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© КОЛЛЕКТИВ АВТОРОВ, 2016 UDC 616.24-08
A. Chesca1, T. Sandle2, G. A. Gyurka1
MEDICAL CONSIDERATIONS REGARDING CHRONIC OBSTRUCTIVE PULMONARY DISEASE
1Faculty of Medicine of Transilvania University of Brasov (Romania), 2Bio Products Laboratory (United Kingdom)
The clinical manifestations of chronic obstructive pulmonary disease symptoms variably affect the health of the patients, requiring them to visit specialized doctors in medical units. Diagnosis is by a specialized and complete medical examination accompanied by laboratory investigation. The interpretation of the results has the aim of establishing an appropriate therapeutic conduct according to the stage of the disease. The selected medical methods, aimed at improving the symptomatology of the disease, are undertake to ensure the life quality of patients diagnosed with chronic obstructive pulmonary disease. Among the laboratory tests that are required in order to evaluate the respiratory function of patients is spirometry. To consider this a study was performed in the second quarter of 2014 on a population segment, selected from the medical specialized service. The study collected statistical data on the testing of the respiratory function. This provided a comprehensive picture of patients investigated by this functional exploration method. Key words, chronic obstructive pulmonary disease, patients, tests, spirometry, statistics, lungs
Chronic obstructive pulmonary disease (COPD) is a respiratory pathology that is extensively studied. Studies performed on COPD have different orientations. Some are related to epidemiological aspects, which refer to clinical issues and assess laboratory data; whereas other studies consider functional investigations to establish therapeutic regimens and patient monitoring [1, 12, 16].
Given the magnitude of this pathology, priority needs to be given to the determinants of the disease and the associated risk factors (either objective or subjective). It is important that health programs, for prevention and control of citizens' health, are in place [2, 8]. These screening programs are useful for early diagnosis as well as for prevention, and for creating of an appropriate treatment regimen [10, 17]. The pathology of COPD is in the form of chronic bronchitis and lung emphysema (the characteristic symptomatology). Using this information the corroboration of specific clinical data leads to the diagnosis of COPD. In this context, two entities regarding patients diagnosed with COPD are known [3, 4]. Thus, patients diagnosed with COPD, based on their chronic bronchitis, are heavy smokers. This has been clinically investigated [13, 20].
On the other hand, the category of patients diagnosed with emphysema-based COPD requires sizeable specialized investigation [21]. This includes, in addition to clinical examination, conducting laboratory tests. It is our argument that the diagnosis of COPD in this category of patients needs to be made by the combination of changes observed from standard chest radiographs in conjunction with data obtained from laboratory investigations [5, 11, 19]. In this context, it is im-
portant to note that patients diagnosed with COPD derived from lung emphysema show certain characteristics of prior pathology [15, 18]. In this regard, in the case of COPD, emphysema is defined by abnormal and permanent enlargement of air spaces beyond the terminal bronchioles and this is associated with the destructions of the alveolar walls, without the association of pulmonary fibrosis [7, 9].
In either of the two types of COPD, the testing of the respiratory function by performing spirometry (the measuring of breath) is necessary. This can be performed using betamimetic substances (drugs that mimic the stimulation of the beta-adrenergic receptors of the sympathetic nervous system), in patients who require it, depending on their stage of disease [6, 14].
The study outlined in this paper is a retrospective one. The study was performed by examining data gather over a three-month period. The collected data and analysis aims to highlight some aspects of pulmonary function tested in patients who had appointments at specialized physicians. The patients were demonstrating an acute exacerbation of their condition. In the context of assessing the status of the disease, spi-rometry tests were performed. The information collected in this study draws together many aspects of exploration of the respiratory function and shows the complex aspects that need to be considered for diagnosis.
MATERIAL AND METHODS
This study gathered medical information from spirometry tests in symptomatic patients. The results were analysed by physicians in the specialized ambulatory belonging to the TB Hos-
pital Brasov. The study included patients analysed in the second quarter of 2014. The tests of spi-rometry were performed in all patients who came to this medical unit. For patients under investigation spirometry, with tests including betamimet-ics, were performed. The spirometry tests were undertaken using Spirolab III spirometer model.
RESULTS AND DISCUSSION Testing of the respiratory function of patients was carried out in the second quarter of 2014. This was in order to establish the correct stage of the disease and to administrate appropriate regimens. The data was gathered based on certain parameters. One parameter was gender breakdown. Figure 1 presents the entire group of investigated patients divided into males and females (fig. 1). The study also aimed to observe the provenance of the patients by their area of residence: urban or rural (fig. 2). Given the fact that COPD is a disease that occurs in all age groups, with symptoms of lesser or higher severity, the study included statistical data relating to the age groups of the patients. Age groups are based on admission enrolment (fig. 3).
1000 989 952
900
700
■ Female
400 • 300 -U ■ Male
Figure 1 - Cases classified by gender
Figure 2 - Cases classified by area of residence
As a method of investigation of the pulmonary function, spirometry is performed initially in all patients without supporting testing. With this,
Figure 3 - Cases classified by age group
depending on the severity of the disease and in conformance with specialized medical indication, spirometer with and without betamimetics test substances like salbutamol inhaled in puffs were performed. The graph below displays the results of spirometry performed without the betamimetics test (fig. 4). The study assessed the obtained results after performing spirometry (fig. 5).
Figure 4 test
Case classified by spirometry without
Figure 5 - Cases classified by spirometry with test
The study examined the respiratory function in the group of investigated patients. The results of this study show that 1,941 COPD patients were symptomatic in the second quarter of 2014 and required specialized medical investigations. Of the patients in the study group, 989
were male and 952 female. This tallies with data that suggests an increased incidence of COPD in males compared to females. This is due to risk factors like smoking, working in an environment with toxins, environmental pollutants and low temperatures.
Male patients who were investigated were: April 2014, 192 lived in urban areas and 24 in rural areas; May there were 330 male patients in urban and 82 in rural areas; and ib the last month of the study, 322 patients were from urban areas and 39 male patients were from rural areas. From the study group, the numbers of female patients diagnosed with COPD were: in April, 200 were from urban areas and 38 were from rural areas. In May there were 362 patients in urban and 51 in rural areas. In June there were 267 female patients from urban areas and 34 female patients were from rural areas.
Given the fact that the testing of the pulmonary function using spirometry is mandatory, 795 free spirometry test in males and 753 free spirometry test in women were performed. In addition there were 194 conducted spirometry tests with test to betamimetics in men and 199 in women.
The data of the conducted study on the group of investigated patients shows that the most affected population segment by COPD is with adults aged between 40 and 59 years (685 patients). The age group least affected by COPD in the study group is the youngest population segment, between 8 and 24 years.
CONCLUSIONS
1. Given the high incidence and that COPD is a current, and complex pathology, patients diagnosed with COPD require careful monitoring of their respiratory function in order to be prescribed appropriate medications. In this context, the role of the specialized physician is to competently investigate the affected patients and to prescribe the adequate medication. Set correctly, proper treatment can improve the symptoms of patients diagnosed with COPD.
2. Here, the practical application of screening programs concerning respiratory function assessment are control measures that monitor the integrity or degree of deterioration of respiratory function parameters. This study has identified various factors: age, gender and area of residence that can help aid the physician when undertaking diagnosis.
3. Given the fact that this study is limited by only including statistics on testing of the respiratory function, the study of COPD should be continued with other studies in which spirograms and suggestive chest X- ray aspects of COPD can
be presented. Such studies of COPD are, by necessity, large given the complexity of symptoms and various demographic factors.
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Received 16.04.2016
А Ческа1 Т Сэндл2 Г А Гюрка1
СОВРЕМЕННЫЕ АСПЕКТЫ ЛЕЧЕНИЯ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХ 1 Факультет медицины университета Трансильвании Брашов (Румыния), 2Bio Products Laboratory (Соединенное Королевство Великобритании)
Клинические проявления хронической обструктивной болезни легких оказывают различное влияние на здоровье пациентов, заставляя их посещать специалистов в различных медицинских учреждениях. Диагноз хронической обструктивной болезни легких устанавливается на основании результатов специализированного и полного медицинского обследования с использованием лабораторных исследований. Интерпретация результатов преследует цель подбора соответствующей тактики лечения в соответствии со стадией заболевания. Выбранные медицинские методы, направленные на улучшение симптоматики заболевания, являются обязательными для обеспечения качества жизни пациентов с диагнозом хронической обструктивной болезни легких.
Одним из основных лабораторных тестов, необходимым для оценки дыхательной функции пациентов, является спирометрия. Исследование было проведено во втором квартале 2014 года среди населения, выбранного по результатам исследования медицинской специализированной службы. В исследовании собраны статистические данные об оценке дыхательной функции, что обеспечило создание полной картины результатов пациентов, проанализированных функциональным методом спирометрии.
Ключевые слова: хроническая обструктивная болезнь легких, пациенты, тесты, спирометрия, статистика,
легкие
А Ческа1 Т Сэндл2 Г А Гюрка
ЭКПЕН1Й СОЗЫЛМАЛЫ ОБСТРУКТИВТАУРУЫНА КАТЫСТЫМЕДИЦИНАЛЫК ПАЙЫМДАУ Брашов (Румыния) Трансильвания университеты^1 медицина факультетi, 2Bio ProductsLaboratory (¥лыбритания Б1рккен КорольдИ)
бкпенщ созылмалы обструктивт1 ауруы симптомдарынын клиникалык кер1н1стер1 пациенттердщ денсаулыктарына эртYрлi эсер1н типз1п, оларды тYрлi медициналык мекемелерге баруFа мэжбYP етедк бкпенН созылмалы обструктивт ауруынын диагнозы зертханалык тексерулердi колданумен мамандандырылFан жэне толык медициналык тексерудН нэтижелер^н непз^де аныкталады. НэтижелердН интерпретациясы аурудын денгей^е байланысты ™iCTi емдеу тактикасын тандауды максат етедг Аурудын симптоматикасын жаксартуFа баFытталып тандалFан медициналык эдiстер екпенН созылмалы обструктивт ауруы диагнозымен пациенттердщ емiр сапасын камтамасыз ету Yшiн м^детл болып табылады. ПациенттердН тыныс алу функциясын баFалау Yшiн кажетт непзп зертханалык тестшердН бiрi спирометрия болып табылады. Тексеру 2014 жылдын екiншi токсанында медициналык мамандандырылFан кызметтщ жYргiзген тексерулер^Н нэтижелерi бойынша тандалFан туррындардын арасында етюзтдк Тексеруге тыныс алу функциясын баFалау туралы статистикалык мэлiметтер жинакталды, бул спирометриянын функционалдык знамен тaлдaнFaн пациенттердщ нэтижелер^н толык сипатын жасауды камтамасыз еткен.
Клт сездер: екпенН созылмалы обструктивт ауруы, пациенттер, тестлер, спирометрия, статистика, екпе
