Chronic obstructive diseases of lungs

Description:

The Chronic Obstructive Disease of Lungs (CODL)  – the chronic disease which is characterized by diffusion damage of airways, restriction of passability of respiratory tracts which is not completely reversible. Restriction of passability of respiratory tracts usually progresses and is associated with the unusual inflammatory answer of lungs to harmful particles or gases, mainly, in connection with smoking. Along with damage of lungs, HOZL results in considerable system effects, associated diseases which burden the course of a disease at certain patients. The following system disturbances are characteristic of HOZL: a cachexia with loss of fatty weight, loss of skeletal muscles and its weakness, osteoporosis, a depression, anemia, the increased risk of development of cardiovascular diseases which are an important component of a vicious circle and in clinical maintaining patients they need to be considered always.
This disease it is possible to warn and it answers treatment.
Chronic restriction of respiratory tracts at HOZL is caused by a combination of a disease of small respiratory tracts (an obstructive bronchiolitis) and destruction of a parenchyma (emphysema) which degree of manifestation varies at various patients. Damage caused to HOZL to each certain patient depends not
only from extent of bronkhoobstruktivny disturbances, but also from expressiveness of symptoms (especially asthmas and decrease in portability of exercise stresses), system effects and associated diseases (GOLD, 2006) which are available for the patient.
Epidemiology.
According to the international researches, HOZL occurs at 4-6% of adult population. The tendency to its increase is noted. According to predictive WHO data, the damage from HOZL will increase in the next decades and by 2020 HOZL will take the 5th place in the world on social and economic damage and the third – on mortality.

Symptoms of Chronic obstructive diseases of lungs:

Main complaints:
1) Chronic cough usually is the first symptom preceding an asthma. Arises at first sometimes, over time – disturbs daily, is more often in the afternoon, is more rare – at night. Can be unproductive, without mokrotootdeleniye, in some cases – is absent.
2) Department of a phlegm is observed usually in a small amount, mucous, after cough.
3) An asthma – progressing (amplifies gradually with a current of years), persistent (disturbs the patient daily), arises or worsens at an exercise stress, promoting its bad portability. Further arises at rest and considerably limits life activity, amplifies during respiratory infections, can be defined by the patient as need of additional effort at breath, respiratory discomfort, compression of a thorax, frequent breath.
At heavy HOZL loss of weight, anorexia, a pneumorrhagia (are possible at respiratory infections), depressions and/or concern, alarm; at cor pulmonale – hypostasis of anklebones.

Reasons of Chronic obstructive diseases of lungs:

The main factor of risk of HOZL in 80-90% of cases – smoking (a smoking index – 10-20 pachko-years).
Also industrial and household harmful emissions belong to external factors of risk of development of HOZL (air pollyutant, gases and couples of chemical compounds, products of combustion of bioorganic fuel). Professions with the increased risk of development of HOZL – miners, builders whose work assumes contact with cement, workers of metallurgical industry (hot processing of metals), the railroad workers, workers occupied with processing of grain, cotton and production of paper.
Infections (children's infections with heavy course, respiratory infections, HIV), the low social and economic status (scanty food, density, overcooling, addictions).
Internal factors of risk: genetic predisposition. Treat genetically caused risk factors hereditary deficit α1-антитрипсина which leads to development of emphysema, HOZL and formation of bronchiectasias.

Treatment of Chronic obstructive diseases of lungs:

Main objectives of maintaining sick HOZL:
• prevention of progressing of a disease;
• reduction of symptoms;
• improvement of portability of exercise stresses;
• prevention and treatment of complications;
• prevention and treatment of aggravations;
• mortality reduction.
In treatment of HOZL  the inhalation way of introduction of drugs – bronchial spasmolytics, inhalation corticosteroids, the combined drugs has advantage.
At purpose of high doses and for improvement of the technology of inhalation use of nebulizers, and also spacers of large volume is recommended that considerably reduces an oropharyngeal depozition of drugs, leads to reduction of side effects at use X (candidiasis, a dysphonia) and system effects at use β2-агонистов owing to reduction of absorption of drug with mucous a GIT. Use of spacers brings to two - and to quadruple increase in a depozition of drug in lungs in comparison with DAI. Use of nebulizers also gives the chance of simultaneous supply of oxygen (at requirement).
After establishment of the diagnosis of HOZL of any stage it is necessary to stop smoking and to bend all efforts to treatment of an obstructive syndrome.
The basic principles of therapy of patients on HOZL:
• gradual accumulation of intensity of treatment depending on severity of a disease;
• a regularity, regularity of basic therapy according to severity of a disease;
• variability of the individual response to treatment defines need of carrying out attentive and regular monitoring of kliniko-functional symptoms of a disease.