University of Zagreb. School of Medicine. Chair of Internal Medicine.
Abstract
Kronična opstruktivna plućna bolest (KOPB) je upalna i progresivna bolest dišnog sustava
koja obuhvaća kronični opstruktivni bronhitis, emfizem i astmu, a karakterizirana je ireverzibilnom ili slabo reverzibilnom opstrukcijom dišnih putova. KOPB je velik javnozdravstveni problem koji zbog svojeg kroničnog tijeka i visoke prevalencije među populacijom značajno opterećuje zdravstvene resurse. To se prvenstveno odnosi na česte
posjete specijalističkim ambulantama, hospitalizacije zbog akutnih egzacerbacija te potrebe za kroničnom terapijom. Postupan razvoj simptoma (kašalj, iskašljavanje i zaduha) je uzrok
kasnog dijagnosticiranja KOPB-a, što znatno narušava kvalitetu života, smanjuje radnu sposobnost, povećava invalidnost i stopu smrtnosti. Kronični opstruktivni bronhitis se klinički manifestira kroničnim produktivnim kašljem u trajanju od 3 mjeseca kroz 2 uzastopne godine (drugi uzroci kašlja isključeni). Prema GOLD-u (Global Initiative for Chronic Obstructive Lung Disease) bolest se klasificira u 4 stupnja prema izraženosti simptoma, nalazu spirometrije i razvoju komplikacija. ----- U kliničkom tijeku možemo razlikovati stabilnu fazu bolesti i egzacerbacije. Egzacerbacija podrazumijeva pogoršanje simptoma, a praćena je komplikacijama i povećanim rizikom smrtnog ishoda. Najčešći uzrok egzacerbacija su respiratorne infekcije te kardiovaskularne bolesti koje se smatraju najvažnijim komorbiditetom u bolesnika s KOPB-om. Svrha liječenja KOPB-a je spriječiti progresiju bolesti i učestalost egzacerbacija, poboljšati kvalitetu života te smanjiti smrtnost. Svakako treba naglasiti da je bolest u velikoj mjeri preventabilna i da pušenje, kao najjači faktor rizika za razvoj bolesti, treba smanjiti ili najbolje ukloniti u potpunosti. ----- Važan korak u liječenju je edukacija pacijenta o bolesti i poticanje na aktivno sudjelovanje u terapiji. Bronhodilatatori su temelj simptomatskog medikamentoznog liječenja. U terapiji
stabilnog KOPB-a koriste se kratkodjelujući i dugodjelujući beta-adrenergički agonisti i antikolinergici. U slučaju egzacerbacije, potrebno je utvrditi postoje li kriteriji za hospitalizaciju, te osnovnu terapiju intenzivirati kortikosteroidima, oksigenoterapijom i antibioticima (ovisno o nalazu sputuma). Hospitalizacija ovisi o težini KOPB-a, brzini progresije simptoma, prisutnosti komorbiditeta, odgovoru na ambulantno liječenje te mogućnostima adekvatne kućne skrbi.Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory disease of the
respiratory system comprising chronic obstructive bronchitis, emphysema and asthma, and is
characterized by an irreversible or poorly reversible airway obstruction. Because of it’s
chronic character and high prevalence among the population, COPD is a major public health
problem and significant burden on healthcare resources. That primarily involves frequent
visits to specialized clinics, hospitalization for acute exacerbations and the need for chronic
therapy. The gradual development of symptoms (cough, sputum production and shortness of
breath) is the cause of the late diagnosis of COPD, which significantly impairs quality of life,
reduce work capacity, increase disability and mortality. Chronic bronchitis is defined
clinically as the presence of a chronic productive cough for 3 months during each of 2
consecutive years (other causes of cough being excluded). According to the Global Initiative
for COPD (GOLD) disease is classified into 4 levels according to the severity of symptoms,
spirometry findings and the development of complications. ----- The clinical course can vary from stable phase of the disease to exacerbation. Exacerbations
include instability or worsening of symptoms and are associated with the development of
complications, and an increased risk of death. The most common cause of exacerbations are
respiratory infections and cardiovascular diseases which are considered the most important
comorbidities in patients with COPD. The treatment goals are to prevent progression of the
disease and the frequency of exacerbations, to improve quality of life and reduce mortality. It
should be noted that the disease is largely preventable and that smoking, as the strongest risk
factor for developing the disease, should be reduced or eliminated entirely. ----- The most important steps in the treatment are patient education about the disease and the
encouragement for his active cooperation in the therapy. Bronchodilators are the cornerstone
of symptomatic drug treatment. Generally, short-acting and long-acting beta adrenergic
agonists and anticholinergics are commonly used. In case of exacerbation, it is necessary to
establish if the patient meets criteria for hospitalization or is it necessary to modify the
existing therapy by introducing corticosteroids, oxygen therapy and antibiotics (depending on
the findings of sputum). Hospitalization depends on the severity of COPD, the rate of
progression of symptoms, the presence of comorbidities, response to outpatient treatment and
the possibilities of adequate home care
