Zgodnje odkrivanje kronične obstruktivne bolezni : ali se splača in kako to naredimo? = Early diagnosis of chronic obstructive pulmonary disease : is it cost-effective and how can it be accomplished?
Šuškovič, Stanislav
Chronic obstructive pulmonary disease (COPD) is typically a disease of cigarette smokers. It develops very slowly, so that patients do not detect itssymptoms for many years or tend to interpret them ...in their own way. Naturally, they notice regular coughing and expectoration in the morning, but think this is normal for cigarette smokers. Later, they feel breathlessness upon physical exertion, which they quite correctly ascribe to their poor levelof fitness. Because of breathlessness, they tend to avoid physical exertion and prefer to sit at home, which leads to a further loss of physical fitness (1, 2). COPD is marked by several vicious cycles. A lack of exercise and social isolation tend to bring latent depression in many patients with COPD to the surface. According to some estimates, this happens in up to 30 to 40% of these patients. Depression makes them even more socially isolated, theysmoke even more, and the disease progresses at an increased rate (2). COPDis a systemic disease, which in addition to lungs also affects peripheral muscles. Cytokines such as TNF alpha (tumor necrosis factor alpha), which is released in large quantities from pathologically inflamed lungs and overflows the entire body, cause peripheral muscles to deteriorate and patients also lose weight. For this reason as well, they are not keen on any physical activity. Because of poor nutrition and a lack of exercise, patients with COPDfrequently develop significant osteoporosis (3). How do cigarettes cause damage to the lungs? Severe irreversible damage occurs at the level of small airways - bronchioles. These become cicatrized very slowly, but irreparably, their lumen is reduced and obstruction unstoppably increases. The patients detect this progressive bronchial obstruction via increasing breathlessness upon physical exertion. In patients with COPD, the alveoli are gradually destroyed and emphysema develops. Lung damage due to emphysema is also irreversible (4).
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