Chronic nonspecific lung disease - causes, symptoms, diagnosis and treatment
Chronic nonspecific lung diseases (COPD) - a variety in the etiological and pathologic against diseases of the respiratory system, proceeding with a constant productive cough and dyspnea due to a primary lesion of the bronchi and parenchyma. Include such nosologically independent forms as chronic bronchitis, BEB, bronchial asthma, pulmonary emphysema, pulmonary fibrosis, chronic pneumonia. COPD diagnosed according to the results spirography, X-ray and endoscopic examination. Methods of treatment of COPD may include drug therapy, bronchoscopic sanitation, physical therapy, exercise therapy; when persistent morphological changes - surgical treatment.
Chronic nonspecific lung diseases
chronic bronchitis, asthma and emphysema. Three years later, at a conference in Moscow on this list would be supplemented with bronchiectasis, chronic pneumonia and pneumosclerosis. Specific lung disease (tuberculosis), professional disease (pneumoconiosis) and bronchopulmonary cancer in this group were not included.
In modern pulmonology the classification of chronic nonspecific pulmonary diseases remain debatable. Thus, a number of authors further referred to as COPD, interstitial lung disease. Others argue that independent nosologies of COPD are only hr.bronhit, emphysema and asthma; the rest (fibrosis, hr.pnevmoniya, bronchiectasis) are syndromic and should be considered as a major complication, independent forms. The existence of chronic pneumonia and is not recognized by all researchers.
smoking (over 10 years). Premorbid conditions for the symptomatic forms of COPD are the frequent and prolonged SARS, repeated acute bronchitis and pneumonia, chronic respiratory diseases, allergic diseases, immune disorders. Indicator COPD increases with age and reaches its peak in the age group 40-60 years. Among the patients, most are men. chronic bronchitis (60%), the structure predominates in COPD, bronchial asthma (~ 35%), bronchiectasis (about 4%), accounting for less than 1% for other diseases.
The morphogenesis based on a variety of chronic non-specific lung diseases is one of three mechanisms: bronhitogenny, pnevmoniogenny and pnevmonitogenny. Bronhitogenny way of development of COPD is associated with bronchial obstruction and bronchial drainage function. By this mechanism, develop the disease with obstructive component: chronic bronchitis, BEB, asthma and emphysema. Pnevmoniogenny mechanism underlies the formation of chronic pneumonia and chronic lung abscess, which is a complication of pneumonia or lobar pneumonia. In these diseases pronounced restrictive component. Pnevmonitogenny path determines the development of interstitial lung disease.
The outcome of any of these morphogenetic mechanisms of COPD is the development of pulmonary fibrosis (fibrosis, pnevmotsirroza), pulmonary hypertension, pulmonary heart and lung failure. Chronic nonspecific lung diseases are considered as a risk factor for pulmonary tuberculosis, lung cancer.
influenza, measles, adenovirus infection or PC) or bacterial origin (caused by long-term persistence in the bronchi Hib, pneumococcus, etc.). It may develop as a result of prolonged exposure to the airways of chemical and physical factors (smoking, air dust, industrial pollution).
As the prevalence may be local or diffuse; on the type of inflammation - catarrhal or mucopurulent; by the presence /absence of bronchial obstruction - obstructive and non-obstructive; the nature of morphological changes in the bronchi - atrophic, polypous, deforming. The clinical criteria for chronic bronchitis are acute inflammation 2-3 a year for 2 years with an annual period of at least 3 months. Patients worried about a persistent cough with phlegm. During exacerbations enhanced cough, sputum becomes purulent, joins low-grade fever, sweating. Outcomes and complications of chronic bronchitis may become chronic pneumonia, pulmonary atelectasis, emphysema, pulmonary fibrosis.
Asthma
It is the second most common form of chronic nonspecific pulmonary diseases. It is characterized by hyperresponsiveness of the bronchial tree, leading to hypersecretion of bronchial mucus, edema and paroxysmal spasm of the airways. The main clinical types include non-atopic, atopic, mixed, aspirin-induced, occupational asthma.
Clinically, asthma of any origin manifested by repeated episodes expiratory dyspnea. In their development distinguish 3 periods: precursors, suffocation and reverse development. Harbingers, signaling an imminent attack of asthma may be coughing, mucus from the nose, conjunctivitis phenomenon, restlessness. During attacks of breathlessness appears wheezing, severe shortness of breath with extended, diffuse cyanosis, nonproductive cough. Patients taking forced a vertical position with a raised shoulder girdle. In a severe attack, the death of the patient can occur from respiratory failure. During the return of the attack begins when coughing sputum, wheezing amount decreases, breathing becomes free, shortness of breath disappears.
Between bouts of the condition of patients with asthma is quite satisfactory. In the long history of chronic non-specific lung disease develops obstructive emphysema, pulmonary heart, pulmonary heart disease.
Chronic obstructive pulmonary emphysema
It is a chronic non-specific lung disease, morphological basis of which serves a persistent expansion of the lumen of respiratory bronchioles and alveoli as a result of chronic obstructive airways with chronic bronchitis and bronchiolitis obliterans. Light acquire increased lightness become pererazdutymi, increased in size.
Clinical manifestations of emphysema due to a sharp reduction in gas exchange area and a violation of pulmonary ventilation. Symptoms increases gradually as the spread of pathological changes in the larger area of the lung tissue. Worried progressive shortness of breath, cough with scanty mucous expectoration, weight loss. Noteworthy is barrel-shaped chest expansion, blueness of the skin, thickening of the nail phalanxes of fingers according to the type of drum sticks. In emphysema frequent infectious complications, pulmonary hemorrhage, pneumothorax. The cause of death becomes severe respiratory distress.
Bronchiectasis
Morphological substrate of this form of chronic nonspecific lung diseases are saccular, fusiform or cylindrical bronchiectasis. Bronchiectasis may be localized or diffuse, congenital or acquired origin. Congenital bronchiectasis caused by disorders of the bronchial tree in the prenatal and postnatal periods (as a result of intrauterine infection with the syndrome, Kartagener Sievert, cystic fibrosis and others.). Acquired bronchiectasis can be formed on the background of recurrent bronchopneumonia, hr.bronhita, long-term presence of foreign bodies in the bronchi.
The main respiratory symptoms include a persistent cough, highlighting the yellow-green phlegm with the smell, sometimes hemoptysis. Exacerbations occur according to the type of exacerbations of chronic purulent bronchitis. Extra-pulmonary syndrome with bronchiectasis presented finger deformity in the form of drum sticks and nails in the form of time windows, "warm" cyanosis. Complications of chronic non-specific lung disease may be pulmonary haemorrhage, lung abscess, cardio-pulmonary failure, amyloidosis, purulent meningitis, septicemia. Each of these states is a potential danger to the life of patients with COPD.
Chronic pneumonia
Pathological changes in chronic pneumonia combine an inflammatory component, carnification, hr.bronhit, bronchiectasis, chronic abscesses, fibrosis, so now this chronic non-specific lung disease as an independent nosology is not recognized by all the authors. Each exacerbation hr.pnevmonii leads to the appearance of new foci of inflammation in the lung tissue and increase the area of sclerotic changes.
By constant symptoms that accompany the course of chronic pneumonia should include cough with sputum (mucous-purulent in remission and exacerbation of purulent) and persistent wheezing in the lungs. In the acute period of increased body temperature, there is pain in the chest in the projection infiltrate, respiratory failure. The disease may be complicated by pulmonary heart failure, abscess, pleural empyema, gangrene of the lungs, and others.
Pulmonary fibrosis
Chronic nonspecific lung disease, occurring with the functioning parenchyma replacement by connective tissue is called fibrosis. It is the result of inflammatory and degenerative processes, leads to wrinkling, airless and densification of the lung tissue. Often it develops in the outcome hr.bronhita, BEB, hr.pnevmonii, COPD, pnevmokonikozov, pleurisy, fibrosing alveolitis, tuberculosis and many others. al. As the prevalence of changes distinguish local (focal) and diffuse pulmonary fibrosis. According to the severity of proliferation of connective tissue are three stages of the pathological process - pulmonary fibrosis, pulmonary fibrosis, pnevmotsirroz.
It is shown as a significant cause of disease symptoms and signs of respiratory distress (shortness of breath, cough, bluish tint of the skin, "Hippocratic fingers"). At the stage of cirrhosis lung pronounced deformity of the chest, there is atrophy of the pectoral muscles. The patient relaxed, quickly get tired, it loses weight. The course of the underlying disease leads to progressive fibrosis and pulmonary fibrosis aggravates the underlying pathology.
pulmonologist taking into account features of the clinical course of disease and the results of instrumental and laboratory diagnostics. In order to confirm the nature of morphological changes performed plain radiography of light, which, if necessary, supplemented by linear tomography or CT scan of the chest.
In order to identify structural changes in the bronchial tree is performed bronchoscopy (if necessary with a fence sputum or biopsy), bronchography. With the analysis of phlegm and flush with the bronchus (microscopic and microbiological), you can specify the activity of the inflammatory process in the bronchi and the reason for its occurrence. Rate the functional reserves of the lung in chronic non-specific diseases of the ERF study helps. Identify signs of hypertrophy of the right ventricle of the heart is possible by electrocardiography and echocardiography.
bronchoalveolar lavage. In this period are widely used postural drainage, vibration massage, microwave and ultraviolet irradiation to the chest. During bouts of breathing difficulties are recommended bronchodilators, oxygen therapy.
Outside exacerbation shown dispensary observation pulmonologist, treatment in a sanatorium, physical therapy, speleotherapy, aerophytotherapy, taking herbal adaptogens and immunomodulators. With the purpose of anti-inflammatory and desensitizing can be assigned glyukokortikosterodidy. For adequate control over asthma selected basic therapy.
The question of surgical tactics for chronic non-specific lung diseases is put in the case of persistent local morphological changes in the lungs or bronchial tubes. More often resorted to the resection of the affected portion of the lung or pneumonectomy. At bilateral diffuse pnevmoskleroze can be displayed lung transplantation.