Chronic non-specific 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 system, which appear due to various causes and development mechanisms, but with similar signs of the course and similar morphofunctional dysfunctions.
What is COPD
Traditionally, chronic non-specific lung diseases include the following groups of pulmonary diseases:
- Chronic bronchitis.
- Bronchial asthma.
- Emphysema
- Bronchiectatic disease.
- Chronic pneumonia
- Pneumosclerosis
However, some authors attribute interstitial pathologies of the respiratory system to independent types of NHL. Others object, believing that the independent manifestations of nonspecific pathologies of the respiratory system are only chronic bronchitis, emphysema and bronchial asthma. Therefore, the classification of chronic non-specific lung diseases still raises some questions and even disputes among specialists.
Reasons for the 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 detected in the air: nitric oxide, sulfur dioxide and carbon dioxide, dust particles and other components. In such regions, the frequency of diagnosed chronic lung diseases (such as a medical and social problem) often goes to the federal level.
Occupational chronic lung pathologies most often occur in people exposed to constant exposure to drafts, gas contamination and dust. In addition, according to numerous studies, smokers are most at risk of developing non-specific diseases of the respiratory system.
Other factors leading to chronic nonspecific lung diseases include: frequent and prolonged acute respiratory viral infections, repeated bronchitis and pneumonia. Protracted 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, proceeding in a chronic form, increases in people who have reached the age of 40. Moreover, similar 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%.
- Bronchial asthma - about 36%.
- Bronchiectasis - about 3.5%.
- The remaining lung diseases are less than 1.5%.
The pathanatomy of chronic nonspecific lung diseases can be based on one of three scenarios of the development of the disease: bronchitogenic, pneumoniogenic, and pneumonitogenic causes.
The pathogenesis of bronchitiogenic development is due to the occurrence of violations of bronchial obstruction and drainage ability of the bronchi. Usually, pathologies related to the classification of obstructive pulmonary diseases develop in such a way: chronic bronchitis, asthma, emphysema and BEB (bronchiectatic disease).
Pneumoniogenic and pneumonitogenic mechanisms are associated with the formation of chronic forms of pneumonia and lung abscess, which, in turn, are complications of bronchial or croupous pneumonia.
The outcome of these mechanisms are most often pathologies such as pneumosclerosis (pneumofibrosis, pneumocirrhosis), cardiopulmonary failure and other undesirable consequences. In recent years, COPD is increasingly seen as the main cause of the development of tuberculosis and lung cancer.
Major non-specific pulmonary diseases
Classification of chronic nonspecific lung diseases includes pathologies that are a consequence of prolonged acute diseases that develop against a background of viral infection or bacterial origin. They can occur against the background of prolonged exposure to negative chemical and physical factors.
Chronical bronchitis
By prevalence, bronchitis is local or diffuse, by the type of inflammatory process - catarrhal or mucopurulent. It can be obstructive and non-obstructive, in nature - atrophic, polypous, deforming.
The clinical manifestations of chronic non-specific lung disease of this type are expressed in annual, periodically recurring, long-lasting 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 sputum. During exacerbations, the cough usually becomes more severe, sputum becomes purulent, sweating and fever are added. The outcome of this pathology may be the development of chronic pneumonia, lung atelectasis, emphysema, pneumofibrosis.
Bronchial asthma
There are several types of bronchial asthma: it can be non-atopic, atopic, mixed, aspirin-induced or occupational disease. This pathology is the second most common diagnosis of all non-specific 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 spasms of the airways.
With any genesis, the clinical manifestations of bronchial asthma are attacks of expiratory dyspnea. The development of such phenomena occurs in three stages:
- Harbingers. They signal the onset of an asthma attack in the form of coughing, mucous discharge from the nose, the appearance of edema and redness of the conjunctiva of the eyes.
- Suffocation. It is characterized by the appearance of wheezing, shortness of breath with prolonged expiration, diffuse cyanosis, and unproductive cough. During 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.
- Stage of the reverse development of the attack. It is characterized by sputum discharge, a decrease in the number of wheezing and more free breathing. Gradually shortness of breath disappears completely.
Between the manifestations of asthma attacks, the condition of the patients remains quite satisfactory provided that the clinical recommendations are observed: chronic non-specific lung disease with a protracted course leads to the development of obstructive emphysema, pulmonary heart, pulmonary heart failure.
Manifestations of chronic obstructive pulmonary emphysema
The morphological basis of this disease is manifested in a persistent expansion of the lumen of bronchioles and alveoli due to a 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 the rapid reduction in gas exchange area and a decrease in lung ventilation. Symptoms of this pathological process are manifested 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, blueness 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 hemorrhages, pneumothorax. Respiratory failure can be fatal for the patient.
Bronchiectasis
The pathological anatomy of chronic non-specific lung diseases includes changes in the structure of the respiratory tract. Bronchiectatic disease is characterized by saccular, cylindrical or spindle-shaped extensions of the bronchi. Similar phenomena are called bronchiectasis. They can be local or diffuse, congenital or acquired.
The appearance of congenital chronic non-specific lung diseases in children is usually due to impaired development 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 an acquired form of bronchiectasis occur against the background of recurrent bronchopneumonia, chronic bronchitis, or the prolonged presence of a foreign body in the bronchi. Bronchiectatic disease, like many other lung diseases and their symptoms in adults, manifests itself in the form of a cough with sputum separation. A distinctive feature in this case is the allocation of yellow-green pus with a smell, and in rare cases, hemoptysis is manifested. With exacerbations of this pathology, 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 to 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 patient's life 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.
Symptoms of chronic pneumonia: persistent cough with separation of mucopurulent sputum during remission, purulent during exacerbation, as well as persistent wheezing in the lungs. In the acute period of the disease, an increase in body temperature usually occurs, pain in the chest occurs, and respiratory failure appears. Often, the disease is complicated by pulmonary heart disease, abscesses and pulmonary gangrene.
Pneumosclerosis
Chronic nonspecific lung diseases with diffuse pneumosclerosis occurring with the gradual replacement of parenchyma tissues with connective tissue include a pathology called pneumosclerosis. This phenomenon occurs due to inflammatory and dystrophic conditions in the lungs and leads to drying out, airlessness and compaction of the lungs. Often this pathology is a consequence of chronic bronchitis, BEB (bronchiectasis), COPD, chronic pneumonia, fibrosing alveolitis, tuberculosis and many other inflammatory processes.
The main symptom of pneumosclerosis is shortness of breath, which appears even with little physical effort. Soon she begins to bother constantly, even at rest. Another symptom of this pathology is cough. Depending on the degree of lung damage, pneumosclerosis can manifest itself in the form of mild coughing or nasal coughing. Sometimes the clinical picture is supplemented by cyanosis of the skin and pain in the chest. As the connective tissue in the lungs increases, symptoms become more noticeable.
COPD in pediatrics
Children who were born earlier than the due date are at increased risk of chronic lung diseases in newborns, because the organs of the bronchopulmonary system are formed at the last stages of intrauterine development. Therefore, in premature infants, the probability of partially underdeveloped lungs remains. Sufficiently frequent diseases of the bronchopulmonary system in infants are bronchopulmonary dysplasia (BPD) and congenital malformations of the lungs, but often they are also diagnosed with other inflammatory pathologies.
Pneumonia is a common phenomenon in young children, which is most often the result of colds, sore throats, or can be easily transmitted by airborne droplets. Most children who have suffered an acute illness 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 the bronchopulmonary lymph nodes and destruction of the lung tissue.
With all such dysfunctions and lung diseases, their symptoms indicate the presence of deformations and extensions in the structure of the bronchi, as well as signs of chronic bronchitis. This is due to the early development of chronic pneumonia, while mucus accumulates in the altered small branches of the bronchi.
Predisposing factors for the development of a chronic form of the disease most often become:
- disturbances in the formation and malformations of the bronchopulmonary and vascular systems of the lungs;
- congenital and acquired mucociliary apparatus dysfunctions;
- chronic pathology of ENT organs;
- immunodeficiency disorders;
- adverse ecopathogenic environmental effects;
- second hand smoke;
- unfavorable premorbid background: artificial feeding, diathesis, congenital pathologies of immunogenesis, etc.
In microbiological studies of sputum and swabs from the bronchi, pneumococcal and staphylococcal infections are often detected. In most children, during the 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 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 patient's age, the symptoms of bronchiectasis begin to prevail in the clinical picture of the disease. Often, an adult patient does not even realize the relationship of his bronchiectasis with an adversely acute acute form of pneumonia suffered in childhood.
Diagnosis and treatment of pediatric chronic lung infections
Chronic pneumonia in children can only be diagnosed in a hospital with the help of comprehensive clinical and radiological studies using bronchoscopy, bronchography and laboratory tests. On radiological images of the lung in chronic pneumonia, there is an enhanced pulmonary pattern that has a pronounced deformation with a reduction in the volume of individual segments and a 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 studies of sputum and laboratory indicators of inflammation activity (quantitative ratio of ESR in the blood, leukocyte shift, positive CRP).
In the treatment of the chronic form of pneumonia in children, the same methods are used as in the treatment of acute. The main tasks of the treatment are to restore the drainage function of the bronchi and normalize the immunological reactivity of the body. After effective treatment, the sanatorium recovery phase and regular medical examination in the clinic are recommended. With the ineffectiveness of conservative treatment, the use of surgical procedures is possible.
With the correct organization of clinical 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 at an older age.
Prevention of chronic pneumonia in children
Preventive measures to prevent the development of lung diseases in newborns are, first of all:
- Antenatal protection of the fetus.
- Ensuring breastfeeding.
- Preservation of the baby from acute respiratory infections.
- Active treatment of protracted and complicated forms of respiratory diseases.
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Based on the results of a 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.
Treatment of COPD in adults
Therapy of non-specific 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 determine some generally accepted methods of treatment of independent manifestations of COPD.
In order to stop the infectious and inflammatory pathologies in the bronchopulmonary system, antibacterial agents are selected depending on the sensitivity of the microflora. Be sure to appoint bronchodilator, expectorant and secretolytic drugs.
For the rehabilitation of the bronchi bronchoalveolar lavage is used. At this stage, physiotherapy, postural drainage and vibration massage of the chest are usually prescribed. When respiratory failure occurs, the use of bronchodilators and oxygen therapy is recommended.
At the stage of remissions, it is recommended that a pulmonologist undergo monitoring , sanatorium-resort treatment, physical therapy exercises, the use of speleotherapy and aerophytotherapy techniques, as well as the use of plant 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 associated pathologies, it is necessary to select the basic therapy.
The question of surgical intervention in chronic kidney disease is posed only in cases of clinical manifestations of persistent local morphological changes in the patient's respiratory system. In this case, they usually resort to resection of the affected areas. With the development of bilateral diffuse pneumosclerosis, lung transplantation may be recommended.