Hobli lіkuvannya zagostren new naukovі statti. "Therapy for COPD
Chronic obstructive lung disease (COPD) is an illness characterized by persistent impairment of lung ventilation, which leads to the development of hypoxemia, lung hypertension and heart failure.
Today COPD third by the frequency, the cause of mortality is due to coronary and infections of the lower dycal pathways. Mortality in COPD may well outweigh the same in cancer years after the tribute of 2015.
The main symptoms of chronic obstructive ailment of the leg - back and cough with phlegm, which appear independently in the season of fate and can be caused by slight physical anxiety.
Cause development of chronic obstructive ailment legen
- Chicken, including passive.
- High rіven zabrudnennya povitrya near the places and on the big virobnits.
- Congenital deficiency of α₁-antitrypsin.
Diagnosis of chronic obstructive ailment legen
Formal diagnosis of COPD is based on additional spirometry with the appointment of an increase in forced viability in one second (FEV1) to forced vital capacity of the leg (FVC).
In quiet cases, if the Tiff index becomes less than 70% of the case, then it is a diagnostic criterion for designating a significant obstructive defect.
Criteria for assessing the severity of obstruction of dyhal passages for today are considered to be an indicator of FEV1 and look like an upcoming rank:
- stage I (mild): FEV1 - 80% or more than normal;
- stage II (pomirna): FEV1 - 50-79% of normal;
- stage III (mazhka): FEV1 - 30-49% of normal;
- Stage IV (argument): FEV1 - less than 30% of normal.
To clarify the diagnosis, we also use MRI and analyzes of biochemical blood tests.
Successful treatment of COPD in Belgium
- In Europe, there are two main approaches to the elimination of COPD - conservative and radical. This is the first and foremost recognition of possibilities, as it is supposed to be Belgian medicine in the medicine of the country of SND, de radical surgical methods are not victorious at the remaining stages.
- Another point of view lies in the fact that in Belgium there is (albeit paradoxically) a complex approach to treating bronchoconstriction therapy. That's why the entire available arsenal of therapeutic benefits, arranged in a singing order, is balanced out of the scheme of grace. For the European medicine, this is an extraordinary pidkhid, until today, some drugs in Europe should be put on the alert.
Conservative treatment of COPD in Belgium
The meta of conservative treatment of COPD is the expansion of the functional state of the bronchogenetic system and the improvement of the patient's life quality in a way:
- preservation of the optimal function of the leg;
- change in symptoms of illness;
- zabіgannya zagostrennyam.
The greater number of drug treatments in COPD is directly related to 4 potentially reversible causes of the decrease in the flow in the legenia.
- Bronchospasm.
- Swelling of the mucous membrane of the bronchi.
- Inflammation of wild ways.
- Increased secretion of sputum and viscosity.
For usunennya or change in the injection of tsikh causes of the patient in Belgium, an individual scheme for managing the symptoms of illness is selected.
The scheme includes a combination:
- inhaled α₂-adrenergic agonists for short and long periods;
- inhaled m-anticholinergics for short and long periods;
- daily inhaled corticosteroids;
- mucolytic preparations that may have a minimal impact on sputum consumption (carbocysteine and other);
- Kisnedotherapy.
If necessary, the regimen can be supplemented with systemic corticosteroids and antibiotics.
Also, in Belgium, due to the need, correction of α₁-antitrypsin deficiency is carried out for these patients, in some cases of development of COPD, the effects of these disorders. Correction is carried out with modern preparations. Prolastin, Zemaira and Aralast seem to have a high level of efficacy with minimal side effects. Tse vigidno vіdrіznyаєєїх від Tamoxifen and Danazol, yakі vikoristovuvalis earlier.
The headache of the efficiency of conservative treatment is the individual use of drugs in the required doses, as in the correct regimen. The very same pidkhid, for the sake of all the light of the remaining 15 years, give us the opportunity to be ill with COPD to improve the normal quality of life.
Therefore, in the clinics of Belgium, the main respect is given to teaching the patient the right way to use the best methods to achieve the best therapeutic effect.
Radical methods of treating COPD in Belgium
With the help of improving the function of breathing, improving life expectancy and reducing mortality in Belgium, it is possible to carry out three types of surgical intervention in COPD.
Bulectomy
The operation bulektomії vikoristovuєtsya at great middle cases of emphysema legenia, which change 3-4 cm in diameter or occupy in total not less than a third of one legeni. Extending these follicles to expand the squeezed legenev tissue and complete the function of the breath.
The operation is carried out using a minimally invasive technique through a thoracoscopy, so the stay at the hospital takes only 3-4 days.
Surgical change obyagu legen (LVRS)
The visible parts of the legenia (sound about 20-30%) to increase the radial thrust again in the parts that are lost, thereby changing the symptoms for the increase in the increase in the overflow and the decrease in the intra-legal pressure. The operation of the change is obligatory for the additional help of the median sternotomy around the edges of the leg. Most often, parts of the upper chasms of the skin leg are visible.
A decimal of clinical monitoring (including the large mega-centric global European Treatment Trial) demonstrated a significant improvement in reduced spirometry and tolerance to physical inclination, as well as a change in back in LVRS patients after.
transplantation legenia
Irrespective of the prospects for a complete recovery of COPD, which seems to be the best way to carry out transplantation, the spectrum of indications before such an operation is very narrow. The limiting age for which a transplant can be performed is 65 years.
In Belgium, a similar operation is carried out only if we are ill, as if we have all the other possibilities to support the life of the exhausted. Transplantation allows such patients to live for an average of 6.5 years.
The transplantation of the leg in Belgium shows that for the total transplant cost 20-30 000 € lower, lower in Germany and Switzerland, the patient also may be able to select a donor organ from the global European system.
Clinics in Belgium, in which a comprehensive treatment of COPD is carried out
- University Clinic of Saint-P'yer;
Get more information about the possibility of improving the quality of life of those who are ill with COPD during treatment in Belgium. Send us a request through the form of a return call, or close the return call.
Chronic obstructive ailment of the leg, do you want a cigarette?
Chronic obstructive ailment of the leg (COPD) - tse ailment of the leg, which becomes a threat to life, which pereskodzhaє normal diarrhea, more, lower "cough chicken".
Chronic obstructive ailment of the leg - tse ill, with the legenevy manifestations of some kind of obstruction of the affected stream, so I won’t be a werewolf. The ailment of legends is insufficiently diagnosed, which threatens life, pereskodzha normal sickness.
The main reason for the development of COPD is tyutyunovy dimum (after the reduction of tyutyun or inhalation of secondary tyutyunovy dimum). The most common terms “chronic bronchitis” and “emphysema” are no longer used; in Denmark, stench is included in the diagnosis of COPD.
The most widespread symptoms of COPD are asshole (otherwise it seems to be repeated), pathological sputum (summary mucus and mucus in the windpipe) and chronic cough. In the world of step-by-step development of a disease, physical activity can significantly become more difficult, such as climbing on a sprat of steps, or transferring it.
Riskiku factor:
COPD is ahead of the curve. The main reason for the development of COPD is tyutyunovy dimum (including inhalation of secondary tyutyunovy dimum, or passive smoking). Other risk factors include:
- zabrudnennya povitrya in the middle of the place (for example, as a result of vikoristannya hard fire for cooking їzhi and heating);
- zabrudnennya atmospheric wind;
- the presence of a saw and chemical speeches at work (viparіv, teasing speeches and dimіv);
- parts of infection of the lower dichal pathways in children.
For clarification of all conditions, you need to go back to the "Center of Pulmonology" to get to know fahivtsiv.
Diagnostics:
- taking anamnesis;
- spirometry;
- computer tomography legen;
- chest x-ray;
- cytological analysis of sputum;
- microbiological studies of sputum;
- scanned light from xenon;
- somnological investigation;
- biopsy;
- pulse oximetry;
- wild blood test.
Likuvannya:
COPD is non-violent, but it allows you to spread the disease. Various forms of grace can relieve symptoms and improve the quality of life of people who suffer from this disease. So, for example, the faces that spread the expansion of the main distal paths in the legs can lighten the butt.
The doctor-pulmonologist can choose an individual treatment program, depending on the results of laboratory tests, diagnosis and severity of the disease. The drug may include antibiotics, antiseptic, immunomodulatory, antiviral drugs, vitamin therapy, physiotherapy, diet, infusion or drainage therapy.
Before the house:
According to estimates, in 2004 64 million people in the whole world suffered from COPD.
In 2005, over three million people died of COPD, which accounted for 5% of the total deaths in the world.
Mayzhe 90% of deaths due to COPD occur in countries with low and average incomes.
In this time of the disease, people and women are attacked evenly, often at the link with the increasing situation of the middle women in the lands with a high equal income.
According to the forecasts, although there will be no attempts to change the risk, especially to reduce the infusion of tyutyun dima, the total mortality in COPD in the nearest 10 years of age was higher by 30%.
For quote: Zarembo I.A. Vedennya ailing for chronic obstructive ailment legen // RMZ. 2004. No. 24. S. 1362
H And today, chronic obstructive ailments of the legenies (COPD) are brought to the widest ailments of the people, which are confused with us in front of the wanderings of the superfluous middle, the high breadth of the tyutyunopalinny and the repeated respiratory infections. COPD is one of the most important causes of sickness and mortality in the whole world, which leads to significant economic and social harm, moreover, rіvіn її zrostaє. At the agreed Global Burden Of Disease (“Global Skoda in Ailments”), conducted for the support of the Holy Organization for the Protection of Health and the Holy Bank, the indicators of the prevalence of COPD in 1990 were 9.34/1000 for people and 7.33/1000 for women in all age groups. Statements of authority, greater for everything, є more high extension of chickens among people and more frequency of influx of unfriendly professional and virobnicheskih shkidnosti on them. In this hour, according to official statistics, the number of ailments with COPD in Russia is close to 1 million people, and according to the results of the study of epidemiological markers of ailments, hypothetically, it can be close to 11 million. A lot of evidence is rightly admitted that the actual statistical data do not reflect the true breadth of pathology, as if it is really rich. It is explained that it is significant that the number of depressions is not diagnosed at the early stages, ailments, as a rule, seek help in the late stage of the development of ailments, if the illness is already severe or the middle stage of severity. Illnesses with a slight overbіgom COPD, some may have an obvious cough of curts, but the back of the day is not significant, self-feeling like a good one, they don’t spend the morning of doctors in the field, the oskilki pomilkovo vvazhayut themselves healthy. The Crimea is everywhere guarded by the increase in the spread of COPD, but the other figures represent an indication of mortality due to illness. Zaraz COPD is in the fourth month of the structure of causes of death in the world However, the next decade is predicted to increase both in breadth and in COPD mortality. As predictive data until 2020, COPD will take the fifth place after the composite indicator DALY (Disability–Adjusted Life Years) in the middle of the world after IXC, depression, travel and cerebrovascular disease. Entrepreneurship Temia Wailing, Masswords, I mean Econichnu, Socyalna Skoda Vіd Hozle, Knowledge of the Diagnostic Criterіїv Ta Diazvyvnya to Lіkuvannya Zakhvoruvannya є Requaluctance of the successful control over the pussy, the Maximum Minor Division of Obligatniki Accepted, Shah, promiscuity. Diagnosis of COPD Diagnosis of COPD mentally includes a few steps: І stage includes a report analysis of obvious symptoms of illness. The key symptoms of COPD are chronic cough, chronic sputum production and back. The stage and severity of the buttocks are presented in Table 1. II stage polagaє in otsіntsі influx of risk factors in the anamnesis. Risk factors from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2003) are divided into internal and external (Table 2). III stage Diagnosis of COPD is based on an assessment of the objective status. The results of ob'ektivnoe exacerbation of ailments in COPD lie in the degree of severity of bronchial obstruction and emphysemia, the manifestation of such conditions, such as dychal insufficiency (DN) and chronic lung disease of the heart. IV stage diagnostics of COPD include the follow-up function of the ovarian breath (FDD) indicative of the presence of bronchial obstruction. The key provisions of GOLD (2003) "Assessment and monitoring of illness" are designated: "Spirometry is the "gold standard" for diagnosing and assessing COPD, it is the most effective, standardized and objective way to reduce the amount of blood flow. Introduction FEV1/FVC<70% и постбронходилатационное значение ОФВ1<80% от должного подтверждают наличие ограничения скорости воздушного потока, которое обратимо не полностью». V stage use of conducted laboratory and instrumental methods of diagnostics, which allow to reveal complications, which have come, specify the phase of COPD, the nature of the ignition process, the stages of hypoxemia and in. Table 4 shows the classification of COPD by stages and degree of severity. Table 3 of the report shows a clinical picture of severe COPD. The main stages of the diagnostic process in COPD are represented by a baby 1. Treatment COPDEffective wedding plan in COPD patients, following the recommendation of GOLD (2003), including the following components: - reduction in risk factors; - lighting programs; - Treatment of COPD with a stable state; - Likuvannya zagostrennya ill. Reducing the cost of risk factors it is guilty of obov'yazkovo to include zusilla shchodo pripinennya kurinnya, among them there are only two methods that are significantly more effective: nicotinic therapy and interviews with doctors and medical staff. Krіm zusil tsomu directly, first and second prophylactic visits are carried out, directed at the prevention of COPD and early manifestations in risk groups. Lighting programs for those who are ill with COPD, they play a role in helping newcomers, coping with living conditions and living with ailments. Induction may be carried out in all aspects of the treatment of illness and are carried out in various forms: consultations with a doctor or other medical practitioner, home programs or employment at home, full program of legenevy rehabilitation. When ill with COPD, a frail and old age is dotally trained to take relatives or people who live together with the patient. Meals, as may be discussed at the hour of the lighting programs: – go to therapy and specific nutritional treatment; - the beginners of self-knowledge that accepted the solution for the hour of zagostre. Treatment of COPD with a stable state Vіdpovіdno to GOLD revision 2003 rock the main provisions of tactics for the management of patients with COPD in a stable state , offensive: n A steep approach to the recovery of COPD of a stable overshoot may be but the principle of strengthening the therapy is fallow due to the severity of the disease; n For those who are ill with COPD, training can play a role in improving skills, coping with illness and becoming healthy. It is effective in reaching goals, including the wild type of chicken tyutyun (river A). n It has been shown that the alternatives for COPD in a long-term perspective do not allow to outperform the reduced function of the leg, which is the case with ailment (riven A). Thus, pharmacotherapy in COPD is aimed at reducing the symptoms of the disease and / or worsening. n Bronchodilators are the main drugs for symptomatic relief of COPD (Rule A). The stench is stopped for the need or on a regular basis to prevent this / or change of symptoms. n The main bronchodilators are stagnation? 2-agonists, anticholinergics, theophylline and their combinations (river A). n Are you planning a jubilee? 2-agonists more effectively and easily, less congestion of short-lived? 2-agonist, prote cost more expensive (riven A). n Addition to bronchodilator therapy with planned treatment with inhaled glucocorticosteroids (GCS) may be delayed for patients with COPD due to significant clinical symptoms in FEV1<50% от должного (стадии III и IV – тяжелая и крайне тяжелая ХОБЛ) и при повторяющихся обострениях (уровень А). n Следует избегать постоянного лечения системными ГКС в связи с неблагоприятным отношением польза/риск (уровень А). n У всех больных ХОБЛ эффективными являются программы физической тренировки; это касается как увеличения толерантности к физической нагрузке, так и уменьшения одышки и слабости (уровень А). n Показано, что длительное назначение кислорода (более 15 ч в день) у больных с хронической ДН увеличивает выживаемость (уровень А). Эксперты GOLD (2003) разработали схему терапии на различных стадиях ХОБЛ, приведенную в таблице 5. Bronchodilator therapy є the basis of symptomatic treatment of COPD and can be recognized both as needed (for a change in the severity of symptoms in a stable state in case of an illness), and regularly - for preventive purposes, and for a change in the severity of symptoms (rіven A). The main pharmacodynamic effect of the preparations of this group in vozhat їkhnu zdatnіst reduce the tone of smooth m'yazyv in the bronchial wall and, also, increase the lumen of the bronchi, increasing the increase in the airflow. In COPD, the effect of bronchodilators is significantly less, lower in CAH, but the reversibility of bronchial obstruction in COPD is insignificant (<10%) . По–видимому, основными факторами, вследствие которых у больных ХОБЛ снижается степень ответа на применение бронхорасширяющих средств, является эмфизема легких (неотъемлемая составляющая ХОБЛ), ремоделирование бронхиальной стенки и снижение чувствительности рецепторов к симпатомиметикам. Принимая положение GOLD с уровнем доказательности В о том, что регулярный прием бронхолитиков не предотвращает прогрессирование заболевания и не влияет на прогноз, следует учитывать, что 15–20% больных демонстрируют более значительное увеличение бронхиальной проходимости после ингаляции бронхолитиков,а у 40% больных применение бронхорасширяющих средств позволяет уменьшить выраженность одышки и других симптомов ХОБЛ, а также увеличивает толерантность к физической нагрузке . Следовательно, даже умеренное увеличение бронхиальной проходимости (менее 10–12%) под влиянием базисной бронхолитической лекарственной терапии способствует выраженному улучшению клинического течения болезни, проявляющемуся уменьшением одышки, кашля и повышением переносимости физических нагрузок. В качестве бронхорасширяющих средств у больных ХОБЛ в настоящее время применяются следующие группы препаратов: антихолинергические препараты (ипратропиум бромид, тиотропиум бромид); ? 2–агонисты (фенотерол, сальбутамол, тербуталин, формотерол, сальметерол); метилксантины (теофиллин, аминофиллин). Ингаляционное назначение антихолинергических препаратов (или М–холинолитиков) целесообразно при всех степенях тяжести ХОБЛ . Учитывая, что парасимпатический тонус является ведущим обратимым компонентом бронхиальной обструкции при ХОБЛ, M-cholinolytics as the first choice in treating COPD . Inhaled M-cholinolytics, which zastosovutsya in the present hour, can be seen until a quarter of the ammonium later. Of these, the most widespread is ipratropium bromide (IB), which is well tolerated, effective and safe with trivial congestion, does not cause the development of tachyphylaxis and cardiotoxic effects. The additional dose of IB with a vicarious aerosol metered-dose inhaler (DAI) is 0.16 mg (8 inhalations) and is not due to increase 12 inhalations. M-Holіnolіtiki in DI MO-HOUSE WAS OILED FOR THE DETERMINE SPECEER, CLEANING ON THE TRAINING STOP OF THE HOLOR DOCUMENTALLY PLAYSHSUE OPERATURE OF THE INGALYATISIY DRAVE, NOT WIMAGAє KOORDINATURES WITH YOUR NOTES ON THE BALLDER, SPACEєGAє OROFARINGEAL VІDKLADEMENNA AEROZOL, PACKAYAKHEN'S CHOLOGY DEPORTNING TA MODE. A significant achievement was the development of a new anticholinergic drug, tiotropium bromide (TB). For TB, there is also a unique kinetic selectivity for targeting M1 and M3 receptors. The drug demonstrates a higher degree of sporidity to all types of muscarinic receptors, proteodissociation of the drug with M1- and M3-receptors has been significantly increased, resulting in a triple blockade of cholinergic bronchoconstriction. Now, the dissociation of TB with M2 receptors is quite clear, which allows us to talk about the so-called kinetic selectivity of the drug. Anticholinergic blocking of TB at a dose of 18 mcg/dose. Mayzhe 10 times revisit the same IB. M-anticholinergic trivalodia, TB causes the greatest bronchoconstriction effect for trivality - more than 24 years. In the course of the investigations, it was shown that bronchodilation (~ 24 years old) was registered after a one-time inhalation of TB, it was saved when it was taken for a 12-month period. For the time being, it was carried out to report a lot of randomized clinical reports on the effectiveness of TB in patients with COPD, as well as to report on the significance of the prevalence of TB in patients with COPD in cases of placebo, and IB and salmeterol in cases of TB in patients with COPD. change in the frequency of inflammation, increase in the tolerance of physical stress and in. An important factor is good tolerability of TB: more often than not, dryness in the mouth occurs, but an undesirable reaction is not of great clinical significance and, as a rule, does not lead to exacerbation. TB is released in the form of capsules with powder for inhalation in sets with a single-dose inhaler HandiHaler or without it. The skin capsule contains 22.5 mcg of tiotropium monohydrate bromide, which is equivalent to 18 mcg of TB. Vrakhovuchi, that most of the ailments in COPD are individuals of the older age, as they recognize the most difficult difficulties with the right choice of DAI, the technique of inhalation is available for all age groups. In this case, dosing powder inhalers may have significant advantages in this category of patients through the simplicity of stosuvannya without any zusil. When using HandiHalera, for evacuation instead of a capsule and a total respiratory maneuver, an insignificant volume of air inhalation is required - 20 l / min, which is to inspire patients with severe COPD and ailments of the older age. A simple and convenient dosing regimen is 1 time per dose at a dose of 18 mcg (calculate the time limit or the daily dose) and will also meet the high tolerance of patients to medical recommendations. Knowing the latest reports about TB, it is possible to grow whiskers, which in this hour of TB is seen as a promising drug with a promising future. Vrahovuyuchi scho bronhorozshiryuyuchі zasobi Je Main Klas preparatіv, SSMSC brought his efektivnіst at trivalіy terapії COPD and antiholіnergіchnі Preparations of urahuvannyam mehanіzmu bronhіalnoї obstruktsії COPD rozglyadayutsya yak zasobi Perche Vibor at tsіy patologії TB zdatny Why drug Vibor for velikoї kіlkostі patsієntіv іz serednotyazhkim, severe and very severe illness (Fig. 2). ? 2-agonist short dії recommended for zastosuvannya in the "on the fly" mode with a mild course of COPD; it is not necessary to use it as monotherapy in COPD. ? 2-agonisty of trivalo dії Independently, changes in indications of bronchial patency can improve clinical symptoms and the quality of life of ailments, change the amount of congestion (riven B). The preparations of this group preserve the broncho-expanding effect for 12 years, ale formoterol for the administration of salmeterol may, in addition, the bronchodilator dose for 1-3 minutes, which gives the possibility to zastosovuvat drug for the treatment of acute symptoms. Theophilia trials can be added to regular inhalation bronchodilator therapy with more severe illness and lack of efficacy of M-cholinolytics? 2-agonists of Trivalo di. Nine theophyllines should be placed before the preparations of other worms, tobto. are assigned after M-cholinolytics that? 2-agonist trivalo di or their combinations. The effect of theophylline preparations and the development of side effects depend on their concentration in the blood, and not on the dose of the drug to be administered. This group of drugs has a powerful "therapeutic concentration": in the form of 5 mcg/ml to 15-20 mcg/ml. At a concentration of 7-8 mcg / ml, a slight broncho-rheumatic effect is observed, and at a concentration of more than 15 mcg / ml, side effects are also possible. Moderately severe toxic reactions are observed at concentrations of 15–25 µg/ml, severe ones at concentrations over 25 µg/ml. Inhaled glucocorticosteroids (IGCS) can be added to planned bronchodilator therapy in COPD patients with significant clinical symptoms in FEV1<50% от должного (стадии III и IV – тяжелая и крайне тяжелая ХОБЛ) и при повторяющихся обострениях (уровень А) . Эффективность лечения оценивается спустя 6–12 недель применения ИГКС с помощью бронходилатационного теста (ответ на лечение считается положительным при приросте ОФВ1 на 12% и 200 мл и более к исходной величине) . При необходимости проведения противовоспалительной терапии ИГКС более целесообразным представляется использование комбинации ИГКС и? 2–агонистов длительного действия, которая более эффективна, чем применение отдельных ее компонентов . Постоянного лечения системными ГКС следует избегать в связи с неблагоприятным соотношением польза/риск (уровень А) . Treatment of COPD The main provisions of treatment of COPD zgіdno z GOLD (2003) Advances: The need for medical assistance is an important clinical approach for the ailing COPD; The most common causes of acute episodes are infection of the respiratory tract and atmospheric polytants, proteo in one third of severe episodes of acute episodes, the cause may not be established (line B); Inhaled bronchodilators (especially inhaled 2-agonists and/or anticholinergic drugs), theophylline and systemic, importantly corticosteroid tableting and effective treatment of COPD (Riven A); We are sick, if we endure congestion with clinical signs of respiratory infection (increase in the number of sputum or change in color and / or lihomania), we can show treatment with antibiotics (riven B); Non-invasive intermittent ventilation with a positive impact in case of acute inflammation improves the gaseous warehouse of pH in the blood, reduces hospital mortality, reduces the need for piece ventilation and intubation and reduces the frequency of rehab in hospitals. The principle scheme of drug therapy for acute COPD can be presented as follows (Fig. 3). In this way, knowing the current steps to the diagnosis of COPD, especially at the early stages, allow the physician to promptly decide on the planned therapy from the congestion, including current highly effective medicinal preparations. The healer can reach the head meta likuvannya - control over the disease with the method of improving the quality of life and zbіlshennya її trivality.
Literature
1. Antonov N.S., Stulova O.Yu., Zaitseva O.Yu. COPD: epidemiology, fa-
yaki riziku, prophylaxis // Chronic obstructive ailments legen
/ Ed. A.G.Chuchalina. M: BINOM; St. Petersburg: Nevsky dialect, 1998. - Z.
66 – 82.
2. Global strategy for diagnosis, treatment and prevention of chronic
skoї obstructive ailment legen / Per z English. for red. Chuchalin
A.G. - M.: Vidavnitstvo "Atmosphere", 2003. - 96s.
3. Sinopalnikov A.I. Tiotropium bromide// Clinical recommendations.
Chronic obstructive ailment legen / Ed. Chuchalina A.G. -
M.: Vidavnitstvo "Atmosphere", 2003. - S. 100 - 108.
4. Chronic obstructive disease of the leg. Practical ceramics
for doctors / For red. A.G. Chuchalin. - M.: TOV "Color It Studio",
2004. - 64s.
5. Tsoi A.M., Arkhipov V.V. Evidence-based chronic pharmacotherapy
obstructive disease legen // CONSILIUM MEDICUM. - 2002. - V. No. 4. -
No. 9. - S.486 - 492.
6. Chuchalin A.G. Kalmanova O.M. Theophilins in the treatment of bronchial as-
tmit and chronic obstructive ailment legen // CONSILIUM MEDICUM.
- 2001. - V. No. 3. - No. 3. - P.127 - 133.
7 Barnes P.J. pharmacological properties of tiotropium. chest,
2000; 117 (suppl.): 63-69.
8. Casaburi R., Briggs D.D., Donohue J.F. that in. The spirometric
efficacy of once-daily dosing with tiotropium in stable COPD. chest,
2000; 118: 1294–1302.
9. Casaburi R., Mahler D.A., Jones P.W. that in. A long-term evolution
of once–daily inhaled tiotropium in chronic obstructive pulmonary
disease. Eur. Respir. J. 2002; 19:217-24.
10. Cross NJ, editor. Anticholinergic therapy in chronic obstructive
pulmonary disease. London, Franklin Scientific Publications, 1993.
11. Global strategy for the diagnosis, management and prevention of
chronic obstructive pulmonary disease. National Institute of Health;
National Heart, Lung and Blood Institute, updated 2003.
12. Jones P.W., Bosch T.K. Quality of life changes in COPD patient
treated with salmeterol. Am. J. Respir. Crit. Care Med., 1997;
155:1283–1289.
13. Littner M.R., IIovite J.S., Tashkin D.P. that in. Long-active bronchodilatation
with once–daily dosing of tiotropium (Spiriva) in stable
chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care
Med. 2000; 161:1136-1142.
14. Mahler D.A., Rosiello R.A., Harver A. et al. Comparison of clinical
rhythmic sickness and psychophysical go to the respirators
sensation in obstructive airway disease. Am. Rev. Respir. Dis., 1987;
135: 1229–1233.
15. Tashkin DP, Cooper CB. The role of long-lasting bronchodilators
in management of stable COPD. Chest, 2004; 125(1): 249–259
16. Van Herwaarden C., Dekhuijzen P. van Schayck C. et al. drug
follow-up chronic obstructive pulmonary disease. Ned. Tijdschr.
Geneskd. Apr., 1996; 140(14): 761-765.
17. Van Noord J.A., Bantje T.A., Eland M.E. that in. A randomized controlled
comprasion of tiotropium and ipratropium in the treatment of
chronic obstructive pulmonary disease. The Dutch Tiotropium Study
Group. Thorax. 2000; 55:289-94.
18. Vincken W., van Noord J.A., Greefhorst A.P. that in. Improved
health outcomes in patients with COPD in 1 year?
Tiotropium. Eur. Respir. J. 2002; 19:209-16.
Viysk Medical Academy named after S.M. Kirov
abstract
On the topic
"Chronic obstructive ailment legen"
Prepared by: student 603 gr, 7 faculty Osetrova O.Yu.
Revised: Reiza V A.
St. Petersburg
1. Appointment
2. Assessing the heaviness of the butt according to the MRC scale
3. Classification of COPD according to severity level
4. Pathogenesis
5. Basic criteria for COPD
6.Instrumental follow-up
7. Laboratory follow-up
8.Differential diagnostics
9. Indications for hospitalization of patients with chronic COPD at the hospital
10. Indications for hospitalization of patients with acute COPD in intensive care
11. Treatment of COPD with a stable state (basic principles)
12. Scheme of the treatment of ailments at various stages of COPD
13.Basic principles of management of patients with chronic COPD
14. Classification of chronic obstructive pulmonary disease (COPD) depending on the severity of clinical symptoms
15.Strategy of antibacterial therapy in acute COPD, which will require hospitalization
16. Indications before trivalo acid therapy
17. Forecast
Appointment
Chronіchna obstructive Khruba Leelen (Hose) - Pervinno Chronіchna Filter Zatvyuvnya s in digestible Uzazennyi Distalny Vіddіlіv Dichalli Shathav Ta Parenkhіmi LIGHT, Formulas Emfіsemi, TRANSFERS OF BRONGIENCI SODNOSTІ SK DISTRIBUTION OF PHINKOVA ABOUT ABOUT NEY, VIKLICANCHA.
Assessing the severity of the back according to the MRC scale
(Medical Research Council Dyspnea Scale)
|
Description |
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The rear is not turbulent, for a little bit of intensive vanity |
||
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Back with swedish walking or pidyomi on a small day |
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Back to cause more walking in pairs with other people of the same century, otherwise it is necessary to work the teeth when walking at your own pace on a flat surface |
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The backside of the zushu robits of the teeth when walking on the road is close to 100 m, or for a sprat of hvilin of walking on a flat surface |
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Zadishka does not allow you to go out of the house, otherwise it appears when you are intoxicated and torn |
Classification of COPD by degree of severity (gold 2003)
|
Characteristic |
|
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Productive cough. Spirometry is normal. |
|
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I: Easy |
FEV1/FVC< 70%; FEV1 ≥ 80% of the correct values. |
|
II: Medium |
FEV1/FVC< 70%; 50% ≤ FEV1< 80% от должных величин. Chronic cough and sputum production sound, but don’t worry |
|
III: Vazka |
FEV1/FVC< 70%; 30% ≤ FEV1< 50% от должных величин. Chronic cough and sputum production sound, but don’t worry |
|
IV: Close the sack |
FEV1/FVC< 70%; FEV1< 30% от должных величин или FEV1< 50% от должных величин в сочетании с хронической ДН или правожелудочковой недостаточностью |
Designation:
FEV1 - forced video obsyagh in 1 second;
FZhEL - forced life;
DN - dichal deficiency.
9068 0
It's a pity, people who suffer chronic obstructive ailments legen(COPD), cannot work what is necessary for an active and consanguineous life - they cannot easily die.
This group of chronic ailments, like the enemy of dihal paths, is quite wide.
In other countries, COPD is stable in the third or fourth row in the ranking of the main causes of death.
According to the data of the American Association of Legens (ALA), in the United States more than 11 million people are diagnosed with COPD, and another 24 million simply do not know about their illness.
In our current article, American pulmonologist Dr. Kathrin Nicolacakis from the Cleveland Clinic in Ohio has broken 4 smut myths about COPD and give the sick a little bit of simple joy.
Myth #1: COPD suffers less than women
True: although COPD is truly associated with chickens, it is true that the skin of a quarter of ailments has never been smoked in life. Based on the statistics of the US National Institutes of Health, 42% of patients with COPD add up to many smokes, 34% continue to smoke after the diagnosis, and 24% did not take a lot of cigarettes.Myth #2: there is no cure for COPD
Truth: for patients with COPD, modern medicine can be more advanced.People are guilty of understanding that COPD is elated, and with the right choice of therapy, it is possible to build up at least for relief, I will become that increase in the quality of my life. It is possible, change and not to go back, or you can control the symptoms and save the farther from the future of the leg.
Doctor Nicolasakis asks his patients to calmly throw fire, live a healthy, balanced hedgehog, engage in exuberant physical culture and fight against influenza and pneumococcal infection. Cі come in to help you get rid of aggravated and aggravated COPD.
It is also important to correctly accept the drugs recognized by the pulmonologist. For the treatment of COPD, inhalers are used to expand the respiratory pathways and control the ignition process, as well as kisen, the introduction of alpha-1-antitrypsin (in case of deficiency), PDE4 inhibitors and other modern drugs.
Myth #3: If you have COPD, you should throw cigarettes away
It's true: it's not really bad to throw a fire, because as soon as you grow up, there will be a real chance to make the progress of the disease. Whatever it takes to become more, the more doctors can be built for you at the future.“Unfortunately, with COPD, ushkodzhenya in the legs gradually accumulates. To this you are guilty of understanding, that the ailment does not arise by itself. But we can improve її progress and improve the adequate function of the leg for the longest possible time, ”- even Nicholasakis.
If you can’t independently fix a bad sound, then hurry up with one of the number of options for likuvannya zalezhnosti - nicotine plaster or zhuyka, busy with a psychotherapist, a group of supporters and others.
Myth No. 4: for COPD, it’s not okay to do physical education
Truth: darkened have the right not to harm the lungs. In fact, stench can relieve symptoms of COPD, increase vibrancy, improve the heart, and reduce stress.As you have shown that your butt makes your physical rights worse, you know that there are special complex medical programs under the name of legenev rehabilitation. The stench is directed at teaching the ailments of the correct technique of eating, exercising physical culture and the basics of rational eating in COPD.
For similar problems, it is necessary to see for judicious physical culture, if only 20-30 quills are needed, at least 3-4 times per day. Combine a safe cardio workout with stretching rights and strength development. Obov'yazkovo consult with your doctor before the new complex. Make sure you are right until then, start not earlier than 1.5 years later.
