Chronic obstructive bronchitis and COPD

Chronic obstructive bronchitis is a diffuse inflammatory disease of the bronchi, characterized by early damage to the respiratory structures of the lung and leading to the formation of broncho-obstructive syndrome, diffuse pulmonary emphysema and progressive impairment of pulmonary ventilation and gas exchange, which are manifested by cough, shortness of breath and sputum production, not associated with other diseases of the lungs, heart, blood system, etc.

Thus, in contrast to chronic non-obstructive bronchitis, the key mechanisms that determine the characteristics of the course of chronic non-obstructive bronchitis are:

1. Involvement in the inflammatory process of not only large and medium, but also small bronchi, as well as alveolar tissue.
2. The development as a result of this is a broncho-obstructive syndrome, consisting of irreversible and reversible components.
3. Formation of secondary diffuse pulmonary emphysema.
4. Progressive impairment of pulmonary ventilation and gas exchange leading to hypoxemia and hypercapnia.
5. Formation of pulmonary arterial hypertension and chronic pulmonary heart disease (CPD).

If at the initial stage of chronic obstructive bronchitis formation the mechanisms of damage to the bronchial mucosa resemble those in chronic non-obstructive bronchitis (impaired mucociliary transport, hypersecretion of mucus, seeding of the mucosa with pathogenic microorganisms and initiation of humoral and cellular inflammatory factors), then the further development of the pathological process in chronic obstructive bronchitis and chronic non-obstructive bronchitis differs fundamentally from each other. The central link in the formation of progressive respiratory and pulmonary-cardiac insufficiency, characteristic of chronic obstructive bronchitis, is centroacinar emphysema of the lungs, which occurs due to early damage to the respiratory parts of the lungs and increasing bronchial obstruction.

Recently, the term "chronic obstructive pulmonary disease (COPD)" has been recommended to designate such a pathogenetically conditioned combination of chronic obstructive bronchitis and pulmonary emphysema with progressive respiratory failure. According to the latest version of the International Classification of Diseases (ICD-X), it is recommended to use it in clinical practice instead of the term "chronic obstructive bronchitis". According to many researchers, this term to a greater extent reflects the essence of the pathological process in the lungs with chronic obstructive bronchitis in the last stages of the disease.

Chronic obstructive pulmonary disease (COPD) is a collective term that includes chronic inflammatory diseases of the respiratory system with predominant damage to the distal respiratory tract with irreversible or partially reversible bronchial obstruction, which are characterized by constant progression and increasing chronic respiratory failure. The most common causes of COPD include chronic obstructive bronchitis (in 90% of cases), severe bronchial asthma (about 10%), and pulmonary emphysema resulting from alpha1-antitrypsin deficiency (about 1%).

The main sign by which the COPD group is formed is the steady progression of the disease with the loss of the reversible component of bronchial obstruction and increasing symptoms of respiratory failure, the formation of centroacinar emphysema of the lungs, pulmonary arterial hypertension and pulmonary heart disease. At this stage of COPD development, the nosological affiliation of the disease is indeed leveled.

In the USA and Great Britain, the term "Chronic obstructive pulmonary disease" (COPD - chronic obstructive pulmonary disease; in Russian transcription COPD) also includes cystic fibrosis, obliterating bronchiolitis and bronchiectasis. Thus, at present, there is a clear inconsistency in the definition of the term "COPD" in the world literature.

However, despite a certain similarity in the clinical picture of these diseases at the final stage of disease development, at the early stages of the formation of these diseases it is advisable to maintain their nosological independence, since the treatment of these diseases has its own specific features (especially cystic fibrosis, bronchial asthma, bronchiolitis, etc.).

There are still no reliable and accurate epidemiological data on the prevalence of this disease and mortality of patients with COPD. This is mainly due to the uncertainty of the term "COPD" that has existed for many years. It is known that at present in the USA the prevalence of COPD among people over 55 years old reaches almost 10%. From 1982 to 1995 the number of patients with COPD increased by 41.5%. In 1992 in the USA the mortality rate from COPD was 18.6 per 100,000 population and was the fourth leading cause of death in this country. In European countries the mortality rate from COPD fluctuates from 2.3 (Greece) to 41.4 (Hungary) per 100,000 population. In Great Britain approximately 6% of male deaths and 4% of female deaths are caused by COPD. In France, 12,500 deaths per year are also related to COPD, accounting for 2.3% of all deaths in that country.

In Russia, the prevalence of COPD in 1990-1998, according to official statistics, averaged 16 per 1000 population. Mortality from COPD for the same years ranged from 11.0 to 20.1 per 100,000 population. According to some data, COPD reduces natural life expectancy by an average of 8 years. COPD leads to a relatively early loss of working capacity in patients, and in most of them, disability occurs approximately 10 years after the diagnosis of COPD.

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Risk factors for chronic obstructive bronchitis

The main risk factor for the development of COPD in 80-90% of cases is tobacco smoking. Among "smokers" chronic obstructive pulmonary disease develops 3-9 times more often than among non-smokers. At the same time, mortality from COPD is determined by the age at which smoking was started, the number of cigarettes smoked and the duration of smoking. It should be noted that the problem of smoking is especially relevant for Ukraine, where the prevalence of this bad habit reaches 60-70% among men and 17-25% among women.

Chronic obstructive bronchitis - Causes and pathogenesis

Symptoms of Chronic Obstructive Bronchitis

The clinical picture of COPD consists of various combinations of several interrelated pathological syndromes.

COPD is characterized by a slow, gradual progression of the disease, which is why most patients seek medical attention late, at the age of 40-50 years, when there are already quite pronounced clinical signs of chronic inflammation of the chest and broncho-obstructive syndrome in the form of cough, difficulty breathing and reduced tolerance to daily physical activity.

Chronic Obstructive Bronchitis - Symptoms

Diagnosis of chronic obstructive bronchitis

At the initial stages of the disease, a thorough questioning of the patient, assessment of anamnestic data and possible risk factors are of great importance. During this period, the results of an objective clinical examination, as well as laboratory and instrumental data, are of little informative value. Over time, when the first signs of broncho-obstructive syndrome and respiratory failure appear, objective clinical, laboratory and instrumental data acquire increasing diagnostic significance. Moreover, an objective assessment of the stage of disease development, the severity of COPD, and the effectiveness of the therapy is possible only with the use of modern research methods.

Chronic obstructive bronchitis - Diagnosis

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Treatment of chronic obstructive bronchitis

Treatment of patients with COPD in most cases is an extremely complex task. First of all, this is explained by the main pattern of disease development - the steady progression of bronchial obstruction and respiratory failure due to the inflammatory process and bronchial hyperreactivity and the development of persistent irreversible disorders of bronchial patency caused by the formation of obstructive pulmonary emphysema. In addition, the low efficiency of treatment of many patients with COPD is due to their late visit to the doctor, when signs of respiratory failure and irreversible changes in the lungs are already evident.

However, modern adequate complex treatment of patients with COPD in many cases allows to reduce the rate of progression of the disease leading to an increase in bronchial obstruction and respiratory failure, reduce the frequency and duration of exacerbations, increase performance and tolerance to physical activity.

Chronic Obstructive Bronchitis - Treatment