Treatment of exacerbations of chronic obstructive pulmonary disease

Abstract

Chronic obstructive pulmonary disease (COPD) and its exacerbations remain an important problem of clinical medicine. Aim. To assess the quality of medical care provided in large Russian hospitals to patients with COPD exacerbation. Materials and methods. The study included patients with acute exacerbations of COPD hospitalized into three large clinical hospitals in Moscow. The diagnosis of "COPD exacerbation" was established in accordance with current clinical recommendations. We collected the data about patients’ demography, clinical signs and symptoms, blood gas analysis, chest radiography, drug therapy, oxygen therapy and respiratory support. The follow-up period was 90 days. The obtained data were compared with the data of patients from the multicenter study "European COPD Audit". Results and discussion. The leading clinical symptoms in COPD exacerbation were dyspnea (95.4%) and sputum production (60.7%). The majority of patients with COPD received short-acting β2-agonists (77.4%), systemic steroids (85.1%), antibiotics (79.0%) and theophyllines (48.1%). Noninvasive ventilation was performed in 8.6% of patients, oxygen therapy - in 23,8% of patients, pulmonary rehabilitation - in only 6,2% of patients. Chest radiography was performed in 97.9% of patients, pulmonary function tests - in 79.8%, blood gases analysis - in 19.3% of patients. The mean duration of hospitalization was 18.2±3.9 days, repeated hospitalization within 90 days occurs in 36.2% of patients. In-hospital mortality was 3.3%. Conclusion. Based on the results of the study practical recommendations for improving the quality of medical care in acute exacerbations of COPD are proposed.

Clinical efficacy of mechanical bacterial lysate in the prevention of infectious exacerbations of chronic obstructive pulmonary disease

“…Обострение ХОБЛ -одна из самых частых причин обращения пациентов за неотложной медицинской помощью, в то время как тяжелые обострения ХОБЛ -основная причина смерти пациентов [2]. Наиболее частыми причинами обострений ХОБЛ считаются бактериальные и вирусные респираторные инфекции и атмосферные поллютанты, у пациентов с тяжелыми обострениями ХОБЛ чаще встречаются грамотрицательные энтеробактерии и Pseudomonas aeruginosa [2,3]. С целью профилактики инфекционных обострений ХОБЛ рекомендованы к применению вакцины против гриппа и пневмококка, а в некоторых странах -макролиды на постоянной основе [1,2].…”

Vaccine Prevention of Pneumococcal Infection Among Patients With Chronic Obstructive Pulmonary Disease and Coronary Heart Disease –- A 10-year Horizon of Effectiveness

“…Recently obtained data not only verify bronchopulmonary infection, con rming its role in COPD exacerbations, but also indicate the relationship between the severity of exacerbation of the disease and the nature of the isolated microbial ora. Thus, S. pneumoniae and H.in uenzae were found to be the main etiologic factor of infectious exacerbation (almost 50%) among patients with COPD exacerbation with forced expiratory volume in 1 s (FEV1) values more than 50% vs. normal ones [7].…”