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Chronic obstructive pulmonary disease (HOBL, chronic bronchitis and emphysema of lungs) — slowly progressing chronic illness which is characterized irreversible or partially reversible (at treatment) obstruction of a bronchial tree.
The chronic obstructive pulmonary disease includes chronic bronchitis and emphysema of lungs — two pathological processes which usually meet at chronic bronchitis in a combination, but are expressed at each patient in different degree.
Chronic bronchitis - a state at which at the patient for three months and more within the last two years the productive cough which is not caused by other diseases is observed. Chronic bronchitis can proceed without obstruction, but the chronic obstructive pulmonary disease is always connected with existence of clinically significant obstruction of respiratory tracts. Chronic bronchitis is one of the most widespread diseases and represents one of the leading reasons of an invalidism and premature mortality of the population in industrialized countries.
Emphysema of lungs pathogenetic is closely connected with chronic bronchitis: the inflammatory process in respiratory bronchioles which is followed by obstruction leads to destruction of elastic fabric in adjacent central sites of an acinus (tsentriatsinarny emphysema).
Risk factors of a chronic obstructive pulmonary disease
The main factor of risk of a chronic obstructive pulmonary disease in 80-90% of cases — smoking (including passive smoking). Smokers have tobacco — in comparison with non-smoking, irreversible obstructive disturbances develop quicker. The smoking combination to bronchial hyperreactivity and a giperimmunoglobulinemiya E accelerates forming of a chronic obstructive pulmonary disease.
Other risk factors of a chronic obstructive pulmonary disease are pollution of the air basin production wastes, products of combustion of different types of fuel, exhaust gases.
Unfavorable conditions of professional activity, economic and social situation of patients (poverty), weather conditions and climate (fog and the increased humidity), infectious factors also belong to risk factors of HOBL.
Among major factors of risk of the professional nature which value is established the most harmful are dust, the containing cadmium and silicon. Risk factors of the professional nature also are organic raise dust (cotton, flour, paper, etc.), inorganic raise dust (coal, quartz, cement, etc.), long influence of toxic vapors and gases (the ammonia, chlorine, various acids, sulphurous anhydride, phosgene, vapors and gases formed at gazo-and electric welding, etc.). Adversely high temperature of air in hot workshops, drafts, low temperatures and other features of a microclimate on production influence.
The crude and frigid climate is adverse for patients with a chronic obstructive pulmonary disease. Seasonality of an exacerbation of a chronic obstructive pulmonary disease is observed — their largest frequency is the share of a cold and crude season, and the highest mortality from HOBL is noted in the winter.
Believe that in an etiology of a chronic obstructive pulmonary disease the infection, the genesis more often mixed can matter: virus (adenoviruses, respiratory viruses), virus and mycoplasmal, virus and bacterial. However the listed activators play more part as HOBL aggravation factor. The bacterial flora is the frequent reason of an exacerbation of a chronic obstructive pulmonary disease (a pneumococcus, a hemophilic stick, etc.). There is a point of view that at an aggravation a chronic obstructive pulmonary disease only rhinoviruses are found much more often than other activators.
Approximately at 25% of patients with chronic bronchitis — chronic bronchitis is more often at non-smoking women and men, and then and the chronic obstructive pulmonary disease forms as an outcome of not cured acute long bronchitis and recurrent bronchitis. At these patients the viral and virus and bacterial infection, especially influenza viruses, PC and adenoviruses which create hyperreactivity of bronchial tubes, a bronkhospastichesky syndrome that promotes synchronization of an inflammation in bronchial tubes acts as an initial etiological factor.
An essential role in developing of a chronic obstructive pulmonary disease is played by genetic predisposition. Points the fact that only at part it is long smokers to it the chronic obstructive pulmonary disease develops.
Now communication of genetic insufficiency and - antitrypsin and development of HOBL is well studied.
Risk factors of a chronic obstructive pulmonary disease
Clinical picture of a chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease — the illness of an after-life more often arising after 40 flyings. The first signs with which the patient usually sees a doctor is the cough and short wind which sometimes are followed by goose breathing with expectoration. The phlegm is allocated first in a small amount (seldom more than 60 ml/days). These symptoms are more expressed in the mornings.
The earliest symptom appearing by 40-50 years of life is cough. By the same time during cold seasons the episodes of a respiratory infection which are not connected in the beginning in one disease begin to arise. The asthma felt at an exercise stress arises on average 10 flyings after emergence of cough. However in some cases the disease debut from an asthma is possible.
The chronic bronchial obstruction is characterized by the following clinical signs:
1) an asthma — in the beginning at an exercise stress, in the subsequent — and at rest;
2) strengthening of an asthma at influence of dust, cold air, the irritating substances etc.;
3) hoarse unproductive cough with difficult separated phlegm;
4) lengthening of an expiratory phase at quiet and especially at forced ventilation;
5) dry rattles of a high timbre on an exhalation;
6) symptoms of emphysema of lungs.
HOBL can be classified by severity — proceeding from a clinical picture of a disease and functional indicators.
Classification of a chronic obstructive pulmonary disease by severity
Characteristic emphysematous (And) and bronkhitichesky (B) of types of a chronic obstructive pulmonary disease