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CHRONIC NON-SPECIFIC LUNG DISEASES

About 7% of the total adult population is sick with COPD.

Classification:

Chronic diseases. Genetically determined pulmonary dysplasias.

Acquired diseases

a) with a primary lesion of the bronchi

b) with a predominant lesion of the parenchyma.

Tracheobronchial dyskinesia. During exhalation, stenosis of the bronchus occurs with a prolapsed membrane (expiratory suffocation) during coughing, physical effort.

Mounier-Kun disease. At the age of 8–10 years, the trachea is oversized, dilated and practically devoid of cartilage. This is an extreme degree, is rare. Closure of the trachea by 15-20% - 1 degree, 20-30% - 2 degrees, more than 30% - 3 degrees of tracheobronchial dyskinesia. Surgical methods of treatment are not perfect enough (transplantation of costal cartilage or synthetic atraumatic tube, which is worse). Tracheobronchial dyskinesia occurs with prolonged chronic bronchitis during exacerbation, but rarely more than 1 degree.

Polycystic lung disease. Symmetrically or asymmetrically located cavities. For years, it may not manifest clinically, clinical manifestations of infection, then resembles bronchiectasis with saccular bronchiectasis. Since in most cases the pathology is 2-sided, it is unfavorable for surgical treatment.

Cartagena Syndrome. There are polycystic lungs. This is characterized by situs wiscerus inwersus + bone defects - additional ribs, spina bifidum. Currently, about 70 dysplasias are known, but the rest are extremely rare.

Genetically determined:

1) Cystic fibrosis (7% of all congenital). This is a change in the viscosity of the secretion of all externally secreting glands (saliva, sweat, bronchial glands, etc.). The secret is more viscous. In a pronounced variant, a fatal outcome in the first days of life, since the intestine cannot be freed from meconium. (Such cases are in the homozygous version). In milder cases, symptoms of chronic obstructive bronchitis, inability to provide forced breathing during physical exertion. The 2nd symptom is coughing, it is very tense, because the cilia do not work because of the thick secret, it intensifies with physical exertion. The third symptom is the rapid development of emphysema. The infection quickly joins, severe purulent obstructive bronchitis develops. Sputum has a peculiar appearance, it can not be shaken out of the spittoon, as it is very sticky. It is necessary to find out the genetic history. Digestive defects are often added: loss of appetite, a tendency to diarrhea, poor digestibility of food, in these children growth and weight lag behind.


Diagnosis: sweat analysis and other special methods are performed in special centers. Restrictions on choosing a profession: dust free, in a warm place. Treatment: mucolytic drugs, bronchodilators, acetylcysteine ​​in inhalation. Without treatment, a pulmonary heart will develop. Alpha-1-antitrypsin deficiency (1%).

PROTECTIVE SYSTEMS

The proteolytic system of the lungs is needed for proteolysis of the inhaled foreign protein. The oxidative system. Phagocytosis and muccellular clearance.

Alpha-1-antitrypsin acts as an antiproteolytic system. It is synthesized in the liver. With its deficiency, proteolysis of its own connective tissue structures occurs and a mild emphysema develops. Almost nothing to treat so far, only a lung transplant.

Generalized hypoxia and hypoxemia develop. shortness of breath, first at exertion, then at rest. “Drum sticks” and “watch glasses”, diffuse cyanosis. The only curative measure: permiator - enriches air with oxygen up to 40%.

Congenital immunity deficiency - Bruton's disease (0.1%). Boys are ill, transmitted hereditarily. Clinic: purulent inflammatory diseases of the lungs: pneumonia, purulent bronchitis, empyema. It is very difficult to treat.

Acquired diseases in most have prerequisites in a genetic predisposition. 2 groups of acquired diseases: acute and chronic.

Acute - with acquired damage to the bronchi - acute bronchitis and acute tracheitis; acute lesions of the parenchyma; acute pneumonia, acute destruction of the lung.

Chronic with acquired damage to the bronchi - chronic bronchitis, bronchial asthma, bronchiectasis. Chronic with damage to the parenchyma: emphysema, chronic pneumonia - 1.5% of all chronic lung disease.

Chronic pneumonia is a chronic, recurrent inflammatory process in a limited area of ​​the pulmonary parenchyma, leading to the formation of focal pneumosclerosis. Most often, the 9 - 10 segment is on the right, but it also happens on the left, also the average lobe of the right lung, the reed segments of the left lung. Chronic pneumonia often occurs in a place where there is a "bad bronchus." It is necessary to differentiate from bronchial cancer, bronchoscopy, cytological examination of sputum, tomography are necessary. In chronic pneumonia, cylindrical or spindle-shaped bronchiectases occur. There is little sputum, but frequent bleeding. They can be radically treated surgically.
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