Chronic nonspecific lung diseases (COPD) is one of the most important problems of modern pulmonology, representing etiological and pathomorphological processes in the respiratory system, accompanied by a prolonged productive cough due to damage to the bronchi and parenchyma. The group of these chronic diseases includes pathological disorders in the respiratory organs, which appear due to various causes and mechanisms of development, but have similar signs of the course and similar morphofunctional dysfunctions.
What is CHNLD
Traditionally, chronic nonspecific lung diseases include the following groups of pulmonary diseases:
- Chronic bronchitis.
- Asthma.
- Emphysema.
- Bronchiectasis.
- Chronic pneumonia.
- Pneumosclerosis.
However, some authors refer to independent types of NHPLinterstitial pathologies of the respiratory system. Others object, believing that only chronic bronchitis, emphysema and bronchial asthma are independent manifestations of nonspecific pathologies of the respiratory system. Therefore, the classification of chronic nonspecific lung diseases still raises some questions and even disputes among specialists.
Reasons for appearance
The main factors causing the manifestation of non-specific pathologies of the pulmonary system in the population are:
- urban air pollution;
- industrial hazard;
- frequent acute infectious processes;
- bad habits.
COPD is much more often diagnosed in people living in industrial cities, where a large amount (many times higher than the permissible norm) of hazardous substances is found in the air: nitrogen oxide, sulfur and carbon dioxide, dust particles and other components. In such regions, the frequency of diagnosed chronic lung diseases (as a medical and social problem) often reaches the federal level.
Occupational chronic lung pathologies most often occur in people who are constantly exposed to drafts, gas and dust. In addition, according to numerous studies, smokers are most susceptible to the risks of non-specific diseases of the respiratory system.
Other factors leading to chronic nonspecific lung diseases include: frequent and long-term acute respiratory viral infections, repeated bronchitis and pneumonia. Prolonged and infectious pathologies of the respiratory system, various allergic manifestations and immune disorders can also be the root causes of the development of COPD.
The likelihood of manifestation of non-specific disorders in the lungs, occurring in a chronic form, increases in people who have reached the age of 40. At the same time, such pathologies are mostly found in men. The list of chronic lung diseases, according to medical statistics, in this case looks like this:
- Chronic bronchitis - about 59%.
- Asthma - about 36%.
- Bronchiectasis - about 3.5%.
- Other lung diseases less than 1.5%.
The pathology of chronic nonspecific lung diseases can be based on one of three scenarios for the development of the disease: bronchitogenic, pneumoniogenic and pneumonitogenic causes.
The pathogenesis of bronchitiogenic development is due to the occurrence of violations of bronchial patency and drainage capacity of the bronchi. Usually, pathologies related to the classification of obstructive pulmonary diseases develop according to this scheme: chronic bronchitis, asthma, emphysema and BEB (bronchiectasis disease).
Pneumoniogenic and pneumonitogenic mechanisms are associated with the formation of chronic forms of pneumonia and lung abscess, which, in turn, are complications of broncho- or croupous pneumonia.
The outcome of these mechanisms most often are pathologies such as pneumosclerosis (pneumofibrosis, pneumocirrhosis), cardiopulmonary failure and othersunwanted consequences. In recent years, COPD has been increasingly seen as the main cause of tuberculosis and lung cancer.
Major non-specific pulmonary diseases
Classification of chronic nonspecific lung diseases includes pathologies that are the result of protracted acute diseases that have developed against the background of a viral infection or bacterial genesis. They can manifest themselves against the background of prolonged exposure to negative chemical and physical factors.
Chronic bronchitis
In terms of prevalence, bronchitis is local or diffuse, according to the type of inflammatory process - catarrhal or mucopurulent. It can be obstructive and non-obstructive, in nature - atrophic, polypous, deforming.
Clinical manifestations of chronic nonspecific lung disease of this type are expressed in annual, periodically recurring, long-term inflammation in the bronchi. Often, exacerbations of chronic bronchitis occur up to 4 times a year, while the annual duration of this pathology can reach 3-6 months.
A symptomatic sign of chronic bronchitis is a persistent cough accompanied by phlegm. During exacerbations, the cough usually becomes more severe, the sputum becomes purulent, sweating and fever are added. The outcome of this pathology may be the development of chronic pneumonia, lung atelectasis, emphysema, pneumofibrosis.
Asthma
Varietiesthere are several bronchial asthma: it can be non-atopic, atopic, mixed, aspirin-induced or occupational disease. This pathology is the second most frequently diagnosed of all nonspecific lung diseases. Their symptoms in adults and children are characterized by hyperreactivity of the bronchial tree, which leads to hypersecretion of bronchial mucus, edema and paroxysmal airway spasms.
At any genesis, the clinical manifestations of bronchial asthma are attacks of expiratory dyspnea. The development of such phenomena occurs in three stages:
- Harbingers. Signal the onset of an asthma attack in the form of coughing, mucous discharge from the nose, the appearance of swelling and redness of the conjunctiva of the eyes.
- Suffocation. It is characterized by the appearance of wheezing, sharp shortness of breath with prolonged exhalation, diffuse cyanosis, and an unproductive cough. During the period of suffocation, the patient must lie down so that the head and shoulder girdle are on a hill. In severe suffocation, the patient may die due to respiratory failure.
- The stage of reverse development of an attack. It is characterized by the separation of sputum, a decrease in the number of wheezing and freer breathing. Gradually, shortness of breath completely disappears.
Between the manifestations of asthma attacks, the condition of patients remains quite satisfactory, provided that clinical recommendations are followed: a chronic nonspecific lung disease with a prolonged course leads to the development of obstructive emphysema, cor pulmonale, and pulmonary heart failure.
Manifestations of chronic obstructive pulmonary emphysema
The morphological basis of this disease is manifested in the persistent expansion of the lumen of the bronchioles and alveoli due to chronic obstructive process in the airways against the background of the development of chronic bronchitis and bronchiolitis. The lung acquires increased airiness and increases in size.
The clinical picture of this COPD is due to a rapid reduction in the area of gas exchange and a decrease in lung ventilation. Symptoms of this pathological process appear gradually, while the patient experiences progressive shortness of breath, cough with a small amount of sputum, weight loss.
On examination, barrel-shaped changes in the anatomical structure of the chest, cyanosis of the skin, changes in the nail plates of the fingers are found. Pathology related to the general classification of chronic lung diseases is often accompanied by infectious complications, pulmonary bleeding, pneumothorax. Respiratory failure can be fatal to the patient.
Bronchiectasis
Pathological anatomy of chronic nonspecific lung diseases includes changes in the structure of the respiratory tract. Bronchiectasis is characterized by saccular, cylindrical or fusiform extensions of the bronchi. These phenomena are called bronchiectasis. They can be local or diffuse, congenital or acquired.
The emergence of congenital chronic nonspecific diseaseslungs in children is usually caused by developmental disorders of the structure of the bronchopulmonary system at the stages of the prenatal and postnatal periods. Most often, such pathologies are associated with the development of intrauterine infections, Sievert-Kartagener syndrome, cystic fibrosis, etc.
Signs of the acquired form of bronchiectasis occur against the background of recurrent bronchopneumonia, chronic bronchitis or prolonged presence of a foreign body in the bronchi. Bronchiectasis, like many other lung diseases and their symptoms in adults, manifests itself in the form of a cough with sputum. A distinctive feature in this case is the release of yellow-green pus with a smell, and in rare cases, hemoptysis is manifested. With exacerbations of this pathology, the clinical signs are similar to the course of exacerbations of chronic purulent bronchitis.
Complications of the disease lead to pulmonary hemorrhage, lung abscess, respiratory failure, amyloidosis, purulent meningitis, sepsis. Any of these conditions is life-threatening for a patient with a history of chronic non-specific lung disease. In children and adults, by the way, such a pathology is extremely rare: the percentage of congenital bronchiectasis in relation to other non-specific diseases of the pulmonary system is about two percent.
Chronic pneumonia
No less a threat to the life of the patient is chronic pneumonia, which can combine an inflammatory component, carnification, chronic forms of bronchitis and lung abscesses,bronchiectasis, pneumofibrosis. That is why not all authors agree with the inclusion of this pathology in the classification of lung diseases as an independent nosology. With each exacerbation of pneumonia, a new focus of inflammation appears in the lung tissue and the area of sclerotic changes increases.
Symptomatics of chronic pneumonia: persistent cough with mucopurulent sputum during remission, purulent - during exacerbation, as well as persistent wheezing in the lungs. In the acute period of the course of the disease, there is usually an increase in body temperature, pain in the chest, and respiratory failure. Often the disease is complicated by pulmonary heart failure, abscesses and gangrene of the lungs.
Pneumosclerosis
To chronic non-specific lung diseases with diffuse pneumosclerosis, occurring with a gradual replacement of parenchyma tissues with connective tissue, include a pathology called "pneumosclerosis". This phenomenon occurs due to inflammatory-dystrophic conditions in the lungs and leads to drying, airlessness and compaction of the lungs. Often this pathology is a consequence of chronic bronchitis, BEB (bronchiectasia), COPD, chronic pneumonia, fibrosing alveolitis, tuberculosis and many other inflammatory processes.
The main symptom of the appearance of pneumosclerosis is shortness of breath, which appears even with little physical effort. Soon she begins to disturb constantly, even at rest. Another sign of this pathology is a cough. Depending on thethe degree of damage to the lung pneumosclerosis can manifest itself in the form of a slight cough or hacking thump. Sometimes the clinical picture is complemented by cyanosis of the skin and pain in the chest. As the connective tissue in the lungs increases, the symptoms become more noticeable.
COPD in pediatrics
Children born prematurely are at increased risk of chronic lung diseases in newborns, because the organs of the bronchopulmonary system are formed in the last stages of intrauterine development. Therefore, premature babies remain at risk of partially underdeveloped lungs. Quite common diseases of the bronchopulmonary system in infants are bronchopulmonary dysplasia (BPD) and congenital malformations of the lungs, however, they are often diagnosed with other inflammatory pathologies.
Pneumonia is a common condition in young children and is most often the result of a cold, sore throat, or can be easily transmitted through the air. Most children who have had this disease in an acute form in the first 3 years of life develop chronic pneumonia. The protracted and then chronic nature of this pathology is due to a violation of the drainage functions of the bronchi, which provokes the development of hypoventilation, atelectasis, local purulent bronchitis, infection of bronchopulmonary lymph nodes and destruction of lung tissue.
With all such dysfunctions and diseases of the lungs, their symptoms indicate the presence of deformations and expansions in the structure of the bronchi, as well assigns of chronic bronchitis. This happens due to the early development of chronic pneumonia, while in the altered small branches of the bronchi there is an accumulation of mucus.
Predisposing factors for the development of the chronic form of the disease are most often:
- disturbances in the formation and malformations of the bronchopulmonary and vascular systems of the lungs;
- congenital and acquired dysfunctions of the mucociliary apparatus;
- chronic pathologies of ENT organs;
- immunodeficiency disorders;
- adverse ecopathogenic impact of the environment;
- passive smoking;
- unfavorable premorbid background: artificial feeding, diathesis, congenital pathologies of immunogenesis, etc.
Microbiological studies of sputum and bronchial swabs often reveal pneumococcal and staphylococcal infections. In most children during the period of exacerbation of this chronic nonspecific lung disease, the participation of viral infections is confirmed. Chronic pneumonia is characterized by the presence of sclerotic changes in the affected areas of the lungs. In this case, cellular lymphoid infiltrates often develop, leading to compression of the small airways.
The inflammatory process, which occurs first with prolonged and then chronic pneumonia, gradually subsides, giving way to local pneumosclerosis. In the absence of adequate treatment, with the age of the patient, the symptoms of bronchiectasis begin to predominate in the clinical picture of the disease. Often an adult patient does not evenguesses about the relationship between the bronchiectasis present in him and the unfavorable current acute form of pneumonia suffered in childhood.
Diagnosis and treatment of childhood COPD
Chronic pneumonia in children can only be diagnosed in a hospital with the help of complex clinical and radiological studies using bronchoscopy, bronchography and laboratory tests. On x-ray images of the lung in chronic pneumonia, there is an enhanced pulmonary pattern, which has a clearly defined deformation with a reduction in the volume of individual segments and thickening of the walls of the bronchi.
The stages of exacerbation and remission are determined taking into account the dynamics of the clinical picture, microbiological and cytological examination of sputum and laboratory indicators of inflammation activity (quantitative ratio of ESR in the blood, shift of the leukocyte count, positive CRP).
In the treatment of chronic pneumonia in children, the same methods are used as in the treatment of acute. The main tasks of the ongoing treatment are the restoration of the drainage function of the bronchi and the normalization of the immunological reactivity of the body. After effective treatment, a sanatorium stage of recovery and regular medical examination in the clinic are recommended. If conservative treatment is ineffective, surgical interventions may be used.
With the proper organization of dispensary observation in the clinic and adequate treatment of chronic pneumonia in children, the prognosis of this pathology is relatively favorable. However, there remains a risk of developing other forms of COPD later in life.
Prevention of chronic pneumonia in children
Preventive measures to prevent the development of lung diseases in newborns are, first of all:
- Antenatal fetal protection.
- Ensuring breastfeeding.
- Protecting the baby from acute respiratory infections.
- Active treatment of protracted and complicated forms of respiratory diseases.
- Systematic hardening.
Diagnosis of chronic nonspecific lung diseases in adults
Identification of various forms of COPD is carried out by a pulmonologist. In this case, the features of the clinical manifestations of the pathology, as well as the results of laboratory and instrumental examinations are taken into account:
- To diagnose the pathological process, it is necessary to conduct a survey radiography, which, if necessary, can be supplemented by a linear or computed tomography of the chest. Traditional chest x-ray remains the primary choice for the primary examination of the respiratory system in children and adults. This technique has the lowest radiation exposure, is quite informative and accessible. It is according to the indications of the survey radiograph that the need for the use of additional or special research methods is determined. With the help of X-ray of the lungs, it is possible to dynamically monitor the development of the pathological process. This allows the therapy to be adjusted if necessary.
- To detect structural changes in the bronchial treebronchoscopy, angiopulmonography and bronchography are performed (sputum examinations or biopsy may be ordered if necessary).
- To determine the activity of the pathological process and the nature of its appearance, you can use the study of sputum or microscopic and microbiological swabs from the bronchi.
- You can evaluate the functional reserves of the bronchopulmonary system using the study of respiratory function (functions of external respiration).
- Signs of hypertrophic changes in the right ventricle of the heart can be recognized using EchoCG and ECG.
Based on the results of the study of morphological changes in the respiratory system, the doctor will be able to give appropriate clinical recommendations. Chronic non-specific lung diseases require constant monitoring and treatment.
COPD treatment in adults
Therapy of nonspecific lung diseases is often determined by etiological factors, pathogenetic mechanisms, the degree of morphofunctional changes and the severity of the process. Nevertheless, it is possible to identify some generally accepted methods for the treatment of independent manifestations of COPD.
In order to stop infectious and inflammatory pathologies in the bronchopulmonary system, antibacterial agents are selected depending on the sensitivity of the microflora. Be sure to prescribe bronchodilators, expectorants and secretolytic drugs.
Bronchoalveolar lavage is used for bronchial sanitation. At this stage, physiotherapy, postural drainage and chest vibration massage are usually prescribed.cells. When respiratory failure occurs, the use of bronchodilators and oxygen therapy is recommended.
At the stage of remission, it is recommended to follow up with a pulmonologist, sanatorium treatment, exercise therapy, the use of speleotherapy and aerophytotherapy, as well as the use of herbal adaptogens and immunomodulators. In some cases, it is advisable to prescribe glucocorticosteroids. In order to successfully control the manifestations of chronic nonspecific lung diseases and concomitant pathologies, it is necessary to select basic therapy.
The question of surgical intervention in COPD is raised only in cases of clinical manifestations of persistent local morphological changes in the patient's respiratory system. In this case, resection of the affected areas is usually resorted to. With the development of bilateral diffuse pneumosclerosis, lung transplantation may be recommended.
