MEDICINSKI FAKULTET MOSTAR

Chronic obstructive pulmonary disease - Internal Medicine

prof.dr. sc. Izabela Danki Mostar, lipanj, 2010.god.

Anita Doli

Doli, Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease - Internal Medicine

Chronic obstructive pulmonary disease is a disorder of obstructive airways and lung parenchyma, which is characterized by limit air flow in the airways roads. It is progressive and is associated with inflammation airway tree and lungs to harmful agents and is reversibly fully to therapy. Airways are narrowed due to thickening of the walls of the island resulting from mucosal edema and fibrosis, which is a consequence of the creation of collagen, as well as pressure from the muscles that they surrounds. Inflammatory process leads to destruction of lung tissue in terms of loss of connection at the level of alveoli and capillaries as has the consequence of reducing retraction lungs. That creates the mucus the patient coughs and aggravated congestion. This disease is one of the leading causes of death in the world. Vulnerable groups are people exposed to inhaled particles exposition, smokers, people who work in adverse microclimatic conditions with a lot of dust and smoke, genetic predisposition and premature infants with underdeveloped lungs. Most commonly affects people over age 40 and sometimes even children. From this disease every year more and more ill people, which represents a major socioeconomic problem, and prevention in terms of abstinence from smoking best way to reduce the incidence of this disease. (Interna medicina, dr. Boidar Vrhovac i suradnici)

Etiology
Disease occurs as a result of long term inhaled exposition, harmful agents that result in accumulation in the lung parenchyma which ultimately give rise to inflammation in the lower airways roads. As inflammatory response leads to activation of a series of defense mechanisms such as complement activation, alveolar macrophages, neutrophils and T lymphocytes . Tobacco smoke inhibits the normal defense mechanism leading to accumulation of macrophages in alveolar, neutrophils in the mucous glands in which the release of inflammation mediators - cytokines. (www. doctor.co.yu)

Doli, Chronic obstructive pulmonary disease Chronic inflammation causes swelling, mucus production and swelling of the airways and incomplete vessels due to the formation of collagen which causes constriction and fibroses. Furthermore there is destruction of lung tissue, loss of connection between the alveoli and capillaries and decrease elastic retraction of the lung. All mentioned phenomena have rejection the heart and comes and pulmonary hypertension and the occurrence of pulmonary heart. Inflammation is chronic and occurs in small and large airways and results in the development of various morphological changes in the level of three pulmonary areas and to: 1. Bronchitis in the large airways 2. Bronchitis-peripheral airways disease 3. Emphysema lung disease-lung parenchyma Chronic bronchitis is a disease of the proximal airways and is characterized by regular sputum production most days for at least three months in the last two years. Disease occurs in response to inflammation that results in mucus secretion from sub mucosal glands are hypertrophy. Disease is complicated by the development of bacterial infection and due to mucosal swelling and muscle spasm male leads to bronchial obstruction occurs when the price of dyspnea with exertion and later in peace. (Interna medicina, dr. Boidar Vrhovac i suradnici) Initially, the process is reversible because the docked medication, however, over the disease affects the distal pathways and eventually leads to reflex vasoconstriction of blood vessels in the lungs and loading the right ventricle, resulting in the emergence of Cor pulmonale. Since the epithelium is chronically exposed to inflammation changing. The clinical picture manifested by cough with sputum mucilaginous that the development becomes purulent infection, dyspnea, fever, reduced tolerance to effort. Lung X-Ray provides enhanced bronchial drawing and finding indicates an increase in blood parameters, inflammatory response: The rapid sedimentation rate, elevated white blood cells, neutrophils, high CRP. Examinations of sputum isolate the cause of infection. Therapy is symptomatic and anti-inflammatory, and varies depending on the severity. Antibiotics are given wide spectrum bronchiolitis, bronchodilators aerosols mind, acting locally and corticosteroids. (Patofiziologija, dr Amir Pleho) The patient is given a large amount of fluid due bronchus action, and massage thorax. Bronchial asthma is a disease that is characterized by acute airway obstruction and belongs in a medical emergency because if left untreated can be fatal to complete. 3

Doli, Chronic obstructive pulmonary disease Bronchial smooth muscle contraction that occurs as a consequence of inflammation of various agents, allergens, dust, toxic aerosol on alpha receptors, resulting in mucosal edema and hyper secretion of mucus, which leads to much less mobility bronchia. Depending on the frequency of asthma can be categorized into 4 categories. 1. intermittent asthma attacks-weekly or monthly night 2 times 2. 3. mild persistent asthma-attacks every day, night more than once a week moderately severe persistent asthma, continuous symptoms, limited physical activity 4. severe persistent asthma The clinical picture is characterized by shortness of breath, tachypnea, rambling speech, catching air, coughing, cyanosis, respiratory musculature. Symptoms auxiliary work depend on the variable course of inflammatory reactions. If the situation does not improve after a few hours and days after the therapy time talking about Status asthmatics that leads to serious complications, which even death. Diagnoses establish physical findings, auscultation register intensive respiratory noise, dominated by high frequency noises especially with prolonged expiratory flow. Registers and tachycardia due to increased amounts of air into the lungs. The patient is often confused and frightened. Blood search often show eosinophilia. In patients with clinical signs of asthma, spirometry findings characteristic by increasing lung capacity, residual volume and decreased respiratory capacity, which is an obstructive syndrome. Treatment is symptomatic and includes elimination of causes and symptoms of the disease spreading respiratory, soothing inflammation and possible infection. For this purpose use the dose in mind aerosol bronchodilators via beta adrenergic receptor agonists in the form of inhaled formulations are. Depending on severity, are used with other drugs Aminophylin, beta agonists, inhaled corticosteroids, antibiotics and the use of oxygen as well as the correction of disturbed equilibrium in the case of ABS asthmatic crisis. When establishing control of the disease and maintain at least 3 months of treatment, decreases gradually. The patient is placed in a sitting position and can yield large quantities of liquids.

Doli, Chronic obstructive pulmonary disease

Pulmonary emphysema
Is a chronic disease of the peripheral airways, characterized by permanent enlargement of air spaces and destruction of their walls in the lungs, associated with destruction of alveolar membranes for which they combine and become dysfunctional. The disease a consequence of abnormal inflammatory reaction caused by smoking and other harmful agents in aerosol form. Furthermore, there is destruction of lung tissue, loss of connection between the alveoli and capillaries and decrease lung elastic retraction. The disease is associated with chronic bronchitis.

Clinical picture
Symptoms vary depending on the degree of severity. Sufferers complain of chronic productive cough with phlegm mucilaginous grayish color, difficulty breathing, lose their breath during exertion and later in peacetime, suffocating them and is difficult to recover after colds. The road is weight loss. Progressive disease progresses and the symptoms worsened and the patient and the doctor usually occurs in advanced stage of disease. Stable flow interrupt exacerbation caused by infection tracheobronchial trees, and various irritants, air pollution etc. Patients often find dyspnea, respiratory noise in the form of whistling at expiratory flow, short inspiration, the work of auxiliary respiratory muscles, cyanosis, whether it is central or peripheral type as auscultation wheezing, whistling. The thorax is barrel. Due to the high concentration of air in the lungs is often present tachycardia. Poodle move the stage appearance of diagnosed pulmonary hypertension and pulmonary heart. (Patofiziologija, dr Amir Pleho) Diagnosis is based on history data on long-term smoking experience, the physical findings in the lungs characterized by the appearance of respiratory noise at which expiratory flow is an indication for the measurement of vital capacity lung spirometry. Lung X-Ray shows increased intercostals space with almost Horizontally placed ribs and lungs increased translucence. Due to the repercussions across the pulmonary veins leads to enlargement of the right ventricle Cor pulmonale. 5

Doli, Chronic obstructive pulmonary disease In patients with pulmonary emphysema spirometry register associated obstructive and restrictive syndrome as a consequence of multiplication of connective tissue that is a consequence of chronic inflammatory conditions. Reduced the value of FEV1 and FVC. Radio and bronchodilatation test, where obstruction is still there because the process is not fully reversible. To therapy, Polycythemia caused by excessive secretion of erythropoietin due to chronic hypoxemia. Acid-base balance is disturbed by the state when the FEV1 is less than 4o% in terms of hypoxemia and hypercapnia and respiratory acidosis in arterial blood.

Treatment and prevention of the disease

Treatment is symptomatic and includes elimination of causes and symptoms of the disease in order to improve the general condition of the patient and preventing exacerbations. The phases of exacerbation give the bronchodilatatators in mind aerosol, corticosteroids and antibiotics to calm the inflammation and eventual infection. In these purposes are used dose aerosol bronchodilators with which the drug Enters breath and medication acts locally on the sick tissue. (Interna medicina, dr. Boidar Vrhovac i suradnici) Depending on the severity applied different doses of drugs, oxygen as well. ABS and correction of disturbed balance patient is placed in a sitting position and can yield large quantities of liquids, Consumption of large amounts of fluid secretion due action, massage of the chest. Severe patients in advanced stages are recommended to use household appliances, which are called oxygen concentrator which achieves long-term oxygen therapy patients, and reduces the need for hospitalization. No medication treatment includes rehabilitation exercises, in terms of breathing, tips on nutrition to improve the quality of life. Prevention involves cessation of active and passive smoking and avoiding exposure to adverse agents such as dust and other harmful aerosols. Patients are recommended vaccinations against influenza and regularly practicing breathing exercises.

Doli, Chronic obstructive pulmonary disease

Literature
Interna medicina, dr. Boidar Vrhovac i suradnici Patofiziologija, dr Amir Pleho WWW.doktor.co.yu/forum/viewtopic.pho