Additional methods of examination

Clinical blood analysis: without significant changes, sometimes secondary erythrocytosis; in progression assess leukocytosis, neutrophilia, accelerated ESR.

Sputum analysis: sputum in patients with stable chronic bronchitis is mucoid. During an exacerbation, sputum usually becomes purulent, with an influx of neutrophils.

X-ray examination: in severe disease, persistent, marked overdistention of the lungs is indicated in the frontal view by a low, flat diaphragm and in .the lateral view by widening of t he retrosternal airspace and an increase in the angle formed by the sternum and diaphragm from acute to ≥ 90°. The heart shadow tends to be long and narrow.

Test of ventilatory function (spirometric recording and pneumotachymetry): pulmonary function tests are helpful in diagnosing COPD, in assessing its severity, and in following its progress. Forced expiratory spirometry quantifies airway obstruction. Airflow obstruction is an important indicator of symptomatic respiratory insufficiency and of the likelihood of blood gas abnormalities. The FEV₁ and the FEV₁/FVC fall progressively as the severity of COPD increases. The FEV₁ is less variable than other measurements of airway dynamics and can be predicted more accurately from age, sex, and height. Functional residual capacity and residual volume are increased; vital capacity is decreased. Roughly comparable information can be obtained from the forced expiratory flow-volume loop.

ECG: diagnosing pulmonary hypertension and cor pulmonale in COPD is difficult without right-sided heart catheterization. On the ECG, an R or R' wave as large as or larger than the S wave in lead V₁ and R wave smaller than the S wave in lead V₆ and right-axis deviation >110° without right bundle branch block support the diagnosis of cor pulmonale.

Echocardiography: especially with an esophageal transducer, and pulsed Doppler techniques to estimate mean pulmonary arterial pressure can be used to assess pulmonary hypertension and right ventricular function. Left ventricular size and performance are generally normal inpatients with COPD and no other associated cardiac abnormalities. The right ventricular ejection fraction is frequently abnormal, especially during exercise.

Blood gas analysis: arterial blood gas measurements detect hypoxemia and hypercapnia and determine their severity. In the early stages of COPD, measuring arterial blood gases reveals mild or moderate hypoxemia without hypercapnia. As the disease progresses, hypoxemia becomes more severe and hypercapnia supervenes. Hypercapnia occurs with increasing frequency as the FEV¹ falls below 1L. Blood gas abnormalities worsen during acute exacerbations and may worsen during exercise and sleep. .

Chronic bronchitis Chronic bronchitis is chronic inflammation of the bronchi and bronchioles. Etiology

- smoking, pollution of the environment by products of incomplete fuel substances combustion, organic and inorganic dust;

- infection (bacterial, viral, micoplasms, fungus);

- congenital occurrences in lesser circulation on heart failure;

- exposure of metabolic products on renal failure;

- result of acute bronchitis.

Classification of chronic bronchitis (by N.R Paleev, 1990)

I. According to the character of inflammatory process:

- simple (catarrhally);

- purulent;

- muco-purulent;

- special forms: hemorrhagic and fibrinous.

//. According to the presence of bronchial obstruction:

- obstructive bronchitis (stages: I, II, III; duration: simple, moderate grave, grave);

- non obstructive bronchitis.

III. According to the level of bronchi injury:

- proximal;

- distal;

- diffuse.

IV. According to the duration:

- latently;

- with infrequent aggravations;

- with frequent aggravations;

- continuously progress.

V. According to the phases:

- progress;

- remission.

VI. According to the complications:

- emphysema of the lungs;

- hemoptysis;

- pneumonia;

- respiratory failure;

- "Cor pulmonale".