CC BY
20
© КОЛЛЕКТИВ АВТОРОВ, 2016 УДК 616.24-07
A. Chenca1, S. A. Chenca2, T. Sandle3
MEDICAL DATA REGARDING FUNCTIONAL EXPLORATION IN LUNG PATHOLOGY
1Faculty of medicine of Transilvania university of Bra§ov (Romania), 2Psychiatry and neurology hospital Bra§ov (Romania), 3Bio Products Laboratory (United Kingdom)
This study aims to assess the investigations carried out to monitor respiratory function in lung pathologies. From this point of view, COPD is the focus exploration of the respiratory function. In addition to the theoretical data, the study brings together heterogeneous group performed spirometry, results of patients who have had symptoms and they were in the medical services for a period of time.
Keywords: risk factors, disease, ethiopathogenetic mechanisms, diagnosis, prevention, screening, monitoring
Pulmonary pathologies drew attention to COPD, due to the high incidence and associated morbidity [5, 21]. According with various studies and knowing different medical informations regarding COPD, was developed a specific health guide. So, for monitoring invalidity potential of the patient's with COPD and for them integration into daily socio-human activities, were developed rules and criteria, written in the specific disease guide, according to this pathology profile [7, 12].
More than that, COPD is currently one of lung pathologies that requires careful monitoring and, in this context, requires also a medical management, in respect of using strict protocols by specific medical guide [11, 18]. In this context, we can mention the nowaday use of the specialized COPD guideline [15]. For diagnostic purpose of this disease, medical methods are envisaged used by those who are part of the multidisciplinar team dealing with the diagnosis of COPD [4, 19]. As any pathology, COPD is based on bio-molecular mechanisms in conjunction with pathophysiological mechanisms [2, 16]. From a specific medical point of view, evaluation of respiratory function in COPD is done by routine spirometry without or with bronchodilator test substances, depending of the signs and symptoms for each patient [6]. In this context, spirogram shows the respiratory parameters, the type of airflow limitation, the degree of COPD, to patients with this disease [1, 9].
In addition with specific medical examination and adjacent functional respiratory exploration, for a proper disease diagnostic, it is also important to perform to patients, standard chest X-ray, as an useful imaging method for confirming specific radiological changes in this disease [3, 22]. Certainly, in the diagnosis of COPD, smoking occupying an important place. in addition to risk factors related to lifestyle factors are taken into consideration ambiental factors, em-
ployment and residence area of the ill patients [14, 20].
To reduce risks arising from the gradual advance towards advanced stages of COPD, it is considered useful to implement practical educational methods, with purposes of knowing the disease from different medical perspectives and also the health risks depending of this pathology [10, 13]. In this context, as in any pathology, prevention of COPD is one effective measure for reducing the risks associated with the disease [8, 17].
The aim of the study is evaluation of respiratory function in lung diseases like COPD, using spirometry test. For this purpose, we used two types of spirometry, without test and with test to betamimetics substances, to a hetero-genous group of patients, involving males and females with different residence areas, who were patients in three distinct months for first quarter of 2015.
This study aims at presenting an evaluation of the incidence of COPD in patients who were presented as symptomatics, in the specific medical unit. The study is retrospective and has been done during the first quarter of 2015. The study included all patients who were presented as symptomatics, for disease diagnostic, as a significant group. The evaluated patients were from different residence areas, with different ages, being males and females. Being a statistical study, data were plotted.
The study conducted during the first quarter of 2015 yielded spectacular results on the exploration of respiratory function in patients from the group investigated.
The heterogeneous study group, included all symptomatic patients, with residence in urban areas and rural areas, of both genders with different age groups (table 1).
Since the investigation of respiratory function is useful as a complementary exam of pneu-
Клиническая медицина_
Table 1 - Age groups of patients in the study group
Age group 1 2 3 4 5 6
Age in years 5 - 14 15 - 24 25 - 39 40-59 60-79 After 80
mology, below will present data on the results of the examination spirometry test performed both, this means without and with bronchodilatator test substances. More important to know results performing spirometry without bronchodilatator substances. In this context, of spirometric tests, 265 were performed without bronchodilatator test in males and 204 in womens. Spirometry performed in January 2015 to male gender are shown in the chart below (fig. 1). Spirometry performed in January 2015 to females, are shown in the chart below (fig. 2).
genders, with bronchodilatator test substances (fig. 3). In February 2015, were performed 172 spirometry without bronchodilatator test and 68 spirometry with bronchodilatator test (fig. 4). Spirometry performed to womens in the month of February 2015 were considerably more numerous are those made without bronchodilatator test, respectively 145 and only 71 performed with bronchodilatators tests (fig. 5). In February 2015 were performed in both genders 317 spirometry, patients having a place of residence both urban and rural areas. Also in the month of February 2015 were performed 139 spirometry with bron-chodilatator test in patients of both genders, both from urban and rural residence area (fig. 6).
Figure 1 - Spirometry performed in males. January 2015
Figure 3 - Spirometry performed in both genders. January 2015
Figure 2 - Spirometry performed in womens. January 2015
According to results from the study, spi-rometry performed without bronchodilatator test substances were significantly less in both genders, in the month of January 2015. In the context of both genders were made in January, a total of 469 spirometry without bronchodilatator test and only 110 spirometry performed in both
Figure 4 - Spirometry performed in males. February 2015
Of these investigations, spirometry performed in males were more compared with those in womens. Those without betamimetics test are more numerous than those made with the ron-chodilatator test. In March 2015 were carried 288
Figure 6 - Spirometry performed in both genders. February 2015
spirometry to males patients and 290 spirometry to females patients. As in the previously described months in this study, which was performed spirometry predominantly to males, compared to those that were carried out to females, the study showed the predominance of the spi-rometry test applied to patients, without the bronchodilatator substances.
Total spirometry performed to males in March 2015 is shown in the chart below (fig. 7). This graph gives the percentage correlation of the number of spirometry performed to males in March 2015, respectively 226 investigations without test to bronchodilatators and 62 investigations with test to bronchodilatators. Spirometry performed in womens in March 2015 were 226 without bronchodilatator test and only 64 spirometry with the bronchodilatator test (fig. 8). In March 2015 were performed a total of 578 spi-rometry, to patients from the study group, both from urban and rural residence area. Percentage exploration of respiratory function in March 2015 was equal for both genders, although spirometry test was performed without test or with test to bronchodilatators (fig. 9).
Knowing that this study relates to the exploration of respiratory function to patients with
Figure 8 - Spirometry performed in womens. March 2015
Figure 9 - Spirometry performed in both genders.
March 2015
signs and simptoms typical for COPD, for this disease diagnostic, has been implied an interdisciplinary medical team. For a proper diagnosis for COPD, usually are involved pulmonologists, radiologists, working as a high qualified medical staff , for the same purpose, as we mentioned in the present study.
CONCLUSSIONS The study achieve the importance of investigating respiratory function. Making spirometry is useful in lung pathologies affecting the parameters involved in pulmonary function testing. From there, should be concluded that COPD is one of
the most important pathology. From another point of view, the study results have shown predominant exposed patients to COPD, group both genders, with residence in urban area, with age 60-79 years. Knowing a lot of medical informations about COPD and investigation for diagnosis, usually spirometry test is done without bronchodilators but may be accompanied by performing spirometry test substances with betamimetics, where the gravity of the pathology requires. Such situations are encountered in advanced stages of COPD with high level of bronchial obstruction. In these situations, patients with serious symptoms, carry out the investigations, substance inhaled bronchodilators improving bronchial obstruction degree. After previous exposure and as a finally conclusion, results and discussions are eloquent for the purpose of the present study.
REFERENCES
1 Airflow limitation by the Global Lungs Initiative equations in a cohort of very old adults /E. Turkeshi, B. Vaes, E. Andreeva et al. // Eur. Respir. J. - 2015. - V. 46. - Pp. 123-132.
2 Association between emphysema-like lung on cardiac computed tomography and mortality in persons without airflow obstruction: a cohort study /E. C. Oelsner, E. A. Hoffman, A. R. Folsom et al. //Ann. Intern. Med. - 2014. - V. 161. - Pp. 863-873.
3 Clinical relevance of diagnosing COPD by fixed ratio or lower limit of normal: a systematic review /W. D. van Dijk, N. Gupta, W. C. Tan et al. //COPD. - 2014. - V. 11. - Pp. 113-120.
4 COPD prevalence in a random population survey: a matter of definition /P. Shirtcliffe, M. Weatherall, S. Marsh et al. //Eur. Respir. J. -2007. - V. 30. - Pp. 232-239.
5 Crapo R. O. Reference spirometric values using techniques and equipment that meet ATS recommendations /R. O. Crapo, A. H. Morris, R. M. Gardner //Am. Rev. Respir. Dis. - 1981. - V. 123. - Pp. 659-664.
6 Dynamic laryngeal narrowing during exercise: a mechanism for generating intrinsic PEEP in COPD? /M. Baz, G. S. Haji, A. Menzies-Gow et al. //Thorax. - 2015. - V. 70. - Pp. 251-257.
7 Fletcher C. The natural history of chronic airflow obstruction /C. Fletcher, R. Peto //Br. Med. J. - 1977. - V. 1. - Pp. 1645-1648.
8 Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO 13. Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary /R. A. Pauwels, A. S. Buist, P. M. A. Calverley et al. //Am. J. Respir. Crist.
Care. Med. - 2001. - V. 163. - Pp. 1256-1276.
9 Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary /K. F. Rabe, S. Hurd, A. Anzueto et al. //Am. J. Respir. Crist. Care. Med. - 2007. - V. 176. - Pp. 532-555.
10 Hegerl U. Depression and suicidality in COPD: understandable reaction or independent disorders? /U. Hegerl, R. Mergl //Eur. Respir. J. -2014. - V. 44. - Pp. 734-743.
11 Interpretative strategies for lung function tests /R. Pellegrino, G. Veii, V. Brusasco et al. //Eur. Respir. J. - 2005. - V. 26. - Pp. 948968.
12 Jones W Paul. Depression: a characteristic comorbidity of COPD? //Eur. Respir. J. -2014. - V. 44. - Pp. 570-571.
13 Mannino D. M. Interpreting lung function data using 80% predicted and fixed thresholds identifies patients at increased risk of mortality /D. M. Mannino, E. Diaz-Guzman //Chest. -2012 . - V. 141. - Pp. 73-80.
14 Mannino D. M. Obstructive pulmonary disease in the older adult: what defines abnormal lung function? /D. M. Mannino, A. S. Buist, W. M. Vollmer //Thorax. - 2007. - V. 62. - Pp. 237-241.
15 Population impact of different definitions of airway obstruction /B. R. Celli, R. J. Hal-bert, S. Isonaka et al. //Eur. Respir. J. - 2003. -V. 22. - Pp. 268-273.
16 Reference ranges for spirometry across all ages: a new approach /S. Stanojevic, A. Wade, J. Stocks et al. //Am. J. Respir. Crist. Care. Med. - 2008. - V. 177. - Pp. 253-260.
17 Smoking cessation strategies in patients with COPD /J. M. Warnier, E. S. E. van Riet, H. Frans et al. //Eur. Respir. J. - 2013. - V. 41. -Pp. 727-734.
18 Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper /B. R. Celli, W. MacNee, A. Agusti et al. //Eur. Respir. J. - 2004. - V. 23. -Pp. 932-946.
19 Swanney M. P. Adopting universal lung function reference equations /m. P. Swanney, M. Miller //Eur. Respir. J. - 2013. - V. 42. - Pp. 901903.
20 The ratio of FEVi to FVC as a basis for establishing chronic obstructive pulmonary disease /C. A. Vaz Fragoso, J. Concato, G. McAvay et al. //Am. J. Respir. Crist. Care. Med. - 2010. -V. 181. - Pp. 446-451.
21 The relations between structural changes in small airways and pulmonary-function tests /M. Casio, H. Ghezzo, J. C. Hogg et al. //N.
Engl. J. Med. - 1978. - V. 298. - Pp. 1277-1281.
22 Using the lower limit of normal for the FEVi/FVC ratio reduces the misclassification of airway obstruction /M. P. Swanney, G. Ruppel, P.
L. Enright et al. //Thorax. - 2008. - V. 63. - Pp. 1046-1051.
Received 14.03.16
А. Ческа, С. А. Ческаа2, Т. Сэндл3
ВОЗМОЖНОСТИ ФУНКЦИОНАЛЬНОЙ ДИАГНОСТИКИ ПАТОЛОГИИ ЛЕГКИХ
1 Факультет медицины университета Трансильвании Брашов (Румыния),
2 Госпиталь психиатрии и неврологии Брашов (Румыния), 3Bio Products Laboratory (Соединенное Королевство Великобритании)
В статье проведен анализ исследований, проведенных для контроля дыхательной функции при патологии легких. С этой точки зрения, хроническая обструктивная болезнь легких находится в центре внимания при исследовании дыхательной функции легких. Помимо теоретических данных, в статье описан анализ исследования неоднородной группы больных, которым была выполнена спирометрия, описаны результаты обследования пациентов, у которых регистрировались симптомы хронической обструктивной болезни легких, и которые обращались за медицинской помощью в определенный период времени.
Ключевые слова: факторы риска, болезни, этиопатогенетические механизмы, диагностика, профилактика, скрининг, мониторинг
А. Ческа1, С А. Ческа2, Т Сэндл3
9КПЕПАТОЛОГИЯСЫНЫН ФУНКЦИОНАЛДЫДИАГНОСТИКАСЫНЫЦМYМКIНД[КТЕРI Трансильвания Брашов (Румыния) университетннн медицина факультет, 2Брашов (Румыния) психиатрия жэне неврология госпитал, 3Bio Products Laboratory (¥лыбритания Бiрiккен КорольдП)
Макалада екпе патологиясы кез1нде тыныс алу функциясын бакылу ywH жYргiзiлген зерттеулердщ талдауы келт1р1лген. Осы кезкарас т¥рFысынан алып Караганда екпенщ созылмалы обструктивт1 ауруы екпенщ тыныс алу функциясын зерттеу кез1нде басты назарга алынган. Теориялык мэл1меттермен катар, макалада б1р тект емес наукастар тобын зерттеудН талдауы сипатталган, онда спирометрия орындалган, екпенщ созылмалы обструктивт1 ауруы т1ркелген жэне белг1л1 б1р кезенде медициналык кемекке жYгiнген пациенттерд1 зерттеудН нэтижелер1 бертген.
Клт сездер: тэуекел факторлары, аурулар, этиопатогенетикалык тет1ктер, диагностика, профилактика, скрининг, мониторинг
