Chronic obstructive pulmonary disease (COPD see the first part) is a nosological framework characterized by progressive airflow obstruction, not fully reversible. This reduction of flow is usually associated with an abnormal inflammatory response following inhalation of cigarette smoke and noxious gases or particles. All patients with chronic cough and sputum with a history of exposure to risk factors should be tested for the presence of bronchial obstruction, even in the absence of dyspnea.

.

Chronic obstructive pulmonary disease is a preventable and treatable disease characterized by airflow limitation, not quite reversibile.Tale limitation is usually progressive and associated with abnormal inflammatory response of the lungs to noxious particles and gases, primarily cigarette smoke.

COPD affects the lungs as well as has important systemic consequences

It can distinguish the following clinical pictures (in fact we speak of bronchus COPD:

Simple chronic bronchitis with excessive sputum from large airways, chronic productive cough> 3 months / year> 2 years, if no obstruction: Stage 0

Chronic obstructive bronchiolitis, small airway obstruction with evident inflammation;

Emphysema, ie destruction of alveolar walls with abnormal flaring of the air spaces, loss of elasticity and airway obstruction.

...... From the clinical and pathophysiological bronchitis patients are classically divided them:

type "pink puffer" dyspnoeic stress, thin, pulmonary hyperinflation, with increased lung capacity and normal pulmonary artery pressure, hematocrit limits, pan lobular emphysema.

type "blue bloater" Less dyspnoeic, obese, edematous lung capacity with normal or slight increase, modest increase in pulmonary arterial pressure, hematocrit increased in smokers in general, centrilobular emphysema is

Smoking is a major risk factor for the etiology of chronic bronchitis. There are defense mechanisms that are represented by the activity of cilia of the epithelium lining the airways, the physiological mechanism of bronchospasm and activity scavengers made by cells called macrophages. But when such moments that are causative turn to the clinical COPD, then become pigmented macrophages and bronchiolar implement changes: edema, epithelial changes, fibrosis, mucus hypersecretion and thus overlap with stagnation of mucus and bacterial infection, and hypertrophy of mucous glands themselves and basal cells. The activity is accentuated antielastica (inactivation of antiprotease inhibitor and mucus dell'alfa1-antitrypsin). You can even arrive at the framework neoplastic process hindered by cellular repair and inhibition of oxidative deamination of amino groups.

.
Surely the basis of chronic bronchitis we have the manifestation of the inflammatory process, which at one point, after repeated acute exacerbation of COPD, it becomes irreversible.

Those were the facts, we can safely say that there are stages, ie clinical, during which the patient gradually you start to complete disability, which is the job of the specialist physician and pulmonologist, prevent, slow down and treat different phases:

Impairment: namely the loss of normal respiratory function but also psychological, physiological and anatomical structure of the individual harm that can be quantized through instrumental measurements (spirometry) that are reflected in a decrease of FEV1 and nell'intrappolamento air and loss of peripheral muscle function, particularly in respiratory muscle chest and back.

Disability: refers to the inability to performa a respiratory activity in the range of normality. This disability includes the reduction of dynamic function, its restriction and physical performance. This phase is often characterized by functional tests such as the walk up to 6 minutes or as the baseline and transitional dyspnea Indexes.

Handicap: the disadvantage is that results from a "impariment or" disability "in the sense that a business result disability if you can not change the performance means it has developed a disability, ie a permanent reduction in performance.

Natural history of COPD

Recognize the disease in terms of its natural history, although a long-term variable and the resulting individual exposure to known risk factors and the ability to genetically determined personal response, recognizing that estrisencano different stages in the clinical manifestation through specific signs and symptoms and a decline in lung function that is slow but inexorable, determined by a chronic inflammation of the lung tissue that becomes, ultimately, systemic disease, monitor through the markers of inflammation: polymorphonuclear and PCR.

In this context, the exacerbations of the disease are sudden events that are recognized and treated early because very damaging the economy overall functional disease. This path is therefore characterized by clinical and functional changes that must be recognized early in order to search through un'approccio integrated therapeutic, to avoid the onset of the patient under respiratory disability which constitutes a real handicap was respiratory

How to deal?

In the final stages overt respiratory disability, resulting from exacerbations of COPD, it is still possible treatment with NIV, ie Non-Invasive Positive Pressure Ventilation.

 

>>>see first page

>>>see also RICERCA