The Chronic Nonspecific Diseases of Lungs (CNDL) – various diseases of respiratory system in the etiologichesky and patomorfologichesky relation proceeding with constant productive cough and owing to primary damage of bronchial tubes or a parenchyma. Include such nosologically independent forms as chronic bronchitis, BEB, bronchial asthma, emphysema of lungs, a pneumosclerosis, chronic pneumonia. HNZL are diagnosed by results of the spirography, x-ray and endoscopic inspection. Methods of treatment of HNZL can include pharmacotherapy, bronchoscopic sanitation, physical therapy, LFK; at permanent morphological changes – surgical treatment.
Chronic nonspecific diseases of lungs
The group of chronic nonspecific diseases of lungs unites the diseases of respiratory organs having various reasons and mechanisms of development, but similar clinical manifestations and morfofunktsionalny violations. Indicators of incidence of HNZL in regions of Russia vary from 12 to 29 cases for 1000 of the population. For the first time this concept was introduced into circulation on the international symposium of pulmonologists which took place in 1959 in London. Then were included in the HNZL group three a nosology: chronic bronchitis, bronchial asthma and emphysema of lungs. Three years later at a scientific conference this list is added with a bronkhoektatichesky disease, chronic pneumonia and a pneumosclerosis. Specific damages of lungs (tuberculosis), occupational diseases (pneumoconiosis) and bronkhopulmonalny cancer were not included in this group.
In modern pulmonology questions of classification of chronic nonspecific diseases of lungs remain debatable. So, a number of authors in addition carry interstitsialny pulmonary diseases to HNZL. Others object that independent nozologiya from HNZL are only hr.bronkhit, emphysema and bronchial asthma; the others (a pneumosclerosis, a hr.pnevmoniya, bronkhoektaza) have sindromalny character and have to be considered as complications of the main, independent forms. Existence of chronic pneumonia also admits not all researchers.
The major factors determining the frequency of incidence of the population of chronic nonspecific diseases of lungs are the high level of impurity of the air environment, professional and production harm, acute infectious diseases of airways, negative habits. Higher epidemiological rates on HNZL are noted in the industrial cities where in atmospheric air the maintenance of pollyutant (nitrogen oxides, dioxide of sulfur, carbon dioxide, dust, the weighed particles, etc.) exceeding maximum allowable concentration by 3-5 times is registered. The main professional contingent among patients with HNZL is made by the persons which are exposed to drafts, influence of a gas contamination, dust content, the irritating smells in a workplace.
Numerous researches confirm communication between the frequency of development of HNZL and long smoking (over 10 years). As Preyomorbidny states for clinically expressed HNZL forms the SARS, repeated sharp bronchitis and pneumonia, hroyonichesky diseases of the top airways, allergic diseases, immune violations act frequent and a zatyazhnyyoa. The indicator of HNZL increases with age and reaches the peak in age group of 40-60 years. Among patients the majority is made by men. In structure of HNZL chronic bronchitis (about 60%), bronchial asthma prevails (~ 35%), bronkhoektaza (about 4%), less than 1% are the share of other diseases.
One of three mechanisms is the cornerstone of a morphogenesis of various chronic nonspecific diseases of lungs: bronkhitogenny, pnevmoniogenny and pnevmonitogenny. The Bronkhitogenny way of development of HNZL is connected with violation of a bronchial prokhoyodimost and drainage function of bronchial tubes. On such mechanism diseases with an obstructive component develop: chronic bronchitis, BEB, bronchial asthma and emphysema of lungs. The Pnevmoniogenny mechanism is the cornerstone of formation of chronic pneumonia and chronic abscess of a lung which are complications of bronchial pneumonia or krupozny pneumonia. At these diseases the restrictive component is expressed. The Pnevmonitogenny way defines development of interstitsialny diseases of lungs.
As outcome of any of the called HNZL morphogenetic mechanisms serves development of a pneumosclerosis (pneumofibrosis, pneumocirrhosis), pulmonary hypertensia, pulmonary heart and warm and pulmonary insufficiency. Chronic nonspecific diseases of lungs are considered as risk factor of development of tuberculosis of lungs, lung cancer.
HNZL main forms
As well as other chronic nonspecific diseases of lungs, often is a consequence of a long current of the acute bronchitis of a virus etiology (which developed against the background of flu, measles, adenoviral or RS-infections) or the bacterial genesis (caused by a long persistention in bronchial tubes of a hemophilic stick, pneumococcus, etc.). Can develop as a result of long impact on pneumatic ways of chemical and physical factors (smoking, dust content of air, pollution by industrial wastes).
On prevalence moyozht to be local or diffusion; as an inflammation – catarrhal or mucopurulent; on existence/lack of bronchial obstruction – obstructive and not obstructive; on the nature of morphological changes in bronchial tubes – atrophic, polipozny, deforming. As clinical criteria of chronic bronchitis serve 2-3 aggravations of inflammatory process a year for 2 years with an annual duration not less than 3 months. Patients are disturbed by constant cough with a phlegm. During aggravations cough amplifies, the phlegm becomes purulent, the subfebrilny temperature, perspiration joins. Chronic pneumonia, a lung, emphysema, pneumofibrosis can become outcomes and complications of chronic bronchitis.
Is a form of chronic nonspecific diseases of lungs, the second for frequency. It is characterized by the hyperreactivity of a bronchial tree leading to hyper secretion of bronchial slime, hypostasis and a paroksizmalny spasm of pneumatic ways. Treat the main clinical types not atopic, atopic, mixed, aspirin - induced, professional OH.
Clinically OH any genesis it is shown by the repeating attacks of expiratory short wind. In their development allocate 3 periods: harbingers, suffocation and return development. As the harbingers signaling about the coming attack OH the tussiculation, mucous allocations from a nose, the conjunctivitis phenomena, motive concern can serve. During an attack of suffocation there is a whistling breath, sharp short wind with the extended exhalation, diffusion cyanosis, unproductive cough. Patients accept the compelled vertical position with the raised humeral belt. At a heavy attack the death of the patient can come from respiratory insufficiency. During the return development of an attack at cough the phlegm begins to separate, the number of rattles decreases, breath becomes free, short wind disappears.
Between attacks condition of patients OH quite satisfactory. At the long anamnesis of a chronic nonspecific disease of lungs obstructive emphysema, pulmonary heart, pulmonary heart failure develops.
Chronic obstructive emphysema of lungs
Represents a chronic nonspecific disease of lungs as which morphological basis permanent expansion of a gleam of respiratory bronchioles and alveoluses as a result of chronic obstruction of pneumatic ways against the background of chronic bronchitis and the obliterating bronkhiolit acts. Lungs gain the increased lightness, become reinflated, increased in sizes.
Clinical displays of emphysema are caused by sharp reduction of the area of gas exchange and violation of pulmonary ventilation. The symptomatology accrues gradually, in process of distribution of pathological changes on the big area of pulmonary fabric. The progressing short wind, cough with a poor mucous phlegm, weight loss disturbs. Barrel-shaped expansion of a thorax, cyanosis of skin, a thickening of nail phalanxes of fingers of hands as drum sticks pays attention. At emphysema infectious complications, pulmonary bleedings, pheumothorax are frequent. Heavy respiratory insufficiency becomes a cause of death.
As morphological substratum of the real form of chronic nonspecific diseases of lungs serve meshkovidny, cylindrical or spindle-shaped expansions of bronchial tubes. Bronkhoektaza can have local or diffusion character, the congenital or acquired origin. Congenital bronkhoektaza are caused by violations of development of a bronchial tree in the prenatal and post-natal periods (as a result of pre-natal infections, at a syndrome of Ziverta-Kartagenera, a mukovistsidoza, etc.). The acquired bronkhoektaza can be formed against the background of recidivous bronkhopnevmoniya, a hr.bronkhit, long finding of a foreign matter in bronchial tubes.
The main respiratory symptoms include constant cough, allocation of a flavovirent phlegm with a smell, sometimes a blood spitting. Aggravations proceed as exacerbations of chronic purulent bronchitis. The extra pulmonary simptomokompleks at a bronkhoektatichesky disease is presented by deformation of fingers in the form of drum sticks and nails in the form of hour glasses, "warm" cyanosis. Pulmonary bleeding, lung abscess, warm and pulmonary , , purulent meningitis, sepsis can become complications of a chronic nonspecific disease of lungs. Each of these states poses potential hazard to life of the patient with HNZL.
Patomorfologichesky changes at chronic pneumonia combine an inflammatory component, a karnifikation, hr.bronkhit, bronkhoektaza, chronic abscesses, pneumofibrosis therefore now the given chronic nonspecific disease of lungs as the independent nosology admits not all authors. Each aggravation of a hr.pnevmoniya leads to emergence of the new centers of an inflammation in pulmonary fabric and to increase in the area of sclerous changes.
It is necessary to carry cough with office of a phlegm to the constant symptoms accompanying the course of chronic pneumonia (mucopurulent remission in a phase and purulent in an aggravation phase) and permanent rattles in lungs. In the sharp period body temperature increases, there are breast pains in an infiltrate projection, respiratory insufficiency. The disease can be complicated by pulmonary heart failure, an abstsedirovaniye, an empiyemy pleura, gangrene of lungs, etc.
The chronic nonspecific disease of lungs proceeding with replacement of the functioning parenchyma with connecting fabric carries the name of a pneumosclerosis. Is a consequence of inflammatory and dystrophic processes, leads to wrinkling, a bezvozdushnost and consolidation of pulmonary fabric. Often develops in the outcome of a hr.bronkhit, BEB, hr.pnevmoniya, HOBL, pnevmokonikoz, pleurisy, a fibroziruyushchy alveolit, tuberculosis and . other. On prevalence of changes distinguish a local (focal) and diffusion pneumosclerosis. On degree of expressiveness of growth of connecting fabric allocate three stages of pathological process - pneumofibrosis, a pneumosclerosis, pneumocirrhosis.
It is shown both by symptoms prichinno of a significant disease, and signs of respiratory insufficiency (short wind, cough, a cyanotic shade of skin, "Hippocrates's fingers"). In a stage of cirrhosis of a lung deformation of a thorax is sharply expressed, the atrophy of pectoral muscles is noted. The patient is weakened, quickly is tired, loses in weight. The course of the main disease leads to progressing of a pneumosclerosis, and the pneumosclerosis makes heavier the main pathology.
Diagnostics of HNZL
The diagnosis of various forms of chronic nonspecific diseases of lungs is established by the pulmonologist taking into account features of a clinical course of pathology and results of tool and laboratory diagnostics. For confirmation of nature of morphological changes the survey X-ray analysis of lungs which if necessary is supplemented with a linear tomography or KT of a thorax is carried out.
For the purpose of identification of structural changes in a bronchial tree the bronkhoskopiya (if necessary with a fence of a phlegm or a biopsy), a bronchography is carried out. By means of the analysis of a phlegm and washout from bronchial tubes (microscopic and microbiological) it is possible to specify activity of inflammatory process in bronchial tubes and the reason of its emergence. Helps to estimate functional reserves of lungs at chronic nonspecific diseases research FVD. It is possible to reveal signs of a hypertrophy of the right ventricle of heart by an electrocardiography and EhoKG.
Treatment of HNZL
Treatment of chronic nonspecific diseases of lungs depends on etiologichesky factors, pathogenetic mechanisms, extent of morfofunktsionalny changes, sharpness of process. However it is possible to allocate some general approaches to treatment of the HNZL various independent forms.
For the purpose of knocking over of infectious and inflammatory processes in bronchial tubes and lungs antimicrobic medicines taking into account sensitivity of microflora are selected. Bronkholitichesky, expectorant and sekretolitichesky means are appointed. For the purpose of sanitation of a bronchial tree the bronkhoalveolyarny unleavened wheat cake is carried out. In this period the posturalny drainage, vibromassage, the microwave oven and Ural federal district on a thorax are widely used. During attacks of difficulty of breath bronchodilators, oxygenotherapy are recommended.
Out of an aggravation dispensary observation of the pulmonologist, treatment in sanatorium, LFK, a speleoterapiya, aero phytotherapy, reception of vegetable adaptogens and immunomodulators is shown. With the desensibilizing and anti-inflammatory purpose glyukokortikosterodida can be appointed. For adequate control over a current basic therapy OH is selected.
The question of surgical tactics at chronic nonspecific diseases of lungs is raised in case of development of permanent local morphological changes of lungs or bronchial tubes. Most often resort to a resection of an affected area of a lung or a pnevmonektomiya. At a bilateral diffusion pneumosclerosis transplantation of lungs can be shown.