Care of patients with chronic lung diseases in family medicine

Abstract

Kronična opstruktivna plućna bolest (KOPB) je kronična multisustavna bolest obilježena progresivnom opstrukcijom dišnih putova koja nije u potpunosti reverzibilna. U KOPB-u dolazi do preklapanja simptoma kroničnog bronhitisa i plućnog emfizema uzrokovanih neprimjerenim upalnim odgovorom dišnih putova na dugotrajnu izloženost štetnim tvarima i plinovima. KOPB je četvrti uzrok smrtnosti u svijetu i značajan uzrok invalidnosti. U početku je bolest supklinička i razvija se polako, stoga se najčešće dijagnosticira pojavom simptoma u srednjim pedesetim godinama. Kao glavni rizični čimbenik u nastanku KOPB-a tradicionalno je smatrano pušenje što je i potvrđeno mnogim epidemiološkim studijama. Klinička slika obilježena je kašljem, produktivnim iskašljajem i zaduhom u naporu. Dijagnoza KOPB-a se postavlja na temelju anamneze, kliničkog pregleda i spirometrije, koja se smatra zlatnim standardom. Spirometrijski nalaz omjera forsiranog izdisajnog volumena u prvoj sekundi i forsiranog izdisajnog volumena (Tiffeneau indeks) manji od 0.70 upućuje na dijagnozu. Uz spirometriju koriste se testovi za procjenu težine bolesti poput CAT i mMRC upitnika, zatim radiogram pluća, analiza plinova u arterijskoj krvi i sl. Glavno mjesto u farmakološkom liječenju KOPB-a zauzimaju bronhodilatatori kratkog i dugog djelovanja, a kod težih oblika bolesti primjenjuju se i inhalacijski kortikosteroidi. Glavna uloga liječnika obiteljske medicine je preventivno djelovanje u vidu poticanja pacijenata na prestanak pušenja te pravovremeno prepoznavanje, liječenje, praćenje te edukacija bolesnika s KOPB-om. Bitno je istaknuti da su uz KOPB često prisutni komorbiditeti koje je potrebno pravovremeno prepoznati i liječiti. Unatoč dostupnosti i jednostavnosti testova za dijagnozu KOPB-a, rana dijagnoza ostaje jedan od vodećih javnozdravstvenih problema.Chronic obstructive pulmonary disease (COPD) is a chronic systemic disease characterized by airflow obstruction due to abnormalities of both airway (bronchitis) and lung parenchyma (emphysema) which is not fully reversible because of an abnormal inflammatory response of the lungs to noxious particles of gases. The airflow limitation is usually slowly progressive. It is the fourth leading cause of death in the world and an important cause of disability. The disease develops slowly and without any leading symptoms in the beginning, so most of the patients do not even know that they are sick. COPD has traditionally been considered as a disease of the lungs secondary to cigarette smoking, which has been confirmed by many epidemiological studies lately. Symptoms include cough, sputum production and dyspnea but the definitive diagnosis is made by spirometry, which stands for the gold standard nowadays. Spirometry itself is not sufficient to assess the disease severity so additional tests, as the CAT and mMRC questionnaires, arterial blood gas and chest X-ray can be used. Bronchodilatators play the central role in the pharmacological therapy and they can prevent and reduce symptoms and improve the quality of life. The main function of General Practitioners is to prevent the disease by encouraging patients to quit smoking, to recognize and diagnose the disease in the early stage, to monitor stable patients and manage exacerbations. As comorbidity is a common event in COPD, it is necessary to be recognized and treated in time. Although diagnostic tests are widely available and easy to perform, early diagnosis of COPD remains one of the leading public health problems