Upon arrival at the hospital, the patient reported that he had a fever, felt unwell, was suffering from sputum and cough, and during physical activity he began to gasp. In this case of COPD, there is nothing surprising, it is quite typical.

IV. Information about the life of the patient

The patient claims that he is not sick with either STDs, diabetes mellitus, hereditary pathologies, or mental illnesses. He also reports that he does not have tumors and neoplasms. According to the patient, his relatives also do not have a single disease from this list. The patient reports that in childhood he suffered an infection (namely measles), in addition, he had a cold, as well as pneumonia in 2008. Dangerous predilections: smokes, from time to time takes alcohol (on significant dates). He was born in 1958. Was the second child in the family. Mature and developed in good domestic and social conditions. He studied at the school, graduated from the technical school, mason. He started working in 1985.

V. Inspection of the patient

Weight - 95 kg, height - 188 cm. The general condition of the patient is normal, the position is active, and consciousness is not clouded.

Skin light pink shade, warm. Turgor and elasticity are normal. The fatty subcutaneous layer can be called moderate, it is distributed proportionally. Mucous membranes available for inspection do not have any irregularities. Lymphatic peripheral nodes: palpable, enlarged, not soldered with tissues located around them. During the examination, the patient did not experience unpleasant sensations.

The structure of the skeleton of defects was not found. The joints are normal, their movements are not limited, there is no pain. The degree of muscle development, their tone, and also the strength are satisfactory.

As for the thyroid gland, it is of normal size, it is not soldered to the tissues located around it, it is mobile, smooth, it does not appear when examining unpleasant sensations. The examination is necessary for the diagnosis, only the history of COPD alone would not be enough.

Bodies responsible for breathing

The thorax is symmetrical, of a normal shape, both sides actively and proportionally participate in the process of breathing. The examination of the pits above and under the clavicles was carried out. They are well marked and symmetrical. The gaps between the ribs are perfectly expressed, they are elastic, when the unpleasant sensations touch them, the patient does not arise.

Digestive organs

The abdomen is of normal shape. During surface probing soft. No pain. During a deep palpation, no abnormalities were detected. The liver has a normal size, it does not cross the edge of the costal arch. At palpation of pain does not arise. When looking around Kurlov, the edges are not enlarged. The gallbladder and spleen can not be probed. The patient goes to the toilet regularly, once a day, the act of defecation is normal.

VI. Preliminary diagnosis

Based on the patient's story that he suffocates during physical activity (climbing stairs to 3-4 floors) that he has colorless mucous sputum and cough, unpleasant sensations in the chest, information from an anamnesis (the patient underwent examination in the occupational pathology department, There it was found that he had chronic bronchitis) and the body's research (in case of comparative probing above the upper parts of the lungs a box sound is heard, during auscultation rigid breathing is determined above all organs , there are dry individuals E wheezes) it can be argued that Ivanov exacerbation of chronic bronchitis. Thus, the guesses of doctors are confirmed. If the prevention of pulmonary diseases was, then the patient did not help her.

VII. Survey plan

1. General urine test: satisfactory.

2. Blood test for biochemistry: normal.

3. Spirography: a decrease in the Tiffno index.

4. General blood test: satisfactory.

5. X-ray of organs located in the chest: too clear pulmonary pattern.

The diagnosis of "exacerbation of chronic bronchitis" is based on the following:

1. The patient's story that he has mucous sputum, cough and lack of air with physical activity.

2. Information about the life of the patient: he smokes, he has chronic bronchitis.

3. Inspection of the patient, during which dry rales are revealed, as well as hard breathing.

4. Laboratory studies, during which a decrease in the Tiffno index, a decrease in the peak expiratory flow rate, and an X-ray, a too clear pulmonary pattern was established.

VIII. Treatment

1. Necessary mode: general.

2. Diet: № 15.

3. The drug "Macropen" - one tablet three times a day. 400 mg.

4. Syrup "Khaliksol" - one large spoon three times a day.

5. Vitamins "Revit" - a pair of pills twice a day.

6. Tablets "Bromhexine" - three times a day to 0.008 g.

7. Physiotherapy: quartz on the chest, as well as iontophoresis.

It is always necessary to remember how dangerous COPD is. The medical history of the disease fully confirms this.