Peculiarities of comorbid pathology among JFO participants
The purpose of the work is to determine the features of the clinical course and the presence of comorbid pathology in servicemen with COPD, participants in JFO (Joint Forces Operation).
Materials and methods. 64 servicemen, participants of JFO, who were hospitalized in the clinics of the NMMCC "GVKG" and sought the advice of a pulmonologist, were examined. Patients were divided into two groups: 1-st group - 35 patients with COPD, group B, GOLD 2, who had mostly signs of chronic obstructive bronchitis, without signs of exacerbation; group 2-nd - 29 patients with asthma, persistent, moderate severity, controlled, combined with COPD, group B, GOLD 2. The mean age of patients was 44.5±3.6 years.
Results. It was found that patients of group 2-nd had a history of asthma with classic manifestations of paroxysmal cough and shortness of breath, and the duration of COPD (classic symptoms of COPD - persistent cough with sputum and shortness of breath) was probably shorter. In both groups of patients in a high percentage of cases concomitant pathology was represented by cardiovascular diseases: in 1-st group of patients in a probably higher percentage of cases there were signs of Heart Failure I-II stage and coronary heart disease. Arterial Hypertension Stage II was detected in both groups, however, patients in group 2-nd had more individuals with stage I AH (p<0.05). In patients with a combination of asthma and COPD, a significantly higher percentage of people with GERD was found, which indicates the provocative effect of regurgitation of gastric acid content on the development of bronchoobstructive syndrome. Pathology of the kidneys and urinary system was presented by CKD I-II stage, which in probably a higher percentage of cases occurred in patients with isolated COPD with the phenotype of chronic bronchitis. In the same group of patients there were probably more people with excess over weight and obesity of the first degree. The number of comorbidities in servicemen with COPD ranged from 1 to 5. At the same time, more than 50% of patients had three or more diseases at the same time.
Conclusions. Servicemen with an Asthma and COPD overlap (ACO) are likely to have a greater number of complaints and symptoms, which significantly affect the activity and performance of professional functions. Long smoking history and high smoking index are the main factors in the formation of COPD in patients with asthma. Patients with ACO have classic spirometry signs of COPD (decrease in the postbronchodilation ratio of FEV1/FVC less than 70%) and reversibility of bronchial obstruction. In patients with COPD, the main comorbid pathology is represented by pathology of the cardiovascular system: arterial hypertension stage II, coronary heart disease and heart failure stage I-II. In the combined course of COPD and asthma in patients in a probably higher percentage of cases revealed pathology of the digestive system - GERD. In the serum of patients with a combination of COPD and asthma revealed an imbalance of cytokines, which is manifested by elevated levels of IL-4 and high concentrations of TGF-β, which are markers of bronchial hyperreactivity and bronchial remodeling.
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