COPD, what is it? How to treat COPD at home

Long-term inflammation of the bronchi of the disease, occurring with frequent relapses, cough, phlegm and shortness of breath are called generic term - chronic obstructive pulmonary disease, COPD for short. Development of pathology contributes to poor environmental conditions, work in areas with polluted air and other factors that trigger the disease of the pulmonary system.

The term COPD appeared relatively recently, about 30 years ago. Basically, the disease of smokers are concerned. Affliction is a constant current, with short or long periods of remission, disease, sick people need a lifetime of medical care. Chronic obstructive pulmonary disease is a pathology which is accompanied with the restriction of air permeability in the airways.

Over time, the disease progresses, the condition worsens.

What it is?

Chronic obstructive pulmonary disease (COPD) - an independent disease, which is characterized by partially irreversible limitation of airflow in the airway, having usually steadily progressive nature and triggered by abnormal inflammatory reaction to lung tissue irritation by various pathogenic particles and gases.

Causes of

The main cause of COPD - smoking, active and passive. Tobacco smoke damages the bronchi and lung tissue itself, causing inflammation. Only 10% of cases due to the influence of occupational hazards, permanent air pollution. The development of the disease can take part, and genetic factors that cause the failure of certain substances protects the lungs.

The main risk factors of COPD:

Probability values ​​of factors	internal factors	External factors
installed	Α1-Antitrypsin Deficiency	Smoking. Occupational hazards (cadmium, silicon)
high	prematurity High levels of IgE bronchial hyperreactivity Familial disease	Ambient air pollution (SO2, NO2, O3) occupational hazards Low socio-economic status Passive smoking in childhood
possible	Genetic predisposition (blood group A (II), the absence of IgA)	Adenovirus infection Deficiency of vitamin C

COPD symptoms

COPD is usually progressive, however, in most of the patients have developed clinical symptoms develop within a few years or even decades.

The first specific symptom of COPD patient is the appearance of cough. At the onset of the disease cough bothers the patient only in the morning and has a short duration, but with the passage of time observed patient deterioration and appearance of painful hacking cough with copious amounts compartment mucous sputum character. Isolation of viscous sputum yellow indicates the nature of purulent secretions of inflammatory nature.

A long period of COPD is inevitably accompanied by the development of emphysema bilateral localization of as evidenced by the appearance of shortness of breath expiratory character, ie, difficulty in breathing in phase "Exhalation". A characteristic feature of dyspnea in patients with COPD is its permanent nature with a tendency to progression in the absence of remedial measures. The appearance of the patient's chronic headaches with no clear localization, dizziness, reduce disability and sleepiness favor the development of hypoxic and hypercapnic lesions of the brain structures.

dyspnea scale Medical Research Council (MRC) Dyspnea Scale:

Power	weight	Description
0	No	Shortness of breath only with very intense traffic
1	easy	Shortness of breath when walking fast, a small rise
2	Central	Dyspnea forcing the patient to move around by walking more slowly than healthy people of the same age
3	Weight	Shortness of breath when walking makes stop about every 100 meters
4	Very heavy	Shortness of breath does not allow to go beyond the home or appears when changing

The intensity of the manifestations of data varies from stability to exacerbate, at which increases severity of dyspnea, sputum volume and increases the intensity of coughing, changing the viscosity and character sputum. Progression of disease passes unevenly, but gradually the patient's condition is getting worse, join extrapulmonary symptoms and complications.

Stage of the disease

Classification of COPD involves four steps:

1. The first stage - the patient does not notice at any abnormalities. His chronic cough can attend orientation. Organic changes of uncertainty, so a diagnosis of COPD at this stage is not possible.
2. The second stage - the disease is not hard. Patients go to the doctor for consultation about the shortness of breath during physical exercise. More chronic obstructive pulmonary disease accompanied by intense cough.
3. The third step is accompanied by severe course of COPD. For it is characterized by limited air into the respiratory tract, shortness of breath so formed not only during exercise, but also at rest.
4. The fourth stage - a very severe course. Emerging symptoms of COPD are dangerous to life. Plugged observed bronchus and pulmonary heart disease is formed. Patients who are diagnosed with stage 4 COPD, acquire a disability.

What else should I know?

With increasing severity of COPD, asthma attacks are becoming more and more difficult, and the symptoms grow rapidly and remain longer. It is important to know what to do in case of asthma attacks. The attending physician will help you choose medications to help with such attacks. But in cases of very severe attack may need to call the brigade ambulance. Hospitalization is optimal to a specialized pulmonary department, but in the absence or occupancy of the patient can be hospitalized in therapeutic hospital to arrest the aggravation and prevent complications of the disease.

In these patients over time is often manifested depression and anxiety due to the awareness of the disease is getting worse. Shortness of breath and difficulty in breathing also contribute to feelings of anxiety. In such cases, you should definitely talk to your doctor about what types of treatment you can choose to ease problems with breathing during attacks of breathlessness.

The quality of life

To assess this parameter used questionnaires SGRQ and HRQOL, Pearson χ2 test and Fisher. Taken into account the age starting to smoke, the number of packs smoked, duration of symptoms, disease stage, the degree of dyspnea, blood gases, the number of exacerbations and hospitalizations a year, the presence of underlying chronic conditions, the effectiveness of basic treatment, participation in programs rehabilitation.

1. One of the factors that must be considered when evaluating the quality of life of patients with COPD becomes the experience of smoking and number of cigarettes smoked. Studies confirm. That with increasing length of smoking in COPD patients is significantly reduced social activity, and growing depression manifestations responsible for reducing not only the health but also social adaptation and status patients.
2. The presence of associated chronic pathologies other systems reduces the quality of life through mutual syndrome increases the risk of complications and deaths.
3. Older patients have a worse functional performance and capabilities to compensate.

complications

Like any other inflammation, obstructive pulmonary disease sometimes leads to a number of complications, such as:

• pneumonia (pneumonia);
• respiratory insufficiency;
• pulmonary hypertension (high blood pressure in the pulmonary artery);
• irreversible heart failure;
• thrombosis (blockage of blood vessels by thrombi);
• bronchiectasis (development of functional disability bronchi);
• pulmonary heart syndrome (increase in pressure in the pulmonary artery, leading to thickening of the right heart sections);
• atrial fibrillation (Disorder of heart rhythm).

diagnosis of COPD

Timely diagnosis of chronic obstructive pulmonary disease can increase the duration of life of patients and improve the quality of their existence. When collecting anamnesis modern experts are always paying attention to the factors of production and the availability of unhealthy habits. The basic method of functional diagnostics is considered to spirometry. She reveals initial signs of the disease.

A comprehensive diagnosis of COPD includes the following steps:

1. X-rays of the sternum. It should be done annually (this is a minimum).
2. The analysis of sputum. The definition of its macro- and microscopic properties. If necessary, carry out research on bacteriology.
3. Clinical and biochemical blood. It recommended 2 times a year, as well as during periods of exacerbations.
4. Electrocardiogram. Since chronic obstructive pulmonary disease often gives complication on the heart, it is advisable to repeat this procedure 2 times a year.
5. Analysis of gas composition and blood pH. Make at 3 and 4 degrees.
6. Oximetry. Assessment of the degree of blood oxygen saturation non-invasively. It is used in the acute phase.
7. Monitoring of fluid and salt ratio in the body. Determined by the presence of a pathological lack of certain trace elements. It is important in the exacerbation.
8. Spirometry. It allows you to determine how severe the condition of pathologies of the respiratory system. You must take once a year and more often, in time to correct the course of treatment.
9. Differential diagnosis. Most often dif. diagnosis is performed with lung cancer. In some cases, you want to exclude heart failure, tuberculosis, pneumonia.

Especially noteworthy differential diagnosis of asthma and COPD. Although it is two independent disease, they often appear in one person (the so-called cross syndrome).

How is COPD?

With the help of drugs of modern medicine to cure chronic obstructive pulmonary disease completely until it is impossible. Its main function is to improve the quality of life of patients and the prevention of severe complications of the disease.

COPD treatment may be carried out at home. With the following exceptions:

• Home therapy does not produce any visible results or the patient's condition deteriorates;
• enhanced respiratory failure developing into asthma attack, heart rhythm is disturbed;
• 3 and 4 degrees in the elderly;
• complications severe.

Quitting smoking is a very difficult but also very important; it slows down, but does not completely stop the decline OFV1. The most effective simultaneous use of several strategies: definition of smoking cessation date technology behavior change, group refused, nicotine replacement therapy, bupropion, varenicline or support and doctor.

Level of quitting more than 50% per year, but has not been demonstrated even with the most effective interventions such as bupropion in combination with a nicotine replacement therapy or the use of varenicline.

medication

The goal of drug treatment to reduce the frequency of exacerbations and severity of symptoms, prevent complications. As the disease progresses the amount of treatments will only increase. The main drugs in the treatment of COPD:

1. Bronchodilators - the main drugs that stimulate the expansion of the bronchi (Atrovent, salmeterol, salbutamol, formoterol). Are administered preferably by inhalation. Short-acting medications are used as needed, a long - time.
2. Glucocorticoids are inhaled - used in severe disease with acute exacerbation (prednisolone). In severe respiratory failure episodes cropped glucocorticoids in the form of pills and injections.
3. Antibiotics - used only during exacerbation of the disease (penicillins, cephalosporins, fluoroquinolones may use). Used pills, injections, inhalations.
4. Mucolytics - thin the mucus and facilitate its removal (karbotsistein bromhexine, ambroxol, trypsin, chymotrypsin). Used only in patients with viscous sputum.
5. Antioxidants - may reduce the frequency and duration of exacerbations, courses are applied to six months (N-acetylcysteine).
6. Vaccines - holding influenza vaccination can reduce mortality in half the cases. Spend it once in October - early November.

Breathing exercises in COPD

Experts identify the 4 most effective exercises, which and should pay attention in the fight against COPD.

1. Sitting on a chair and leaning, not stooping to his back, the patient must make a short and strong breath through your nose and count up to ten, with a force exhale through pursed lips. It is important to ensure that the exhalation duration was longer than inhalation. Repeat this exercise 10 times.
2. The second exercise is carried out in the same posture as the first. In this case, slowly raise your hands alternately up, while making a breath, and lowering - exhale. Exercise is repeated 6 times.
3. The following exercise is performed sitting on the edge of a chair. Hands should lie down on his knees. It should be 12 times in a row at the same time carry out curl in the hands and feet in the ankle joint. On bending a deep inhalation, and in extension - exhale. This exercise allows you to saturate the blood with oxygen and successfully cope with his failure.
4. The fourth exercise is also carried out without getting up from his chair. The patient should make the most deep breath and counting to 5 slowly exhale. This exercise is carried out for 3 minutes. If, during this exercise, there are unpleasant sensations, it should not be done.

Gymnastics - an excellent remedy for stopping the progression of the disease and prevent its recurrence. However, it is very important before starting classes breathing exercises, consult your doctor. The fact that this treatment in a number of chronic diseases can not be performed.

Especially diet and lifestyle

The most important component of treatment - exclusion of precipitating factors, such as smoking or withdrawal from the harmful enterprises. If you do not - all the treatment as a whole will be almost useless.

For the purpose of smoking cessation can be used acupuncture, nicotine replacement products (Patches, chewing gum), etc. Because of the tendency of patients to weight loss is necessary for adequate protein food. That is, in the daily diet should be present meat and / or fish dishes, dairy products and cheese. Because of the growing shortness of breath, many patients try to avoid physical activity. This is fundamentally wrong. Required daily physical activity. For example, a daily walk at a pace that allows your condition. Very good effect renders conducting breathing exercises, such as Strelnikovoj procedure.

Daily, 5-6 times a day you need to do exercises that stimulate diaphragmatic breathing. To do this, sit down, put his hand on his stomach to control the process of breathing and stomach. Take on the procedure for 5-6 minutes at a time. This way of breathing helps to involve the entire lung capacity and strengthen the respiratory muscles. Diaphragmatic breathing may also help reduce dyspnea on exertion.

Oxygen

Most patients require the addition of oxygen, even those that have not used it for a long time. Hypercapnia may deteriorate against a background of oxygen. Deterioration takes place, as is commonly believed, because of the weakening of hypoxic respiratory stimulation. However, increasing the ratio V / Q is probably a more important factor. Before prescribing oxygen ratio V / Q minimized while reducing lung perfusion plohoventiliruemyh portions due to vasoconstriction of pulmonary vessels. The increase in V / Q ratio on a background of oxygen caused.

Decrease hypoxic vasoconstriction of pulmonary vessels. Hypercapnia may be enhanced due to the effect Haldane, but this version is questionable. Haldane effect is to reduce the affinity of hemoglobin for CO2, which leads to excessive accumulation of CO2 dissolved in the blood plasma. Many patients with COPD may experience both chronic and acute hypercapnia, and therefore heavy defeat CNS unlikely if RaSO2 does not exceed 85 mm Hg The target level for RaO2 is about 60 mm Hg; higher levels do not bring great effect, but increase the risk of hypercapnia. Oxygen supply is via the Venturi mask, so her need to be closely watched, and the patient should be carefully monitored. Patients whose deteriorated condition on the background oxygen (e.g. in combination with severe acidosis or lesion CFB) required ventilatory support.

Many patients who after discharge from the hospital, where they were due to acute exacerbation of COPD, the first time it took oxygen therapy in the home oxygen is getting better, and further use after 50 days they no longer required. Thus, the need for oxygen therapy at home should be reviewed after 60-90 days after discharge.

Treatment of COPD exacerbations

The goal of treatment of exacerbations - is the maximum possible relief of the current exacerbation and prevent them in the future. Depending on the severity of exacerbations can be treated as an outpatient or in the hospital.

Basic principles of treatment of exacerbations:

• With the use of short exacerbation preferred long-acting bronchodilators. Dosage and dose rate, tend to increase compared with conventional. It is desirable to use spacers or nebulizers, especially in critically ill patients.
• It is necessary to properly assess the severity of the patient's condition, to eliminate the complications that can masquerade as a COPD exacerbation, and time spent on hospitalization during life-threatening situations.
• With little effect bronchodilators, intravenous aminophylline added.
• If you previously used monotherapy, a combination of beta-stimulants with anticholinergic (also short-acting).
• The dosage oxygen therapy in the treatment of patients in a hospital through a nasal catheter or mask Venturi. The content of oxygen in the inspired mixture - 24-28%.
• Connection of intravenous or oral administration of corticosteroids. An alternative to systemic administration of corticosteroids considered pulmicort inhalation by nebulization 2 mg twice a day after inhalation beroduala.
• In the presence of bacterial inflammation symptoms (the first indication of which is the appearance of purulent sputum) are assigned to broad spectrum antibiotics.
• Other activities - maintaining water balance, anticoagulant, treatment of concomitant diseases.

Surgery

There are surgical methods for the treatment of COPD. Spend bullectomy, debilitating symptoms in patients with large bullae. But its effectiveness is established only in quit rates in the near term. Developed torokoskopicheskaya laser Bullectomy and Reduction pnevmoplastika (pererazdutoy removing part of the lung).

But these operations is currently used only in clinical trials. It is believed that in the absence of the effect of all the measures undertaken should contact a specialized center to address the issue of lung transplantation

Care for the terminally ill

In severe stages of the disease when death is imminent, undesirable exercise and daily activity aimed at minimizing energy costs. For example, patients may limit their living space one floor of the house, to eat more often and in small portions, rather than rare and long hours, avoid tight shoes.

Should discuss the terminally ill care, including the inevitability of mechanical ventilation, use of time relieves pain sedation appointment responsible for making medical decisions in the event of disability patient.

prevention

Prevention is very important to prevent the occurrence of various problems with the respiratory system, and in particular - chronic obstructive pulmonary disease. First and foremost, of course, should give up tobacco. Additionally, as a preventive disease measures, doctors advise:

• conduct proper treatment of viral infections;
• comply with safety when working in hazardous occupations;
• make daily walks in the fresh air at least one hour;
• timely cure the defects of upper respiratory tract.

Only when caring for their health and for safety at work, you can protect yourself from an extremely dangerous disease called COPD.

Forecast for life

COPD has conventionally unfavorable prognosis. The disease is slowly but steadily progressing, leading to disability. Treatment, even the most active, can only slow down the process, but does not eliminate the pathology. In most cases, treatment is life-long, with an ever-increasing doses of medication.

If you continue smoking obstruction progresses much faster, dramatically reducing life expectancy.

Incurable and deadly COPD simply encourages people to quit smoking forever. And for at-risk people board one - when it detects signs of disease in their immediate contact to the lung. After all, the earlier the disease is detected, the less the likelihood of premature death.