COPD is a collective term, which means a group of respiratory system chronic diseases: chronic obstructive bronchitis (COB), pulmonary emphysema (PE), severe bronchial asthma (BA). COPD is regarded as a syndrome with symptoms of terminal respiratory failure: forced expiratory volume 1 (FEV1) < 1,5 l. or 30% of the due value, when the disease progression leads to the loss of an bronchial obstruction inversive component, known as pulmonary hear. Often the reason of COPD is the COB (about 90%), about 1 % is the pulmonary emphysema (due to lack of α1-antitrypsin) and about 10% fall on the severe bronchial asthma.
Bronchial asthma - a chronic inflammatory disease of the respiratory tract, in which mast cells, eosinophils and T-lymphocytes are involved. In predisposed people this inflammation leads to the repeated episodes of wheezing, breathlessness, heaviness in the chest and coughing, especially at night and / or early morning. These symptoms are usually accompanied by widespread, but variable bronchial tree obstruction, which is at least partly reversible either spontaneously or under the influence of treatment. The inflammation also causes an increase in friendly response of the respiratory tract to different stimuli (с) GINA (Global Initiative for Asthma).
Distribution of bronchial asthma.
1. More than 300 million of people suffer from bronchial asthma
2. The disease of bronchial asthma in different country affects 1% to 18% of population (In Russia – 6,2%).
3. The maximum spread of the asthma is observed in countries with warm and humid climate, the minimum - in the deserts and the Arctic.
4. Today there is the rising in the severity of bronchial asthma.
1. More than 300 million of people suffer from bronchial asthma
2. The disease of bronchial asthma in different country affects 1% to 18% of population (In Russia – 6,2%).
3. The maximum spread of the asthma is observed in countries with warm and humid climate, the minimum - in the deserts and the Arctic.
4. Today there is the rising in the severity of bronchial asthma.
Facts which influence increase in development and severity of bronchial asthma.
Endogenous
Genetic (predisposing to atopy and respiratory tract hyperresponsiveness)
Corpulence
Sex
Exogenous
Allergens
a) Indoor (mites, pets, cockroaches allergens, fungi)
b) external (pollen, fungi)
Infections (mainly - viral)
Professional allergens
Nutritional habits
Air pollution
Smoking (active and passive)
The development mechanism of bronchial asthma
1. Pathomorphology
Respiratory tract inflammation
Remodeling of the bronchial wall
2. Pathophysiology
Narrowing of the respiratory tract
Respiratory tract hyperresponsiveness
3. Special mechanism
Acute exacerbation
Nocturnal asthma
Clinical picture
The main symptoms of the bronchial asthma are shortness of breath, wheezing, cough and chest congestion.
The appearance of the symptoms after contact with allergen, seasonal variability of the symptoms, having relatives with bronchial asthma or other atopic diseases has high priority.
The main drug group used for treatment of the bronchial asthma.
β2 – adrenoceptor agonist (short acting – fenoterol, medium acting – salbutamol, long acting – salmeterol, formoterol)
Effects:
Relaxation of the respiratory tract smooth muscles.
Suppression releases of mediator from mast cells.
The increase of mucociliary clearance.
Bronchospasm prevention.
M- cholinolytic - ipratropium bromide (Atrovent)
Methylxanthines (short action – theophyllin, aminophylline, long action – theopack, theophyllin)
Effects:
Bronchodilation
Membrane-stabilizing effect
Improving of the bronchial patency
Positive foreign-, chrono-, drome and bathmotropic effects
Excitation of the respiratory center
Psycho-emotional excitement
Membrane stabilizers of mast cells
Sodium cromoglycate (intal)
Nedocromil sodium
Ketotifen
Applied for the basic therapy of mild bronchial asthma, prevention of bronchospasm caused by physical stress, inhalation of tobacco smoke, cold air.
Antileukotriene preparation
Antagonists of leukotriene receptors – (zafirlukast, montelukast)
Inhibitors of 5-oksiLOG (Zileuton)
Glucocorticosteroids
They regulate expression of genes, change the range and quantity of synthesized proteins that have anti-inflammatory effect (FLA2, Stabilization of lysosomal membranes); affect activity of fibroblasts, reduce the migration of monocytes in inflammatory tissue and suppress the enzyme hyaluronidase.
Also for treatment of bronchial asthma PFA (polyunsaturated fatty acids) are used as asternal substrates.