ESTIMATION OF INDICES EXTERNAL RESPIRATION’ FUNCTION AMONG PATIENTS WITH THE CHRONIC OBSTRUCTIVE PULMOARY DISEASE IN COMBINATION WITH THE ISCHEMIC HEART DISEASE ON THE BACKGROUND OF THE METHABOLIC SYNDROME

Treumova S. I., Petrov Ye. Ye., Burmak Yu. G., Boriak V. P.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The chronic obstructive pulmonary disease (COPD) is one of the most important medico-social problems both in Ukraine and in the world. According to the data of the WHO, 600 million people suffer from the COPD, and this amount will have been doubled by 2020. According to the prognosis, the COPD will take the third place among the main reasons of mortality. Many experts inform that the COPD is a multimorbid state. Ischemic heart disease (IHD), arterial hypertension, metabolic imbalance is a background for a manifestation of the COPD. Prevalence of metabolic syndrome (MS) among the patients with the COPD is from 21 to 53% (during its early stages, peculiarly). Comorbidity of the COPD with the cardiovascular pathology (with the MS, peculiarly) remains the most important. Nowadays the COPD is interpreted as a progressive disorder of the function of external respiration (FER). Decrease of forced expiratory volume per 1 second (FEV1) by 10% promotes to increase of the mortality risk by 14% or cardiac death by 28%. Taking into account the above-mentioned information our aim was to study ventilation disorders among the patients with the isolated COPD and in combination with the IHD on the background of the MS. We have marked the increase of the respiratory rate (RR) even among the patients with the isolated COPDII – 19,0±0,3 (among healthy people – 16,0±0,2). It is a compensatory reaction (due to a development of the pulmonary failure), which is typical of these patients for supporting of a gas exchange and a gas composition of blood at the adequate level. The RR among the patients of the 1st group (COPD+IHD) has increased by 3,0±0,2 in comparison with the isolated COPD (a comparison group). It testifies about the adding of the left ventricular load (typical of the IHD) and it is confirmed by changes of the left border of a relative cardiac dullness, an electrocardiogram, an echocardiogram. These changes are more evident among the patients of the 2nd group (with the metabolic imbalances). It directs to a severer course of the disease and is caused by higher percentage of the pulmonary and heart failure (when hypercapnia and acidosis aggravate the course) and increased metabolic needs. A tendency to increase of the minute respiratory volume (MRV), the decrease of the maximal lung ventilation (MLV), FEV1, forced vital capacity (FVC), vital capacity (VC) is marked with progressing of the pulmonary and heart failure (among the patients with the MS peculiarly). A comparison of the 1st group with the isolated COPD has revealed a significant decrease of VC by 5,7±0,5% (P<0,05), peak expiratory flow rate (PEFR) by 20,0±0,4 l/min (P<0,01), minute volume flow rate (MVFR)75 by 5,8±0,7% (P<0,05), FEV1 (the main index of bronchial patency) by 10,3±0,6% (P<0,05). These indices change more intensively among the patients of the 2d group (with MS). Respiratory disorders of the mixed type (obstructive and restrictive) are verified among them (among patients with the isolated COPD – the obstructive mainly). Restrictive disorders are connected with an adding of an abdominal obesity as a result of the MS. Besides, disorders of bronchial patency at the level of the all calibers’ bronchi were revealed in this group of the patients. Expiratory force among the patients with the COPD and the IHD has decreased by 1,1±0,1l/sec. in comparison with healthy people. It is caused both by disorder of bronchial patency and by changes of the lungs’ rigidity, their VC. Its further decrease is caused significantly by development of metabolic disorders which lead to an aggravation of the lung ventilation, increase of the lung failure’s degree, a severity of the course of disease and an aggravation of the prognosis. It is confirmed by significant differences of FEV1 and MVFR75 between patients with the isolated COPD and the COPD with the IHD on the background of the MS. Reversibility of bronchial obstruction is marked to have more stable irreversible character among the patients with the COPD and the IHD on the background of MS. It reflected a dominant of emphysema in pathogenesis of the disease. Summing up the indices of FER, it is necessary to mark that they were more changed among the patients with the COPD in combination with the IHD on the background of the MS in comparison with patients with the isolated COPD. It testifies about “the mutual complication syndrome” which leads to a severer course of disease, early disability and mortality. Respiratory disorders among the patients with the combined pathology on the background of the MS have mixed (obstructive and restrictive) type mainly.

chronic obstructive pulmonary disease, ischemic heart disease, combined pathology, metabolic syndrome, bronchial obstruction, heart failure, function of external respiration

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