Post on 04-Feb-2016
description
transcript
Andriy Lepyavko, MD, PhDDepartment of Internal Medicine № 2
WHO Report on the Global Tobacco Epidemic
According GOLD COPD – this is disease which is
characterized by combination of clinical signs of chronic obstructive bronchitis (inflammation and narrowing of bronchi) and emphysema (changes of lung tissue structure).
Permanent hyperactivity of parasympathetic Permanent hyperactivity of parasympathetic nervous system nervous system with hyperproduction of with hyperproduction of acetylcholine, bronchial spasm and hypersecretion acetylcholine, bronchial spasm and hypersecretion of mucusof mucus
Insufficiency of adrenal receptors in bronchial Insufficiency of adrenal receptors in bronchial wallswalls as the result of deep morphological changes as the result of deep morphological changes with bronchial hypersecretion, bronchial spasm and with bronchial hypersecretion, bronchial spasm and coughcough
Bronchial hyperreactivity Bronchial hyperreactivity which is characterized which is characterized by immune inflammation of bronchioles walls by immune inflammation of bronchioles walls
All that lead to:All that lead to: 1) 1) narrowing of bronchiolesnarrowing of bronchioles; ; 2) 2) development of emphysemadevelopment of emphysema
Severe smoking Occupational diseases Family anamnesis Chronic cough is the earliest sign of
COPD and arise earlier then dyspnea Sputum – as a rool in small amount, after
cough Dyspnea – persistent, progressive,
becomes worse during physical activity and in severe cases – even if patient is calm
Central cyanosis, emphysematous chest, additional breathing muscles are necessary for breathing
Increasing of breathing rate, decreasing of its deepness, prolongation of expiration
Percussion: decreasing of heart dullness Auscultation: wheezing, dry rales, heart tones are
dull
Investigation of external breathing (spyrometry);
Bronchodilatation test; Cytology of sputum; Blood analysis; X-ray; ECG; Blood gases
Investigation of external breathing FVC – max air volume which is expired during
forced expiration after max inspiration; FEV1 (<80 %) FEV1/FVC (<70 %) Peak flow (of expiration)
Is necessary to find bronchial reversibility
Spyrometry has to be provided before and 15 min after inhalation of 400 mkg of Salbutamol (or 30-45 min – 80 mkg of Ipratropium)
Increasing of FEV1 more than 15 % tells us about reversibility
Stage and severity Signs
І, mild
FEVІ ≥80% , FEVІ/FVC < 70% - As a rule chronic cough with sputum
II, moderate
50%< FEVІ < 80% - FEVІ/FVC < 70% - Symptoms are more significant, presence of dyspnea during physical activity and exacerbation
III, severe
30%< FEVІ < 50% FEVІ/FVC < 70% - Symptoms cause worsening of life quality
IV, very severe FEVІ < 30% FEVІ/FVC < 70% and CRF
Increasing of intensivity of treatment in correlation with COPD severity;
Permanent basis therapy; Individual sensitivity of patients to
different medicines leads to necessarity of permanent control;
Inhaled medicines are useful.
Short action – (Ipratropium bromid, Berodual Н) has more slowly beginning but longer action than β2-agonists
Prolonged action – (Thyotropium bromid, Spiriva ) is active for 24 hours
2-agonists of short action (Salbutamol, Fenoterol) – fast beginning of action, but duration – 4-6 hours
2-agonists of prolonged action (Salmeterol, Formoterol ) are active for 12 hours.
Methylxantines Theophyllines of prolonged action are useful –
Teopec, Teotard.
Are useful for permanent basis therapy for patients with COPD III-IV st.
Inhaled GCS are used. Prednisone may be used only during
exacerbation and is not recommended for basis therapy
Inhaled GCS (Beclomethasone, Budesonid, Fluticasone).
Seretid (GCS+Salmeterol) is used in patients with III-IV st. of COPD and oftern exacerbations in anamnesis.
Thanks for your attention!