Author/Editor		Šuškovič, Stanislav
Title		Zgodnje odkrivanje kronične obstruktivne bolezni: ali se splača in kako to naredimo?
Translated title		Early diagnosis of chronic obstructive pulmonary disease: is it cost-effective and how can it be accomplished?
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 42, št. Suppl 4
Publication year		2003
Volume		str. 5-9
Language		slo
Abstract		Chronic obstructive pulmonary disease (COPD) is typically a disease of cigarette smokers. It develops very slowly, so that patients do not detect its symptoms 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 level of 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, they smoke even more, and the disease progresses at an increased rate (2). COPD is 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 COPD frequently 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).
Summary		Kronična obstruktivna pljučna bolezen (KOPB) je tipično bolezen kadilcev cigaret. Razvija se zelo počasi, zato bolniki dolga leta ne zaznajo simptomov bolezni ali pa si jih razlagajo po svoje. Seveda opazijo, da zjutraj kašljajo in izkašljujejo. Vendar menijo, da je to za kadilce cigaret normalen pojav. Kasneje se jim pojavi naduha ob telesnih obremenitvah, ki jo bolniki pripišejo slabi telesni kondiciji. Pa še kar prav imajo. Zaradi naduhe se bolniki izogibajo telesnim naporom, posedajo doma in ob tem zares izgubijo telesno kondicijo (1, 2). KOPB označujejo nekateri nesrečni začarani krogi. Zaradi telesne neaktivnosti in socialne izolacije se mnogim bolnikom s KOPB razkrije prikrita (latentna) depresija. Po ocenah je takšnih bolnikov 30-40%. Zaradi depresije so bolniki še bolj socialno izolirani, še več kadijo in bolezen pospešeno napreduje (2). KOPB je sistemska bolezen, ki poleg pljuč prizadene periferno mišičje. Zaradi citokinov, kot je TNF alfa (dejavnik tumorske nekroze alfa), ki se v obilici sproščajo v bolezensko vnetih pljučih in preplavljajo organizem, periferno mišičje propada, bolniki tudi hujšajo. Tudi zato bolniki niso zavzeti za kakršnokoli telesno aktivnost. Zaradi slabe prehrane in pomanjkanja gibanja se pri bolnikih s KOPB pogosto razvije pomembna osteoporoza (3). Kako cigarete okvarjajo pljuča? Hude in nepopravljive okvare se dogajajo na nivoju malih dihalnih poti - bronhiolov. Ti se zelo počasi, toda nepopravljivo brazgotinijo, svetlina se jim zmanjšuje in zapora se neustavljivo povečuje. Bolniki napredujočo zaporo sapnic (bronhijev) zaznavajo kot napredujočo naduho ob telesnih obremenitvah. Bolnikom s KOPB propadajo pljučni mešički - razvije se emfizem. Tudi emfizemska okvara pljuč je nepopravljiva (4).
Descriptors		LUNG DISEASES, OBSTRUCTIVE FORCED EXPIRATORY VOLUME ANOXEMIA HYPERCAPNIA BLOOD GAS ANALYSIS OXYGEN