Currently, diseases of the respiratory system are increasingly common. This state of affairs, of course, alarms doctors. They encourage people to take their he alth more seriously.
Four degrees of COPD
International experts distinguish several stages in the progression of COPD:
- Degree 0 (not yet a disease). This is the initial stage at which there is a high risk of COPD, but fears are not always justified. The person often coughs and expectorates mucus. This is just the beginning of the classification of COPD. What's next?
- Grade I (moderate disease). It is characterized by slight obstructive changes, persistent cough and expectoration of sputum.
- Grade II (moderate course of the disease). Obstructive changes progress. The person is out of breath when walking, and there are also clinical signs that increase during physical activity.
- Grade III (severe disease). Increased airflow restriction when a person exhales. The patient suffocates even more during physicalloads, and exacerbations occur more often. At this stage, diseases of the human respiratory system can be very dangerous.
- Grade IV (very severe disease). It is characterized by a complex form of bronchial obstruction, which often threatens with death. Respiratory failure appears, cor pulmonale occurs.
COPD treatment
Therapy for an ailment is determined by the degree of its complexity. It should be clearly understood that drug treatment can only slow down the development of the disease, as well as make its course stable. If you do not exclude factors contributing to the progression of the disease (for example, cigarettes), then therapy may not bring the desired results. The list of medicines, their quantity and the possibility of combining with other pharmacological agents is determined by the doctor. A pulmonologist specializes in diseases of the lungs. In particular, he knows the classification of COPD, he also knows how to treat these ailments.
Therapy for moderate disease
With noticeable signs of shortness of breath, the patient may resort to using inhaled bronchodilators. The doctor can prescribe the following medications: Salbutamol, Ventolin, Berotek, Terbutalin, Fenoterol. But they should not be taken by those who have tachyarrhythmia, CHD, decompensated diabetes mellitus, glaucoma, myocarditis, aortic stenosis, and thyrotoxicosis. The patient can take medication no more than four times a day. You shouldn't do this more often. COPD disease, which is treated until the death of the patient, requires a responsibleself relationship.
It is necessary to inhale properly. If this is the first time you have been prescribed such a treatment, you should carry out the initial procedure with the doctor so that he informs you of possible wrong actions. The medication must be inhaled into the mouth (injected) exactly at the entrance level: this way it will reach the bronchi, and not just fall into the throat. At the end of the procedure, you must hold your breath while inhaling and sit like this for 5-10 seconds.
What to do if you have a moderate degree of the disease?
Here you can not get by with drugs prescribed for moderate COPD. In addition to them, you need to take medications that expand the bronchi and act for a long time. You must definitely buy them. Broncho-pulmonary diseases are usually expensive.
In particular, the drug "Serevent" is prescribed. It comes in the form of a metered dose inhaler. The optimal daily dose for adults is 50-100 mcg twice a day. Inhalation must be performed in compliance with all rules.
Also, doctors prescribe Formoterol. It is produced in capsules, where the inhalation powder is located. The procedure is performed using a handihaler device. Doctors usually prescribe 12 micrograms twice a day. It should be noted that the treatment of lung diseases does not always give the desired effect. It's sad but true.
Severe illness
At this stage, the person needs continuous anti-inflammatory therapy. Moderate and large doses of glucocorticosteroids are prescribed forinhalation. The following medicines are prescribed: Beklazone, Benacort, Flixotide, Bekotid, Pulmicort, etc. They are made 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, at this stage of the disease, mixed medicines can be prescribed, which include both a long-acting drug that dilates the bronchi, and a corticosteroid for inhalation. Your doctor may prescribe Symbicort or Seretide. Mixed drugs today are considered the most effective medicines for the treatment of pulmonary diseases of this stage. They really deserve attention. Chronic lung disease can be stopped when used.
Very severe COPD: what to do?
In addition to drugs prescribed at a severe stage of the disease, oxygen therapy is added (inhalation of air containing a lot of oxygen, carried out regularly). For this procedure, in stores that sell medical products, or in large pharmacies, you can buy both fairly large devices for self-use, and small cans. The latter can be taken with you to the street and applied when you start to feel a lack of air. Asthma is COPD and is life threatening so always carry a spray bottle.
If the person is not yet very old and is in satisfactory shape, it is possible to carry outsurgical intervention. A critically ill patient may need a ventilator.
How to prevent COPD?
Prevention of diseases of the respiratory system is very important. The first and most serious action aimed at preventing lung disease is to eliminate cigarettes from your life. This measure is effective both for the prevention of the disease, and for stopping the development of an already begun pathology. If your profession is connected with any production, where a lot of aerosol of metals or industrial dust is always collected, be sure to resort to the help of protective equipment. But the most effective measure to prevent illness is dismissal from hazardous work. For chronic respiratory problems, you should go to the doctor from time to time and be examined.
Example case history
For those who are interested in COPD, the medical history of therapy may also seem curious. Let's look at an example.
I. Passport information
1. Patient name: Sergeev Vladimir Kuzmich.
2. Patient gender: male.
3. Age: 53.
4. Place of residence: Omsk, st. Red Way, 18/7.
5. Speci alty: unemployed.
6. Date and time of arrival at the hospital: 19.02.2014 at 14:55.
7. Date of leaving the hospital or transfer to another clinic: -.
8. Who referred the patient: brought by the ambulance staff.
9. The diagnosis made by the institution that brought the patient: right-sided out-of-hospital lower lobe pneumonia.
10. Illness at admission: respiratoryfailure of the first stage. Right-sided out-of-hospital lower lobe 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 expectorate. This may be a sign of a respiratory problem.
III. Secondary Patient Complaints
Patient worries about low energy, malaise, body trembling, inability to do his job properly, sweating, migraine.
Respiratory system survey
Shortness of breath: occurs with physical activity, is combined.
Cough: does not stop throughout the day, moderate amounts of mucous sputum. It can be difficult to expectorate.
Sputum: available, mucous, hard to expectorate, ¼ cup per day, it does not depend on the position of the patient, its smell is unremarkable (this is how many diseases of the respiratory system manifest themselves).
IV. Case history
The illness began unexpectedly on February 13, 2014, after a long stay in the cold, when the patient's temperature rose to 39.5ºС and a dry cough developed. The patient did not take any medication. Two days later, the cough was already wet, and the sputum was hard to expectorate. 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 givenDiagnosis: right-sided out-of-hospital lower lobe pneumonia. The patient was not registered. He reports that he had not previously had any ailments of the respiratory system, except for an acute respiratory viral infection. This concludes the story of moderate COPD.
V. Life of a patient
Sergeev Vladimir Kuzmich was born in 1961 in the city of Omsk. He was the first child of his parents. His weight after birth was 2700 g. The patient's mother was 20 years old at the time of his birth, and his father was 28. The patient was breastfed. He entered first grade when he was 6 years old. Studied mainly in the fourth. After school, he entered a technical school. Trained as a builder.
Information about the profession. The patient got a job at the age of 22, he became a builder. Hazards: outdoor work, dust, physical and emotional overload. Not long ago, he quit his job.
Housing and living conditions are normal. The patient owns a three-room apartment in a brick building. Before the onset of respiratory disease, he lived there calmly and did not expect trouble.
What was sick in childhood, does not remember. He reports that he once suffered an acute respiratory viral infection. Claims to be free of tuberculosis, STDs, AIDS, and viral hepatitis.
VI. Body study
The general condition of the patient can be called moderate, his position is active, and his consciousness is not clouded by anything. The facial expression is normal, manifestations of paranoia and schizophrenia are not observed. The walk is easy. Body typesatisfactory. According to the constitution, he is a normosthenic. The size of the neck, arms and legs are proportional to the length of the body. Height - 165 cm, weight - 73 kg. The patient is overweight and may soon become obese.
Visible mucosal and skin system
Light pink skin, visible mucous membranes (eyes, lips, nose, mouth) of the same color. Painful pigmentation was not found. The skin is quite elastic. There is turgor. Skin moisture is normal. During the study, general edema was not found. There are no rashes, no scars, no peeling, no vessels appearing through the skin on the body.
Chest examination
The chest is of a normosthenic type. The epigastric angle is straight. The shoulder blades are tightly pressed to the chest. The course of the ribs is straight. Noticeable gaps between them. The clavicles are also well defined, with little pits above and below them. On the surface of the chest there are no asymmetrical bulges or concavities. Scoliosis was not detected.
Superficial probing of the abdomen
With superficial probing, the patient did not experience any discomfort, the abdomen is soft, neither tense muscles nor hernial bulges are observed. Shchetkin-Blumberg's symptom is not confirmed. The inguinal and umbilical ring are normal.
Appearance of the abdomen when the patient is lying on his back
Belly seems large due to fatty subcutaneous tissue, its shape is normal, it is symmetrical, it rises when breathing. Noticeable peristalsiswas not found. There is a venous network under the skin on the sides of the abdomen and near the navel. Discrepancies of the rectus muscles, as well as hernias, were not found. The navel is retracted.
VII. Presumptive Diagnosis
Based on the patient's story, history of illness, information about life, as well as an objective study, the patient can be diagnosed with the following presumptive diagnosis: pneumonia of the lower section of the right lung, which is out-of-hospital. The disease is moderate. There is also a complication, namely respiratory failure of the first stage. In addition, many important things can be learned from the COPD history.
VIII. Sequence of examination of the patient
1. Complete blood count.
2. Ultrasound examination of organs located in the abdominal cavity.
3. Blood test for biochemistry (protein, urea, glucose, creatinine).
4. General urinalysis.
5. Blood for the Wasserman reaction.
6. Electrocardiogram.
7. X-ray of organs located in the chest.
8. Feces for worms.
9. Bacteriological examination of sputum.
XI. Final diagnosis and explanation
Based on the patient's story, the history of the disease, instrumental and laboratory tests, the patient can be diagnosed with the following diagnosis: pneumonia of the lower section of the right lung, which is out-of-hospital. The disease is moderate. First stage respiratory failure present.
XII. Essential Therapy
1. The feverish period requires strict bed rest.
2. The patient needs to drink a lot and stick to Pevsner's diet No. 15.
3. Etiotropic therapy - taking antibiotics according to the "feverish period + 5-7 days" type.
Another example of COPD case history
Let's consider one more case history, it is no less interesting. It will be useful for a novice doctor to read and analyze it.
I. Personal information
1. Patient's name: Petr Ilyich Ivanov.
2. Patient gender: male.
3. Year of birth: 1958 (age 56).
4. Speci alty: bricklayer.
5. Education: vocational secondary.
6. Place of residence: Omsk, st. Marx, 23/2.
7. Date and time of arrival at the hospital: 2014-15-04 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. Patient Work Information
Total experience - 40 years, work in the speci alty - 27.
Description of working conditions. The duration of the working day is 8 hours, the break is 60 minutes. The patient can go on vacation in time. The main speci alty is a bricklayer.
III. The patient's story about his condition
Upon arrival at the hospital, the patient reported that he had a fever, felt unwell, had phlegm and cough, and began to choke during physical activity. This case history of COPD is not surprising, it is quite typical.
IV. Information about the life of the patient
Patient claims to have no STDs or diabetesdiabetes, hereditary pathologies, or mental illnesses. He also reports that he has no tumors and neoplasms. According to the patient, his relatives also do not have any of the diseases from this list. The patient reports that in childhood he had an infection (namely measles), in addition, he had a cold, as well as pneumonia in 2008. Dangerous addictions: smokes, from time to time takes alcohol (on significant dates). Born in 1958. Was the second child in the family. He matured and developed in good living and social conditions. He studied at school, graduated from a technical school with a degree in masonry. Started working in 1985.
V. Patient examination
Weight - 95 kg, height - 188 cm. The general condition of the patient is normal, the position is active, and the mind is not clouded by anything.
Light pink skin, warm. Turgor and elasticity are normal. The subcutaneous fat layer can be called moderate, it is distributed proportionally. The mucous membranes available for inspection do not have any disturbances. Peripheral lymph nodes: mobile, enlarged, not soldered to the tissues located around them are palpated. During the examination, the patient did not experience discomfort.
No defects were found in the structure of the skeleton. The joints have a normal shape, movements in them are not limited, there is no pain. The degree of muscle development, their tone, as well as strength are satisfactory.
As for the thyroid gland, it is of normal size, not soldered to the tissues located around it, mobile, smooth, when examining unpleasant sensationsappears. Examination is necessary to make a diagnosis, a COPD history alone would not be enough.
Respiratory Organs
The chest is symmetrical, of normal shape, both sides actively and proportionally participate in the breathing process. The pits above and below the collarbones were examined. They are clearly visible and symmetrical. The gaps between the ribs are well defined, they are elastic, and the patient does not feel any discomfort when touched.
Digestive organs
Belly of normal shape. During superficial probing soft. No pain. During deep probing, no violations were found. The liver has a normal size, it does not exceed the border of the costal arch. When probing pain does not occur. When viewed according to Kurlov, the edges are not enlarged. The gallbladder and spleen cannot be felt. 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 the 3rd-4th floor), that he has a colorless mucous sputum and cough, discomfort in the chest, information from the anamnesis (the patient passed examination in the occupational pathology department, it was found that he had chronic bronchitis) and examination of the body (with a comparative palpation over the upper parts of the lungs, a box sound is heard; during auscultation, hard breathing is determined over all organs;there are dry single rales) it can be argued that Ivanov has an exacerbation of chronic bronchitis. Thus, the doctors' guesses were confirmed. If there was any prevention of lung diseases, then it did not help the patient.
VII. Survey plan
1. General urinalysis: satisfactory.
2. Blood test for biochemistry: normal.
3. Spirography: reduction of the Tiffno index.
4. General blood test: satisfactory.
5. X-ray of organs located in the chest: too clear lung pattern.
The diagnosis of "exacerbation of chronic bronchitis" was made on the following grounds:
1. Patient's story about having mucous sputum, coughing and shortness of breath during physical activity.
2. Information about the life of the patient: he smokes, he has chronic bronchitis.
3. Examination of the patient, during which dry rales were detected, as well as hard breathing.
4. Laboratory studies, during which a decrease in the Tiffno index, a decrease in peak expiratory flow, an X-ray showed a too clear pulmonary pattern.
VIII. Treatment
1. Required mode: General.
2. Diet: 15.
3. The drug "Macropen" - one tablet three times a day. 400 mg.
4. Halixol syrup - one large spoon three times a day.
5. Vitamins "Revit" - a couple of dragees twice a day.
6. Tablets "Bromhexine" - three times a day for 0.008 g.
7. Physiotherapy: quartz on the chest, as well as iontophoresis.
You must always rememberhow dangerous COPD is. The medical history of therapy fully confirms this.
