Хроническая обструктивная болезнь легких (ХОБЛ) во всем мире является важнейшей причиной болезненности и смертности, приводящим к существенному экономическому и социальному ущербу. Статья посвящена проблеме диагностики ХОБЛ. Детально расcмотрены аспекты этиопатогенеза, клинических проявлений болезни. Описан алгоритм обследования больного на амбулаторном этапе. Ключевые слова: хроническая обструктивная болезнь легких, диагностика хронической обструктивной болезни легких.
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Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, leading to significant economic and social damage all around the world. The article deals with the diagnosis of COPD. Discussed in detail are the aspects of the etiology and pathogenesis, clinical manifestations of the disease. The algorithm of examination of the patient is also described. Key words: COPD, COPD diagnosis, diagnostic criteria, respiratory symptoms.
1. Глобальная инициатива по хронической обструктивной болезни легких. Глобальная стратегия диагностики, лечения хронической обструктивной болезни легких. Пересмотр 2006. М.: Атмосфера, 2007.
2. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020 Global Burden Disease Study. Lancet 1997; 349 (9064): 1498–504.
3. ERS/ELF European lung White Book 2003.
4. Siafakas NM, Vermeire P, Pride NB et al. Optimal assessment and management of COPD/The European Respiratory Task Force. Eur Respir J 1995; 8: 1398–420.
5. Soriano JR, Maier WC, Egger P et al. Recent trends in physician diagnosed COPD in women and men in the UK. Thorax 2000; 55: 789–94.
6. Mannino DM, Homa DM, Akinbami LJ et al. COPD surveillance – USA 1971–2000. MMWR Surveill Summ 2002; 51 (6): 1–16.
7. Клинические рекомендации. Хроническая обструктивная болезнь легких. Под ред. А.Г.Чучалина. М.: Атмосфера, 2003.
8. Клинические рекомендации. Хроническая обструктивная болезнь легких Под ред. А.Г.Чучалина. М.: Атмосфера, 2007.
9. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet 2007; 370: 765–73.
10. Viegi G, Pistelli F, Sherrill DL et al. Definition, epidemiology and natural history of COPD. Eur Respir J 2007; 30: 993–1013.
11. Шмелев Е.И. Хроническая обструктивная болезнь легких в руководстве «Респираторная медицина». Т. 1, разд. 8. М.: ГЭОТАР-Медиа, 2007.
12. Buist AS. Risk for COPD. Eur Respir Rev 1996; 6: 253–8.
13. Standarts for the diagnosis and care of patients with chronic ostractive pulmonary disease. Am J Respir Crit Care Med 1995; 152: 77–120.
14. Viegi G, Vollmer WM. Epidemiology of COPD: overview the US perspective, a European perspective. Eur Respir J 2003; 22 (Suppl. 43):
1s-7s.
15. Celli BR, MacNee W. AST/ERS Task Forse. Standards for diagnosis and treatment of patient with COPD: a summary of the AST/ERS position paper. Eur Respir J 2004; 23 (6): 932–46.
16. Stockley RA, O’Brien C, Pye A et al. Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD. Chest 2000; 117 (6): 1638–45.
17. Bestall JC, Paul EA, Garrod R et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999;
54 (7): 581–6.
18. Calverly PMA, Georgopoulos D. Chronic obstructive pulmonary disease: symptoms and signs in «Management of chronic obstructive pulmonary disease». ERS Monograph 38 2008.
19. Клинические рекомендации. Пульмонология. Под ред. А.Г.Чучалина. М.: ГЭОТАР-Медиа, 2005.
20. Хроническая обструктивная болезнь легких. Федеральная программа. 2-е изд., перераб. и доп. Под ред. А.Г.Чучалина.
М., 2004.
21. Global strategy for diagnosis, management, and proventation of chronic obstructive pulmonary disease. National Institutes of Health; National Heart, Lung, and Blood Institutes; updated 2003.
22. Van der Molen T, Willemse BW, Schokker S et al. Development, validy and responsiveness of the clinical COPD Questionnaire health Qual life. Outcomes 2003; 1 (1): 13.
23. Kesten S, Chapman KR. Physician perceptions and management of COPD. Chest 1993; 104 (1): 254–8.
24. Loveridge B, West P, Kryger MN, Autonisen NR. Alteration in breathing pattern with progression of chronic obstructive pulmonary disease. Am Rev Resp Dis 1986; 134 (5): 930–4.
25. Bianchi R, Gigliotti F, Romagnoli J et al. Chest wall kinematics and breathlessness during pursed-lip breathing in patients with COPD. Chest 2004; 125 (2): 459–65.
26. Lacass Y, Rousseau L, Maltais F. Prevalence of depressive symptoms and depression in patients with sever oxygen-dependent chronic obstructive pulmonary disease. J Cardio-Pulm Rehabil 2001; 21: 80–6.
27. Garcia-Pachon E, Padilla-Navas I. Frequency of Hoover’s sign in stable patients with COPD. Internation. J Clin Pract 2006; 60 (5): 514–7.
28. Badgett RG, Tanaka DJ, Hunt DK et al. Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone? Am J Med 1993; 94 (2): 188–96.
29. Pellegrino R, Viegi G, Brusasco V et al. Interpretative strategies for lung function tests. Eur Respir J 2005; 26 (5): 948–68.
30. Gibson GJ, MacNee W. Chronic obstructive pulmonary disease: investigations and assessment of severity in «Management of chronic obstructive pulmonary disease». ERS Monograph 38 2008.
31. Kelly CA, Gibson GS. Relation between FEV1 and peak expiratory flow in patients with chronic airflow obstruction. Thorax 1988;
43 (4): 335–6.
32. Jackson H; Hubbard R. Detecting chronic obstructive pulmonary disease using peak flow rate: cross sectional survey. BMJ 2003;
327 (7416): 653–4.
33. Тюрин И.Е. Рентгенологическое исследование при обструктивных заболеваниях легких. Атмосфера. 2008; 4 (15): 29–35.
34. Авдеев С.Н. Хроническая обструктивная болезнь легких (карманное руководство для врачей). М.: Атмосфера, 2006.
35. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998; 158: 1384–87.
36. Siafakas NM. Definition and differential diagnosis of chronic obstructive pulmonary disease in «Management of chronic obstructive pulmonary disease». ERS Monograph 38 2008.
37. Hardie JA, Buist AS, Vollmer WM, Ellingsen I et al. Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. Eur Respir J 2002; 20 (5): 1117–22.
Авторы
С.И.Овчаренко
ГБОУ ВПО Первый МГМУ им. И.М.Сеченова Минздрава России