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 bronchial obstructive syndrome, diffuse lung emphysema and progressive impairment of pulmonary ventilation and gas exchange, which are manifested by coughing, shortness of breath and sputum secretion not associated with other lung diseases, 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 is not only large and medium, but also small bronchi, as well as alveolar tissue.
2. The development as a result of this bronchoobstructive syndrome, consisting of irreversible and reversible components.
3. Formation of secondary diffuse emphysema of the lungs.
4. Progressive violation of ventilation and gas exchange, leading to hypoxemia and hypercapnia.
5. Formation of pulmonary arterial hypertension and chronic pulmonary heart (CHS).

If at the initial stage of the formation of chronic obstructive bronchitis the mechanisms of damage to bronchial mucosa resemble those in chronic non-obstructive bronchitis (mucociliary transport disorder, hypersecretion of mucus, contamination by mucous pathogenic microorganisms and initiation of humoral and cellular inflammation factors), then the further development of the pathological process in chronic obstructive bronchitis and chronic Non-obstructive bronchitis is fundamentally different from each other. The central link in the formation of progressive respiratory and pulmonary heart failure, characteristic of chronic obstructive bronchitis, is centroacinar pulmonary emphysema, which is caused by the early defeat of the respiratory sections of the lungs and the growing bronchial obstruction.

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

Chronic obstructive pulmonary disease (COPD) is a collective concept that combines chronic inflammatory diseases of the respiratory system with a predominant lesion of the distal parts of the respiratory tract with irreversible or partially reversible bronchial obstruction 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%), emphysema lung ma, evolved as a result of alpha1-antitrypsin deficiency (about 1%).

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

In the United States and the United Kingdom, the concept of chronic obstructive pulmonary disease (COPD) includes also cystic fibrosis, bronchiolitis obliterans and bronchiectasis, in Russian transcription of COPD. Thus, at present, there is a clear inconsistency in the definition of COPD in the world literature.

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

There are still no reliable and accurate epidemiological data on the prevalence of this disease and the mortality of COPD patients. This is mainly due to the uncertainty of the term "COPD" that existed for many years. It is known that at present in the United States the prevalence of COPD among people over 55 is almost 10%. From 1982 to 1995, the number of COPD patients increased by 41.5%. In 1992, the mortality rate from COPD in the United States was 18.6 per 100 000 population and was the fourth leading cause of death in this country. In European countries, COPD mortality ranges from 2.3 (Greece) to 41.4 (Hungary) per 100 000 population. In the UK, approximately 6% of men's deaths and 4% of women's deaths are due to COPD. In France, 12,500 deaths per year are also associated with COPD, representing 2.3% of all deaths in this country.

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

[1], [2], [3], [4], [5], [6], [7], [8],

Risk factors for chronic obstructive bronchitis

The main risk factor for COPD in 80-90% of cases is tobacco smoking. Among "smokers" chronic obstructive pulmonary disease develops 3-9 times more often than in non-smokers. The mortality from COPD determines 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 harmful habit is 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 a different combination of several interrelated pathological syndromes.

For COPD, a slow progressive progression of the disease is characteristic, and the majority of patients turn to the doctor late, at the age of 40-50 years, when there are already sufficiently pronounced clinical signs of chronic inflammation of bronchial tubes and bronchial obstructive syndrome in the form of cough, shortness of breath and reduced tolerance for everyday physical activity.

Chronic obstructive bronchitis - Symptoms

Diagnosis of chronic obstructive bronchitis

At the initial stages of the development of the disease, careful scrutiny of the patient, evaluation of anamnestic data and possible risk factors is of great importance. During this period, the results of objective clinical research, as well as data of laboratory and instrumental methods, are of little informative value. Over time, when the first signs of bronchial obstructive syndrome and respiratory failure appear, objective clinical-laboratory and instrumental data become more and more diagnostic. Moreover, an objective assessment of the stage of the development of the disease, the severity of the course of COPD, the effectiveness of the therapy is possible only with the use of modern research methods.

Chronic obstructive bronchitis - Diagnosis

[9], [10], [11], [12], [13], [14]

Treatment of chronic obstructive bronchitis

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

Nevertheless, 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 to reduce the frequency and duration of exacerbations, increase work capacity and tolerance to physical activity.

Chronic obstructive bronchitis - Treatment