Tightening of chronic obstructive pulmonary disease
Exacerbation is the persistent deterioration of disease symptoms in relation to their normal state during the period of its stability. This deterioration has a sudden onset and definitely exceeds the normal variation in the severity of symptoms from day to day.
What are the most common symptoms of exacerbation?
Increased breathlessness and cough, and increased sputum production and change in color. Changing the severity of these symptoms often requires a change in treatment.
Typical causes of COPD exacerbation
1. Cold and flu infections (rhinoviruses, influenza viruses, parainfluenza, coronavirus, adenovirus, RS virus)
2. Bacterial infections (infection of the respiratory tract with bacteria: Haemophilus influenzae and Streptococcus pneumonice, M. catarrhalis, Streptococcus aureus, P. aeruginosa).
3. The reason for exacerbation may be periodic strong increase in air pollution (dust, dust, smog, ozone, nitrogen dioxide, sulfur dioxide, etc.).
4. In almost 30% of cases, the cause of the exacerbation can not be determined.
A common cause of exacerbation of COPD is the development of bacterial infection.
Under normal conditions, the mucous membrane of the trachea, bronchi and bronchioles is sterile. However, with the development of COPD, there is abundant production of mucus, and damage to cilia of the epithelial epithelium and the entire mechanism of self-cleaning of the bronchi and throat and nose from the mucus secretion with their help. In view of the abundance of mucus secretion, pathogenic bacteria are activated by Haemophilus influenzae and Streptococcus pneumoniae, which are not normally present in the airways below the larynx. However, now, due to mucociliary damage and abundance of food, they can develop intensely.
Exacerbations of COPD may occur with the following symptoms:
- increased dyspnoea,
- increased cough,
- increasing the secretion of purulent sputum,
- increase in the volume of expectorated sputum,
- symptoms typical for colds, flu, sore throat, etc.
- increased wheezing,
- reduction of exercise tolerance,
- water retention in the body,
- fatigue
Note the above symptoms may also be the result of other diseases!
DIAGNOSTIC AND MEDICINE DURATION IN ASSOCIATIONS
The diagnosis of COPD exacerbation should include:
pneumonia, pneumothorax, left ventricular failure and pulmonary edema, pulmonary embolism, obstruction of the upper respiratory tract, fluid in the pleural cavity, lung cancer. For example, chest pain and fever are not common symptoms of COPD exacerbation and their presence should lead to diagnosis for example for pneumonia.
Treatment of exacerbation of COPD - worsening of breathlessness
If there is a significant worsening of breathlessness that limits the daily activities, it may not be enough to increase the doses of drugs used in the stable form of the disease. In the absence of significant contraindications, your doctor may prescribe oral glucocorticosteroids. They should not be used for more than 14 days; longer corticotherapy does not bring much benefit. In patients requiring frequent oral glucocorticoids, prophylaxis of osteoporosis should be considered.
Treatment of exacerbation with cold symptoms
In this type of exacerbations (if they are not severe), symptomatic treatment appropriate for a given disease should be considered, which caused exacerbation - for example for bronchitis, flu and cold.
Treatment of exacerbation - increased secretion of purulent sputum
Extracting the increased amount of purulent sputum indicates a bacterial infection of the respiratory tract.In the treatment of bacterial exacerbations (angina, pneumonia), alongside bronchodilators (discussed above), antibiotics are used. Patients with exacerbations without expectoration of an increased amount of purulent sputum do not require the use of antibiotics, provided that there is no lung infiltration on the chest radiograph and the patient has no clinical signs of pneumonia.
Severe exacerbation of COPD may require hospitalization
Symptoms indicating a severe exacerbation of COPD are: strong dyspnoea, breathing through the "lace-up mouth", cyanosis, and the appearance of edema. In addition, strong entanglement syndrome (very bad mood, severe headaches, tearing in the members, lack of appetite or disturbance of the digestive tract, insomnia, dizziness and flushes of the blood to the head, hypersensitivity). When deciding on the treatment of the patient in the hospital or at home, the risk of acidosis and patient preferences should be taken into account.
ed. Edward Ozga-Michalski, MA
Literature:
1. Proceedings in chronic obstructive pulmonary disease in adults in basic and specialist healthcare - Current (2004) British recommendations; ed. prof. dr hab. med. Ewa Niżankowska-Mogilnicka, Department of Pulmonology, II Chair of Internal Diseases, Jagiellonian University Medical College in Krakow; Medycyna Praktyczna 2004/04 (based on Chronic Obstructive Pulmonary Disease National clinical guideline on management of chronic obstructive pulmonary disease in adults and adults. National Collaborating Center for Chronic Conditions. Thorax, 2004; 59 (suppl. I): 1-232 -
2. World strategy for the diagnosis, treatment and prevention of chronic obstructive pulmonary disease; Dr. med. Małgorzata Kołaczkowska Chair and Clinic of Fytziopneumonology, University of Medical Sciences in Poznań (Head: Dr. med. Witold Młynarczyk, Prof. AM); Developed on the basis of the National Heart, Lung, and Blood Institute Reports and WHO as part of the Global Initiative for Chronic Obstructive Lung Disease - Gold), Therapy No. 5 (137), MAY 2003
3. Obstructive pulmonary disease; Interview with dr hab. n. med. Dorota Górecka from the Institute of Tuberculosis and Lung Diseases in Warsaw; Mirosława Błażejowska and Agnieszka Siejca; Medycyna Rodzinna, issue 22 (1/2003)
4. The role of infection in the pathogenesis of chronic obstructive pulmonary disease (COPD) Medycyna Rodzinna - issue 14 (3-4 / 2001)
5. Clinical significance of infections in exacerbation of chronic obstructive pulmonary disease Medycyna Praktyczna 2000/10; she translated the medicine. med. Magdalena Celińska; She consulted dr hab. med. Dorota Górecka.
6. Place of cholinolytics in the treatment of airway obstruction; Dr med. Krzysztof Karwat Chair and Clinic of Internal Diseases, Pneumonology and Allergology of the Medical University in Warsaw; : Therapy No. 2 (133), FEBRUARY 2003
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8. Encyclopedias and medical sites
