Sensitivity of physical techniques to determine the severity of COPD is low. The leading role in inflammation belongs eosinophils, mast cells and lymphocytes. Spirometry – reduced FEV1 below 80% of normal for the patient znacheniy. Classification of COPD severity (GOLD, 2003) Stage The main clinical signs Functional indicators I: light cough, sputum production, usually, but not always.
Limited mobility of the diaphragm, auscultation picture changes: reduced the severity of wheezing, prolonged exhalation. In forming the strategy and tactics of treatment of patients with COPD is crucial to allocate two regimens: treatment without exacerbation (maintenance therapy) and treatment of COPD exacerbations. Chronic inflammatory disease of the airways characterized by bronchial hyperreactivity, a common reversible bronchial obstruction. Pikfluometriya – reducing PIC below 80% of normal for the patient’s values. BA-disease, which is based on airway inflammation, accompanied by changes in the sensitivity and bronchial reactivity and manifested asthma, status asthmaticus, or, in its absence, respiratory discomfort (paroxysmal cough, wheezing and shortness of distance), accompanied by reversible airflow obstruction against the hereditary predisposition to allergic diseases, extrapulmonary symptoms of allergies, blood eosinophilia and / or eosinophils in the sputum. Recommended classification of COPD severity with the release of four stages is given in accordance with the latest version of the international program “Global Initiative for Chronic Obstructive Lung Disease» (GOLD, 2003).
As the progression of airflow obstruction and lung hyperinflation increase anteroposterior size of the chest rise. Clinic-choking or difficulty breathing, expiratory dyspnea, cough, tachycardia, dry wheezing, worse on the exhale and listens as auscultation, and at a distance (eg, remote wheezing), percussion – box sound (gipervozdushnost lung tissue) . KLA-eosinophilia, sputum microscopy – is dominated by eosinophils, crystals Charcot – Leyden, spiral Kurshmana. The disease is manifested by coughing, sputum and increasing shortness of breath, has been steadily progressive nature of the outcome of the chronic respiratory failure and pulmonary heart.
Often auscultation revealed raznotembrovye dry rales. Shortness of breath may vary very widely: from a sense of lack of air at standard physical exercise to severe respiratory failure. Asthma in pregnancy – Laboratory – instrumental investigations. List the treatment during acute exacerbations of COPD and beyond and BA. Tell clinical manifestations, laboratory and instrumental methods of diagnosis and complications of lung tumors. COPD – primary chronic inflammatory disease, mainly affecting the distal airways of the lung parenchyma and the formation of emphysema and is characterized by airflow limitation with the development of an irreversible (or not fully reversible) bronchial obstruction caused by persistent productive nonspecific inflammatory response.
Other characters join later in the progression of the disease, with a gradual acceleration of the disease progression. The teacher asks students questions about the activity: 1.
The first (the earliest) COPD is a sign of a cough. Risk Factors Heredity Allergens products house dust mites, mold spores dander, hair, fibers dried saliva and urine of domestic animals, bird feathers, food and drug allergy, smoking (active and passive). Infectious (usually ARI) Air pollutants-SO2, NO2, etc. Membrane of mast cell stabilizers (cromolyn sodium, nedocromil sodium, ditek-inhalation, ketotifen and others in the table., To prevent attacks. Theoretical survey can be carried out using the “Brainstorming” The method of “Brainstorm” Purpose: This method is used to stimulate the exchange of ideas, increases the degree of involvement of the participants, teaches argue and defend their point of view, to find the best solution in this situation.
For clinical work with patients with COPD, in addition to general clinical tests recommended ERF study (FEV1, forced vital capacity and vital capacity) test with bronchodilators (b2-agonists and holinolitikami), chest X-ray. As the disease progresses to coughing joins wheezing, most notable for rapid exhalation. Severe persistent form – persistent symptoms and frequent exacerbations, frequent nocturnal symptoms, limitation of physical activity, POS and / or FEV1 less than 60% predicted, variations PIC over 30%. Aspirin-intolerant characterized by aspirin and other NSAIDs, as well as products containing natural salicylates, manifested severe asthma, until the development of asthma status, often associated with recurrent polypous rhinosinusitis.