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Methods for the early active detection of chronic obstructive pulmonary disease

Level 1 screening is done by a nurse under the supervision of a physician. Questioning, portable ventilometers are used. This allows you to identify not only mild forms of cyclic bronchial asthma, but also acyclic forms, lungs and moderate forms of chronic bronchitis.

The questionnaires include the epidemiological criteria of chronic bronchitis (cough up to 2-3 months a year for two years) in risk groups (working in dusty, gasified rooms, in the cold, with pneumotropic agents in the chemical industry). Alarming symptoms: cough, shortness of breath, decreased FEV1. The irreversible nature of obstruction is documented by tests with bronchodilators: an increase in FEV1 does not exceed 10-15%. For chronic obstructive bronchitis, a decrease in the FEV 1 indicator in dynamics is characteristic. Risk groups: smokers; patients with frequent acute respiratory viral infections; persons whose profession is associated with harmful pneumotropic factors.

Risk facts of bronchial asthma: frequent (2-3 times a year) ARVI; acute bronchopulmonary diseases with a protracted resolution of the inflammatory process; chronic bronchopulmonary diseases; bronchial asthma and (or) allergic diseases in the family; adverse environmental conditions in the area of ​​residence, at work and at home, in kindergarten and school (for children).

Ventilation using portable devices helps to identify chronic bronchitis, cyclic and acyclic forms of bronchial asthma.

The most acceptable for outpatient practice is the Ventilometer VM1. A doctor or nurse teaches the patient techniques for proper breathing, otherwise you can get an artifact.

The patient takes a quiet breath and exhale, 2-3 times. Then it is proposed to take a deep, slow breath followed by a sharp and complete exhalation into the device’s tube. Readings are recorded. Two more similar studies are being done, the evidence is being recorded. If the indicators differ by no more than ± 6% (according to FEV1, l), the result is reliable.
For the calculation, the experimental data with the maximum values ​​are taken.

Forced vital lung capacity by inspiration (FVC, l), forced expiratory volume in the first second (FEV1, l), Tiffno-Votchal index (FEVI / FVC,%), peak volume expiratory flow rate (PEF, l / min) are evaluated. The obtained patient indices are compared with normal ones by the nomogram attached to the device. Normal values ​​depend on the patient’s gender, age and height.

In healthy individuals, the FVC and FEVI values ​​should not be less than 80% of the norm, the FEV1 / FVC ratio ranges from 85-100%, PEF exceeds 75% of the norm.

The most common pathology options:

• FEV1 is lowered, FVC is normal or lowered, FEV1 / FVC is lowered, PEF is normal and / or lowered - a conclusion is made about the obstructive type of respiratory failure;

• FEV1 is normal or decreased, FVC is reduced, FEV1 / FVC is normal or increased, PEF is normal - a conclusion is made about the restrictive type of respiratory failure;

• FEV1 is reduced, FVC is reduced, FEV1 / FVC is normal, PEF is reduced - you should think about a mixed type of respiratory failure.

A rarer variant is when FEV1 is reduced, FVC is normal, FEV1 / FVC is reduced, PEF is reduced, and it is possible to express a judgment on obstruction of the upper respiratory tract (stenosis of the larynx, trachea, etc.).

Using table 19, the doctor and nurse will be able to assess the severity of respiratory disorders.

Samples with bronchodilators. Prior to the test, FEV1 and FVC are determined; the patient is inhaled with the test bronchodilator. After 20-40 minutes, at the peak of the drug, the parameters FEV1 and FVC are again determined. Determine (in%) the change in indicators after inhalation. An increase of 25% or more indicates a good reaction to the test drug, 15-24% - a moderate reaction, 10-14% - a weak reaction. The reaction is considered negative with a decrease of 10% or more.

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Methods for the early active detection of chronic obstructive pulmonary disease

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