RU2303956C1 - Method for predicting the development of chronic obstructive pulmonary disease in patients at no signs of bronchial obstruction - Google Patents

Abstract

FIELD: medicine, therapy, pulmonology.

SUBSTANCE: the present innovation deals with predicting the development of chronic obstructive pulmonary disease (COPD), determining clinical symptoms and risk factors out of life anamnesis: dyspnea, passive smoking, sputum production, cough, crepitation in lungs, episodes of cough with sputum being more than 3 wk, sex, snore. It is necessary to establish their gradations and digital values. Then one should estimate prognostic coefficients F₁, F₂, F₃ by the following formulas: F₁=-4.10-3.35*A₁-2.68*A₂-1.74*A₃-1.22*A₄-0.48*A₅-0.10*A₆-0.20*A₇-0.32*A₈; F₂=-5.69-3.32*A₁+4.62*A₂-1.21*A₃-0.08*A₄-0.79*A₅-0.08*A₆-0.25*A₇+0.01*A₈; F₃=-8.14+7.47*A₁-1.79*A₂-1.16*A₃-0.95*A₄-0.19*A5-0.76*A₆+0.69*A₇+0.38*A₈; F₄=-12.4+3.90*A₁-0.05*A₂+5.87*A₃+3.17*A₄+2.14*A₅+0.98*A₆+0.09*A₇+0.20*A₈. At F₄ being above F₁ or F₂ or F₃ or F₄ one should predict high risk for COPD development. At F₂ being above F₁, or F₃, or F₄ - low risk for COPD development. The innovation enables to carry out early onset of prophylactic measures.

EFFECT: higher accuracy and efficiency of prediction.

3 ex, 1 tbl

Description

The present invention relates to medicine, namely to therapy and pulmonology, and can be used to predict the development of chronic obstructive pulmonary disease.

A known method for predicting bronchial obstruction in chronic bronchitis by determining the concentration of interleukin-1 (IL-1) in the blood, saliva, bronchoalveolar fluid. After that, the distribution coefficient (CR) for IL-1 is established as the ratio of the amount of IL-1 of blood to the amount of IL-1 of saliva and it is found out with an increase in the content of IL-1 by more than 10 times in blood, 2 times in saliva, unchanged level bronchoalveolar interleukin-1. When CR for IL-1 is more than 1.0, bronchial obstruction is predicted (Method for predicting bronchial obstruction in chronic bronchitis: Application No. 2002111601/15 RU: IPC ⁷ G01N 33/50 / Postnikova LB, Kubysheva NI - 2002.04 stated .29).

Closest to the proposed is a method for predicting the progression of airway obstruction in patients with chronic obstructive pulmonary disease by an integrated assessment of bronchial reactivity and smoking. (Kolosov V.P., Kolosov A.V. 13 National Congress on Respiratory Diseases. - St. Petersburg. November 10-14, 2003)

The known method includes a comprehensive examination, determination of functional spirographic indicators, smoking person index (IR), airway reactivity assessment using a pharmacological bronchial provocation test with acetylcholine chloride solution. Using a discriminant analysis, an equation is derived that allows prediction of the progression of airway obstruction in patients with COPD.

The disadvantages of this method, as well as similar, include the fact that the known methods are not designed to predict the development of COPD in people who do not have functional signs of bronchial obstruction, because the main condition for the implementation of known methods is the presence of a disease and prediction of its progression.

In addition to the disadvantages of the prototype should also include the possibility of complications caused by bronchial provocation tests, the complexity of the methodology for its implementation, high economic cost, the duration of its implementation and the inability to use in most medical institutions.

The task of the invention is to develop a method for predicting the development of COPD in individuals who do not have functional signs of bronchial obstruction.

The technical result of the proposed method is to provide an opportunity to assess the risk of developing COPD in people who do not have functional signs of bronchial obstruction, as well as to simplify the method.

The technical result of the proposed method is achieved by the fact that the subject determines the functional spirometric indicators.

The difference of the method lies in the fact that in the absence of signs of bronchial obstruction, clinical symptoms and risk factors from the history of life are additionally determined: the presence of shortness of breath, secondhand smoke, sputum separation, coughing, wheezing, the presence of cough episodes for more than 3 weeks, gender, the presence of snoring.

Establish gradations and numerical values of clinical symptoms and risk factors, after which prognostic factors F ₁ , F ₂ , F ₃ , F _{4 are} determined by the formulas:

F ₁ = -4.10-3.35 * A ₁ -2.68 * A ₂ -1.74 * A ₃ -1.22 * A ₄ -0.48 * A ₅ -0.10 * A ₆ - 0.20 * A ₇ -0.32 * A ₈

F ₂ = -5.69-3.32 * A ₁ + 4.62 * A ₂ -1.21 * A ₃ -0.08 * A ₄ -0.79 * A ₅ -0.08 * A ₆ - 0.25 * A ₇ + 0.01 * A ₈

F ₃ = -8.14 + 7.47 * A ₁ -1.79 * A ₂ -1.16 * A ₃ -0.95 * A ₄ -0.19 * A ₅ -0.76 * A ₆ + 0.69 * A ₇ + 0.38 * A ₈

F ₄ = -12.4 + 3.90 * A ₁ -0.05 * A ₂ + 5.87 * A ₃ + 3.17 * A ₄ + 2.14 * A ₅ + 0.98 * A ₆ + 0.09 * A ₇ + 0.20 * A ₈ ,

respectively, where A _1-8 - gradations and numerical values of clinical symptoms and risk factors (A ₁ - shortness of breath, A ₂ - passive smoking, A ₃ - sputum production. And ₄ - cough, A ₅ - wheezing, A ₆ - episodes cough with sputum lasting more than 3 weeks, A ₇ - sex, A ₈ - snoring).

With numerical values of F ₄ greater than F ₁ , or F ₂ , or F ₃ predict a high risk of developing COPD, and with a value of F ₂ greater than F ₁ , or F ₃ , or F ₄ - a low risk of developing COPD.

The table below shows the characteristics of the signs and the coefficients of the discriminant function (K ₁ j, K ₂ j, K ₃ j, K ₄ j).

Symptoms Graduation K ₁ j K ₂ j K ₃ j K ₄ j 1. Dyspnea (A ₁ ) 0 - no, 1 - there -3.35 -3.32 7.47 3.9 2. Passive smoking (A ₂ ) 0 - no, 1 - there -2.68 4.62 -1.79 -0.05 3. Sputum production (A ₃ ) 0 - no, 1 - there -1.74 -1.21 -1.16 5.87 4. Cough (A ₄ ) 0 - no, 1 - there -1.22 -0.08 -0.95 3.17 5. Whistling wheezing (A ₅ ) 0 - no, 1 - there -0.48 -0.79 -0.19 2.14 6. Episodes of cough with sputum lasting more than 3 weeks (A ₆ ) 0 - no, 1 - there -0.10 -0.08 -0.76 0.98 7. Sex (A ₇ ) 0 - male -0.20 -0.25 0.69 0.09 1 - female 8. Snoring (A ₈ ) 0 - no, 1 - there -0.32 0.01 0.38 0.20

The authors of the proposed method determined the values of the constants: F ₁ = -4,10; F ₂ = -5.69; F ₃ = -8.14; F ₄ = -12.4.

If the value of F _{4 is} greater than F ₁ , F ₂ or F ₃ , then the subject is at high risk for COPD. With a value of F ₂ greater than F ₁ , F ₃ or F ₄ , the risk of developing COPD is low.

The authors of the proposed method found that patients with a maximum value of F ₄ have a high risk of developing COPD at 46.4%.

Minimum risk of developing COPD in patients with a maximum F ₂ value. According to the authors of the proposed method, the minimum risk of developing COPD is 8.7%.

Patients with the maximum values of prognostic factors in F ₁ or F ₃ have a risk of developing COPD of 24.6% and 20.3%, respectively.

From the analysis of patent and specialized literature, the authors found that the proposed method has features that distinguish it not only from the prototype, but also other technical solutions in this and related fields of medicine and, therefore, the proposed technical solution meets the criteria of the invention of "novelty."

In the literature available to us, no method for predicting the development of COPD has been identified, taking into account the proposed combination of general and specific clinical symptoms and risk factors in people who do not have functional signs of bronchial obstruction.

The set of techniques of the proposed method allows to achieve a technical result, namely, to provide an opportunity to assess the risk of developing COPD in people who do not have functional signs of bronchial obstruction by identifying specific and general risk factors. Thus, the proposed method meets the criterion of "inventive step".

A method for predicting the development of COPD in individuals who do not have functional signs of bronchial obstruction, comprising the claimed invention, is intended for use in healthcare. The implementation of its capabilities is confirmed by the methods and means described in the application. From the above it follows that the claimed invention meets the condition of patentability "industrial applicability".

The proposed method is as follows. The subject determines the functional spirometric indicators. The history of life reveals the presence of certain clinical symptoms and risk factors: shortness of breath, secondhand smoke, sputum production, cough, wheezing, cough and sputum episodes lasting more than 3 weeks, sex, snoring. The established signs are assigned gradations and numerical values. Then, according to the formula, prognostic factors F ₁ , F ₂ , F ₃ , F _{4 are} determined, their numerical characteristics are compared with each other and the risk of developing COPD is assessed. So, with F ₄ greater than F ₁ , F ₂ , or F _{3 they} predict a high risk of developing COPD, and with a value of F ₂ greater than F ₁ , F ₃ , or F ₄ - a low risk of developing COPD.

The proposed method for predicting the development of COPD in individuals who do not have functional signs of bronchial obstruction is illustrated by specific examples.

Example No. 1. Patient V., born in 1945. After a survey in 2000, a diagnosis of COPD was established. A retrospective analysis was performed on an outpatient map, as a result of which, according to 1990 data, the following risk factors were determined in a patient: shortness of breath (1), cough (1), sputum production (1), male sex (0), snoring (1).

F ₁ = -4.10-0.20 * 0-1.22 * 1-1.74 * 1-3.35 * 1-0.32 * 1 = -10.73

F ₂ = -5.69-0.2 * 0-0.08 * 1-1.21 * 1-3.32 * 1 + 0.01 * 1 = -10.54

F ₃ = -8.14 + 0.69 * 0-0.95 * 1-1.16 * 1 + 7.47 * 1 + 0.38 * 1 = -2.4

F ₄ = -12.4 + 0.09 * 0 + 3.17 * 1 + 5.87 * 1 + 3.9 * 1 + 0.20 * 1 = 0.74

According to the obtained indicators, the patient belonged to a high-risk group for developing COPD, because the prognostic factor F ₄ has a maximum numerical value (0.74).

Example No. 2

Patient A., born in 1955 No data are currently available for COPD. A retrospective analysis of the outpatient map based on data from 1995 established the following risk factors and symptoms: secondhand smoke (1), episodes of cough with sputum lasting more than 3 weeks (1), female gender (1).

F1 = -4.10-0.20 * 1-2.68 * 1-0.10 * 1 = -7.08

F2 = -5.69-0.25 * 1 + 4.62 * 1-0.08 * 1 = -1.4

F3 = -8.14 + 0.69 * 1-1.79 * 1-0.76 * 1 = -10

F4 = -12.4 + 0.09 * 1-0.05 * 1 + 0.98 * 1 = -11.38

This patient was at low risk for developing COPD, as F2 - maximum (-1.4). During follow-up from 1995 to the present, when examining the data for COPD, it was not found.

Example No. 3

Patient R., born 1950 Currently, according to spirometry, there are no signs of COPD. The following risk factors have been identified: male gender (0), sputum production (1), cough (1), wheezing (1).

F1 = -4.10-0.20 * 0-1.74 * 1-1.22 * 1-0.48 * 1 = -7.54

F2 = -5.69-0.25 * 0-1.21 * 1-0.08 * 1-0.79 * 1 = -7.77

F3 = -8.14 + 0.69 * 0-1.16 * 1-0.95 * 1-0.19 * 1 = -10.44

F4 = -12.4 + 0.09 * 0 + 5.87 * 1 + 3.17 * 1 + 2.14 * 1 = -1.22

This patient has a high risk of developing COPD, as Among the established prognostic factors, F ₄ has a maximum numerical value (-1.22).

The effectiveness of the proposed forecasting method was evaluated in the experimental group of 144 patients with COPD and in the control group of 575 people without COPD. The forecast accuracy was 74.3%.

Thus, the proposed method makes it possible to predict the development of COPD in individuals who do not have functional signs of bronchial obstruction, which allows an early start of preventive measures.

Claims (1)

A method for predicting the development of chronic obstructive pulmonary disease (COPD) in people who do not have functional signs of bronchial obstruction, characterized in that clinical symptoms and risk factors from a medical history are determined: shortness of breath - A ₁ , with 0 in the absence of dyspnea and 1 for the presence of shortness of breath; second-hand smoke - A ₂ , while assigning 0 in the absence of second-hand smoke and 1 - in the presence of second-hand smoke; sputum production - A ₃ , while assigning 0 in the absence of sputum and 1 - in the presence of sputum; cough - A ₄ , while assigning 0 in the absence of cough and 1 - in the presence of cough; wheezing wheezing - A ₅ , while assigning 0 in the absence of wheezing and 1 - in the presence of wheezing; episodes of cough with sputum lasting more than 3 weeks - A ₆ , while assigning 0 in the absence of cough with sputum and 1 - in the presence of cough with sputum; gender - A ₇ , while assigning 0 to the male sex, 1 to the female sex; snoring - A ₈ , while assigning 0 in the absence of snoring and 1 - in the presence of snoring; establish their numerical values, and then determine the prognostic factors F ₁ , F ₂ , F ₃ , F ₄ according to the formulas F ₁ = -4.10-3.35 · A ₁ -2.68 · A ₂ -1.74 · A ₃ -1.22 · A ₄ -0.48 · A ₅ -0.10 · A ₆ - 0.20 · A ₇ -0.32 · A ₈ , F ₂ = -5.69-3.32 · A ₁ + 4.62 · A ₂ -1.21 · A ₃ -0.08 · A ₄ -0.79 · A ₅ -0.08 · A ₆ - 0.25 · A ₇ + 0.01 · A ₈ , F ₃ = -8.14 + 7.47 · A ₁ -1.79 · A ₂ -1.16 · A ₃ -0.95 · A ₄ -0.19 · A ₅ -0.76 · A ₆ + 0.69 · A ₇ + 0.38 · A ₈ , F ₄ = -12.4 + 3.90 · A ₁ -0.05 · A ₂ + 5.87 · A ₃ + 3.17 · A ₄ + 2.14 · A ₅ + 0.98 · A ₆ + 0.09 · A ₇ + 0.20 · A ₈ , and with F ₄ greater than F ₁ , or F ₂ , or F _{3 they} predict a high risk of developing COPD, and with a value of F ₂ greater than F ₁ , or F ₃ , or F ₄ - a low risk of developing COPD.