Currently, diseases of the respiratory system are increasingly common. This state of affairs, of course, alarms doctors. They recommend that people take their health more seriously.
Four degrees of COPD
International experts in the progression of COPD distinguish several stages:
- Grade 0 (not yet a disease). This is the initial stage at which there is a high risk of COPD, but concerns are not always justified. A person often coughs and expectorates sputum. The classification of COPD is just beginning. What next?
- Grade I (moderate course of the disease). It is characterized by slight obstructive changes, persistent coughing and expectoration of sputum.
- Grade II (moderate course of the disease). Obstructive changes are progressing. A person suffocates when walking, and clinical signs are also observed, intensifying during physical activity.
- Grade III (severe course of the disease). The airflow restriction increases when a person exhales. The patient suffocates even more with physical exertion, and exacerbations occur more often. At this stage, diseases of the human respiratory system can be very dangerous.
- Grade IV (very severe course of the disease). It is characterized by a complex form of bronchial obstruction, which often threatens with death. Respiratory failure appears , a pulmonary heart 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 that contribute 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 lung diseases. In particular, he knows the classification of COPD, he also knows how to treat these ailments.
Therapy of moderate illness
With noticeable signs of shortness of breath, the patient may resort to the help of inhaled bronchodilators. The doctor may prescribe the following medications: Salbutamol, Ventolin, Berotek, Terbutaline, Fenoterol. But they can not be taken by those with tachyarrhythmia, CHD, decompensated diabetes mellitus, glaucoma, myocarditis, aortic stenosis, as well as thyrotoxicosis. The patient can take medication no more than four times a day. You should not do this more often. COPD, the treatment of which is carried out until the death of the patient, requires a responsible attitude.
Proper inhalation is required. If you were prescribed such treatment for the first time, you should carry out the initial procedure together with the doctor so that he informs about possible incorrect actions. The medication must be inhaled into the mouth (injected) exactly at the entrance level: so it will reach the bronchi, and not just get into the throat. At the end of the procedure, you need to hold your breath on inhalation and sit for 5-10 seconds.
What to do if you have a moderate degree of the disease?
There is no longer enough medication prescribed for a moderate degree of COPD. In addition to them, you need to take medications that expand the bronchi and last a long time. You must buy them. Broncho-pulmonary diseases are usually expensive.
In particular, the drug Serevent is prescribed. It is made in the form of a metered-dose inhaler. The optimal daily dose for adults is 50-100 mcg twice a day. Inhalation should be performed in compliance with all rules.
Doctors also prescribe Formoterol. It is produced in capsules, where the inhalation powder is located. The procedure is performed using the handihaler device. Usually, doctors prescribe 12 mcg twice a day. It should be noted that the treatment of lung diseases does not always give the desired effect. This is sad, but true.
Severe illness
At this stage, a person needs continuous anti-inflammatory therapy. Moderate and large dosages of glucocorticosteroids for inhalation are prescribed. The following medications are prescribed: Beklazon, Benacort, Flixotide, Bekotid, Pulmicort, etc. They are made in the form of metered-dose inhalation aerosols or solutions injected into the throat with a nebulizer. By the way, this is a very convenient device. If you have lung disease (COPD), you can purchase one.
In addition, at this stage of the disease, mixed medications can be prescribed, which include a long-acting medication that dilates the bronchi and a corticosteroid for inhalation. Your doctor may prescribe Symbicort or Seretide. Mixed drugs are today considered the most effective drugs for the treatment of pulmonary diseases of this stage. They really deserve attention. Chronic lung disease can stop developing when used.
Very severe COPD: what to do?
In addition to drugs prescribed for the severe stage of the disease, oxygen therapy is added (inhaling air containing a lot of oxygen, carried out regularly). For this procedure, in stores where medical products are sold, or in large pharmacies, you can buy both fairly large devices for independent use, as well as small spray cans. The latter can be taken with you to the street and used when there is a lack of air. Asthma is COPD, and it threatens life, so you should always carry a spray can with you.
If the person is not yet very old and is in a satisfactory form, surgery can be performed. In a critical condition of the patient, mechanical ventilation may be needed.
How to prevent the development of COPD?
Prevention of respiratory system diseases is very important. The first and most serious action aimed at preventing lung diseases is the exclusion of 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 associated with any production, where a lot of aerosol of metals or industrial dust is always collected, be sure to resort to protective equipment. But the most effective measure to prevent the disease is the dismissal from harmful work. For chronic ailments of the respiratory system, you should occasionally go to the doctor and be examined.
An example of a history of ailment
For those who are interested in COPD, the medical history of therapy may also seem curious. Let's look at an example.
I. Information from the passport
1. Name of patient: Sergeyev Vladimir Kuzmich.
2. Patient gender: male.
3. Age: 53 years.
4. Place of residence: Omsk, st. Red Way, 18/7.
5. Specialty: unemployed.
6. The number and time of arrival at the hospital: 02.19.2014 at 14:55.
7. Date of leaving the hospital or transfer to another clinic: -.
8. Who sent the patient: brought by ambulance staff.
9. The diagnosis made by the institution that delivered the patient: right-sided outpatient lower lobar pneumonia.
10. Admission ailment: respiratory failure of the first stage. Right-sided outpatient lower lobar pneumonia.
II. The main complaints of the patient
The patient reports that his body temperature reaches 39.5 Ā° C. He also coughs and complains of serous sputum, which can be difficult to expectorate. This may be a sign of a respiratory illness.
III. Minor patient complaints
The patient is concerned about a breakdown, malaise, trembling body, inability to properly perform their work, sweating, migraine.
Respiratory System Interview
Shortness of breath: appears with physical activity, is combined in nature.
Cough: does not stop throughout the day, mucous sputum is secreted in moderation. It can be difficult to expectorate.
Sputum: present, mucous, expectorant, Ā¼ cup per day, it does not depend on the position of the patient, its smell is not noticeable (this is how many diseases of the respiratory system manifest).
IV. Medical history
The illness began unexpectedly on February 13, 2014 after a long stay in the cold, when the patientās temperature rose to 39.5 Ā° C and a dry cough appeared. The patient did not drink any medicine. After two days, the cough was already moist, and sputum was heavily expectorated. The temperature remained unchanged for four days. On February 19, 2014, the patient called the ambulance team and was taken to the Omsk city central clinical hospital. He was diagnosed with right-sided out-of-hospital lower-lobar pneumonia. The patient was not registered. He reports that earlier he had no ailments of the respiratory system, except for an acute respiratory viral infection. This concludes the history of moderate COPD.
V. Patient's life
Sergeev Vladimir Kuzmich was born in 1961 in the city of Omsk. He was the first child of his parents. After birth, his weight 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 breast-fed. He entered the first class when he was 6 years old. He studied mainly for fours. After school I entered college. He learned to be a builder.
Information about the profession. The patient got a job at 22, he became a builder. Dangerous factors: work on the street, dust, physical and emotional overload. Not so long ago, he quit his job.
Housing conditions are normal. The patient owns a three-room apartment in a brick building. Before the onset of a respiratory system disease, he lived there calmly and did not expect trouble.
What is sick in childhood, does not remember. Reports that he once suffered an acute respiratory viral infection. He claims to have no tuberculosis, no STDs, no AIDS, no viral hepatitis.
VI. Body study
The general condition of the patient can be called moderate, his position is active, and his consciousness is unclouded. Facial expression is usual, manifestations of paranoia and schizophrenia are not observed. The gait is easy. The physique is satisfactory. According to the constitution is a normostenic. The dimensions of the neck, arms and legs are proportional to the length of the body. Height - 165 cm, weight - 73 kg. The patient has too much body weight, obesity may soon develop.
The system of visible mucous membranes and skin
The skin is light pink in color, the mucous membranes available for examination (eyes, lips, nose, mouth) are the same color. No painful pigmentation found. The skin is quite elastic. There is a turgor. Skin moisture is normal. No general edema was found during the study. On the body there are no rashes, no scars, no peeling, no vessels appearing through the skin.
Chest examination
The chest is a normosthenic type. The epigastric angle is straight. Shoulders pressed tightly to the chest. The course of the ribs is straight. Noticeable gaps between them. The collarbones are also well defined, the pits above and below them are slightly visible. There are no asymmetrical bulges or concavities on the surface of the chest. Scoliosis is not detected.
Superficial palpation of the abdomen
With a superficial palpation, the patient did not experience any unpleasant sensations, the abdomen was soft, and neither tensed muscles nor hernial bulges were observed. The symptom of Shchetkin-Blumberg is not confirmed. The inguinal and umbilical rings are normal.
The appearance of the abdomen when the patient is lying on his back
The abdomen seems to be large due to subcutaneous fat, its shape is normal, it is symmetrical, rises when breathing. No noticeable peristalsis was found. There is a venous network under the skin on the sides of the abdomen and near the navel. No discrepancies between the rectus muscles and hernias were found. The belly button is retracted.
VII. Presumptive diagnosis
Based on the patientās story, the history of the disease, information about life, as well as an objective study, the patient can be diagnosed with the following: pneumonia of the lower part of the right lung, which is out of hospital. The disease is moderate. There is a complication, namely respiratory failure of the first stage. In addition, many important conclusions can be drawn from the history of COPD.
Viii. Patient Examination Sequence
1. General blood test.
2. Ultrasound examination of organs located in the abdominal cavity.
3. Blood test for biochemistry (protein, urea, glucose, creatinine).
4. General urine test.
5. Blood on the Wassermann reaction.
6. Electrocardiogram.
7. X-ray of organs located in the chest.
8. Feces for the presence of worms.
9. Bacteriological examination of sputum.
Xi. The final diagnosis and its explanation
Based on the patientās story, the history of the disease, instrumental and laboratory tests, the patient can be diagnosed with pneumonia of the lower part of the right lung, which is out-of-hospital. The disease is moderate. There is respiratory failure of the first stage.
XII. Essential therapy
1. A febrile period requires strict bed rest.
2. The patient needs to drink a lot and adhere to diet No. 15 according to Pevzner.
3. Etiotropic therapy - taking antibiotics of the type "febrile period + 5-7 days."
Another example of a history of COPD
Consider another medical history, it is no less interesting. It will be useful for a novice doctor to read and analyze it.
I. Personal Information
1. Name of the patient: Ivanov Peter Ilyich.
2. Patient gender: male.
3. Year of birth: 1958 (56 years).
4. Specialty: bricklayer.
5. Education: secondary special.
6. Place of residence: Omsk, st. Marx, 23/2.
7. The number and time of arrival at the hospital: 04/15/2014 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 Information
Total experience - 40 years, work in the specialty - 27.
Description of working conditions. The working day is 8 hours, a break is 60 minutes. The patient can go on vacation in a timely manner. The main specialty is a mason.
III. The story of the patient about his condition
Upon arrival at the hospital, the patient said that he had a fever, he feels unwell, he is tormented by sputum and cough, and during physical activity he begins to suffocate. There is nothing surprising in this COPD case history; it is quite typical.
IV. Information about the life of the patient
The patient claims that he is not sick with STDs, or diabetes mellitus, or 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 a single disease from this list. The patient reports that in childhood he suffered an infection (namely measles), in addition, he had a cold, as well as pneumonia in 2008. Dangerous addictions: smokes, takes alcohol from time to time (on significant dates). Born in 1958. He was the second child in the family. He matured and developed in good living and social conditions. He studied at school, graduated from college with a degree in mason. Started to work in 1985.
V. Examination of the patient
Weight - 95 kg, height - 188 cm. The general condition of the patient is normal, the position is active, and consciousness is not clouded by anything.
The skin is light pink, warm. Turgor and elasticity are normal. The fat subcutaneous layer can be called moderate, it is distributed proportionally. The mucous membranes available for examination have no abnormalities. Lymphatic peripheral nodes: mobile, enlarged, not fused with tissues located around them are felt. 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, the movements in them are not limited, there is no pain. The degree of muscle development, their tone, and also strength are satisfactory.
As for the thyroid gland, it is of normal size, not fused with the tissues located around it, it is mobile, smooth, and when unpleasant sensations are examined, it does not appear. An examination is necessary to make a diagnosis, a history of COPD would not be enough.
Respiratory Bodies
The chest is symmetrical, normal in shape, both sides are actively and proportionately involved in the breathing process. An inspection of the pits above and below the collarbones was carried out. They are clearly visible and symmetrical. The gaps between the ribs are perfectly pronounced, they are elastic, and when the patient touches them, the patient does not have unpleasant sensations.
Digestive organs
The abdomen is normal in shape. During superficial palpation soft. No pain. During deep palpation, no violations were detected. 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. It is impossible to palpate the gall bladder and spleen. The patient goes to the toilet regularly, once a day, the bowel movement is normal.
VI. Preliminary diagnosis
Based on the patientās story that he suffocates during physical activity (climbing the stairs to the 3-4 floor), that he has colorless mucous sputum and cough, discomfort in the chest, information from the anamnesis (the patient was examined in the professional pathology department, it was found there that he has chronic bronchitis) and body tests (with a comparative palpation above the upper parts of the lungs, a boxy sound is heard; during auscultation, hard breathing is determined over all organs; there are dry individuals e wheezing) it can be argued that Ivanov has an exacerbation of chronic bronchitis. Thus, the guesses of the doctors were confirmed. If the prevention of pulmonary diseases did exist, then it did not help the patient.
VII. Survey plan
1. General urine test: satisfactory.
2. Blood test for biochemistry: normal.
3. Spirography: a decrease in the Tiffno index.
4. General blood test: satisfactory.
5. X-ray of organs located in the chest: too clear pulmonary pattern.
The diagnosis of exacerbation of chronic bronchitis was made on the following grounds:
1. The patientās story that he has mucous sputum, cough and lack of air during physical activity.
2. Information about the patientās life: he smokes, he has chronic bronchitis.
3. Examination of the patient, during which revealed dry rales, as well as hard breathing.
4. Laboratory studies that established a decrease in the Tiffno index, a decrease in peak expiratory flow, and an X-ray - too clear pulmonary pattern.
Viii. Treatment
1. Required mode: general.
2. Diet: No. 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 pair of dragees twice a day.
6. Bromhexine tablets - three times a day for 0.008 g.
7. Physiotherapy: quartz on the chest, as well as iontophoresis.
You must always remember how dangerous COPD can be. The medical history of therapy fully confirms this.