RU2565018C1 - Method of screening assessment of development of chronic obstructive pulmonary disease, associated with presence of arterial hypertension - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: spirometry is performed for people with arterial hypertension. Indices of forced exhalation volume for first second FEV1, forced vital capacity of lungs (FVC) and ratio of said two indices FEV1/FVC are determined. If FEV1 values are 85-80% and FEV1/FVC is 75-70%, risk of development or early stage of chronic obstructive pulmonary disease is predicted.

EFFECT: method makes it possible to efficiently predict risk of development or early stage of chronic obstructive pulmonary disease at the background of arterial hypertension, carry out timely treatment due to carrying out spirometry in people with arterial hypertension and assessment of optimal indices.

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Description

The invention relates to medicine, in particular to pulmonology and cardiology, and relates to a method for predicting the risk of chronic obstructive pulmonary disease (hereinafter, COPD) in patients with arterial hypertension (hereinafter AH). The essence of the method is to use spirography as a screening in patients with arterial hypertension for early diagnosis of changes in the function of external respiration. Using the method allows to predict an increased risk of developing COPD against a background of hypertension, before the development of the pathological process or in the early stages of the disease.

The invention can be used in the field of predictive (preventive), diagnostic and preventive medicine.

Currently, in pulmonology the following patents are known analogues diagnosing COPD.

A known method for the differential diagnosis of clinical and pathogenetic variants of bronchial asthma (hereinafter BA) and the initial stage of chronic obstructive pulmonary disease, described in the patent for the invention of Russia No. 2442532, publ. 07/27/2013

The disadvantage of this method is that it is difficult to apply in practical medicine, since the determination of the content of the cytokine IL-4, cytokine IL-8, the content of transferrin antioxidant is possible only in specialized laboratories.

A known method for predicting the risk of developing bronchial asthma described in the patent for the invention of Russia No. 2510508, publ. 03/27/2014. This method involves the extraction of DNA from lymphocytes of the patient’s peripheral venous blood, genotyping of the polymorphic variant rs7216389 of the gasdermin B gene (GSDMB), the polymorphic variant rs12342831 of the beta gene 1,4-galactosyl transferase 1 (B4GALT1) and the polymorphic variant rs1496499 of the growth factor binding gene 3 (IGFBP3), and when identifying one of the combinations of genotypes at three polymorphic loci of genes.

The disadvantage of this method is that genotyping is possible only in large specialized centers.

A known method for the diagnosis of lung diseases, described in the patent for the invention of Russia No. 2197176, publ. 01/27/2003, the method of diagnosis is carried out by magnetic resonance imaging (MRI) using the study of the lungs in the sagittal, coronary, transverse planes and analysis of the data obtained, using a modified fast sequence STAGE (Small Tip-Angle Gradient Echo) with a duration of 12 -15 s with a breath-holding at the inspiratory height on an MP tomograph with a 0.5 T superconducting magnet, 4-11 slices in each plane are obtained and the image is evaluated according to the MP signal intensity, localization, prevalence, shape and structure of the patho biological formation, contours, as well as the condition of the pleura, lymph nodes, bronchi and other structures of the chest, but it has a drawback, since it allows you to diagnose only volumetric lung formations.

The disadvantage of this method is its complexity and high cost. Examination can be done in specialized centers for a limited number of patients.

A known method for the differential diagnosis of obstructive pulmonary disease, described in the patent for the invention of Russia No. 2341180, publ. 12/20/2008. A method for the differential diagnosis of obstructive pulmonary diseases is that bodyplethysmography is performed and the residual lung volume is determined before and 20 minutes after administration of the bronchodilator and when the residual lung volume after administration of the bronchodilator is below 120% of the proper residual lung volume, bronchial asthma is diagnosed, and with a value of more than 120% - chronic obstructive pulmonary disease.

The disadvantage of this method is that the equipment is expensive and inaccessible to patients.

All of the above methods are of limited use for practical medicine, even in cases of single examinations. They are simply not available for screening the population in order to detect bronchopulmonary diseases.

The closest analogue selected as a prototype is the spirometry method described in the Federal Clinical Recommendations for Using the Spirometry Method, edited by the authors, one of which is Alexander G. Chuchalin, in 2013.

During spirometry, the indicators of forced expiratory volume for the first second of FEV ₁ (FEV ₁ ) are estimated - a decrease is considered a level of less than 80%, forced vital lung capacity FVC (FVC) - a decrease is considered a level of less than 80%, and the ratio of these two indicators is FEV ₁ / FVC (FEV ₁ / FVC) - a pathological deviation is considered a level of less than 0.7.

Spirometry is the "gold standard" in the diagnosis of COPD, because its indicators are best standardized, reproduced and are the most objective in screening studies "Pulmonology / ed. A.G. Chuchalina - 2nd ed. Corr. And add. - M: GEOTAR-Media, 2009, - 336 p. (Series "Clinical recommendations"); “Study of the function of the external respiration apparatus. Fundamentals of the clinical physiology of respiration. Fundamentals of the clinical physiology of breathing ": study guide, 2nd ed., Ext. And rev. F.F. Tetenev, T.N. Bodrova, K.F. Tetenev et al. - Tomsk: Printing Manufactory, 2008 .-- 164 p.

Spirometry is a non-invasive method for measuring air flow and volume as a function of time using forced maneuvers.

The main functional syndrome in patients with COPD and AD is primarily a violation of bronchial obstruction, which is detected by examining the function of external respiration. A common method for registering bronchial obstruction is spirometry performed during a forced expiratory maneuver. Having a high degree of reproducibility, these parameters allow you to document the presence of obstruction in a patient and further monitor the state of bronchial patency and its variability.

This method is better known and available for pulmonological patients with overt bronchopulmonary complaints (cough, shortness of breath, sputum), but only after x-ray examination.

Questionnaires are conducted for such individual patients to identify pathognomonic respiratory complaints - chronic cough, chronic sputum discharge, wheezing and tightness in the chest, shortness of breath, aggravated by physical exertion and risk factors for bronchopulmonary pathology - burdened by heredity for lung diseases, smoking (smoking history, smoking index, degree of nicotine addiction), exposure to industrial air pollutants or environmental factors, the presence of other diseases of the organ respiratory rate, and then, using spirometry, the indicators of forced expiratory volume for the first second FEV ₁ (FEV ₁ ), forced vital capacity of the lungs FVC (FVC) and the ratio of these two indicators FEV ₁ / FVC (FEV ₁ / FVC) are determined, while test FEV ₁ (FEV ₁ ) is less than 80% and FEV ₁ / FVC (FEV ₁ / FVC) is less than 70% as the boundary indicators of COPD.

There are a variety of reasons for the decrease in forced expiratory volume (FEV ₁ ), in particular, its decrease may be due to extrapulmonary causes: changes in the nervous and musculoskeletal systems, skin and subcutaneous tissues, inhaled gas, etc., patients with arterial hypertension, as a rule, the specified examination is received in isolated cases, in the presence of bronchopulmonary complaints, while the development of COPD has already begun.

The objective of the invention is to increase the detection efficiency of chronic obstructive pulmonary disease and to expand the scope of the method for early diagnosis of changes in external respiration function, namely the early detection of risk factors for the development of chronic obstructive pulmonary disease in individuals with arterial hypertension, by screening patients with arterial hypertension using spirography .

The technical result of the claimed method lies in the fact that in a method for screening the development of chronic obstructive pulmonary disease associated with the presence of arterial hypertension, which consists in performing spirometry in individuals with arterial hypertension, according to the invention, the indicators of forced expiratory volume for the first second of FEV1 are determined (FEV1), forced vital capacity of the lungs FVC (FVC) and the ratio of these two indicators FEV1 / FVC (FEV1 / FVC) and at FEV1 (FEV1) 85-80% and FEV1 / FVC (FEV1 / FVC) 75-70% predict a risk of developing or early stage of chronic obstructive pulmonary disease.

Due to the fact that in the method for screening the development of chronic obstructive pulmonary disease associated with the presence of arterial hypertension, on the basis of spirometry, the indicators of forced expiratory volume for the first second of FEV1 (FEV1), forced vital capacity of the lungs FVC (FVC) and the ratio of these two indicators are determined FEV1 / FVC (FEV1 / FVC) and with FEV1 (FEV1) of 85-80% and FEV1 / FVC (FEV1 / FVC) 75-70% predict the risk of developing or early stage of chronic obstructive pulmonary disease, increases the efficiency of detection x onicheskoy obstructive pulmonary disease, and expands the scope of the method of early diagnosis of changes in respiratory function, namely early detection of chronic obstructive pulmonary disease risk factors in hypertensive individuals, due to the screening of patients with hypertension using spirography.

In the claimed method, a comprehensive clinical and functional approach was used, which allows to identify the risk group for bronchopulmonary pathology and to carry out early diagnosis of chronic obstructive pulmonary disease in respondents with arterial hypertension.

The inventive method allows to identify the main risk factors for the development of bronchopulmonary pathology at an early stage in individuals with arterial hypertension and thereby prevent the development of a severe disabling disease.

In the practice of medicine, it is known to use spirometry for screening a population. However, it was shown that the study of the function of external respiration in individuals with arterial hypertension is not used as a screening method for the early detection of chronic obstructive pulmonary disease, which leads to underdiagnosis of lung pathology (low diagnosis of COPD in patients with hypertension).

In the proposed method, spirography for screening individuals with arterial hypertension is used for the first time, the method has novelty and inventive step.

The claimed method uses spirography as a screening in patients with arterial hypertension for early diagnosis of changes in the function of external respiration, the method has industrial applicability.

The method was carried out as follows.

To solve the above problem, 480 male respondents aged 45-65 years were studied at a large industrial enterprise in the city of N, where 167 people were already registered with arterial hypertension, 313 people without arterial hypertension. Research was carried out for two years. Two groups of 167 people were organized (with arterial hypertension and without arterial hypertension). For two groups, screening was carried out by questioning and research of the ventilation function of the lungs by spirometry. A survey of 167 people with arterial hypertension did not reveal obvious pathognomonic respiratory complaints - chronic cough, chronic sputum discharge, wheezing and tightness in the chest, shortness of breath, aggravated by physical exertion, mainly complaints of chest tightness and shortness of breath, intermittent (intermittent) cough with poor sputum discharge, which is usually associated with pathology of the cardiovascular system, acute respiratory viral infections or allergic diseases.

Risk factors for bronchopulmonary pathology - burdened heredity for lung diseases, smoking (smoking history, smoking index, degree of nicotine addiction), the effects of industrial airborne pollutants or environmental factors were almost the same for the respondents, which is explained in terms of place of residence, place of work, social environment and age.

At the beginning of the study, in group I without arterial hypertension, 20 respondents with COPD disease were identified (subgroup 2). The remaining 147 respondents were healthy according to spirometry (subgroup 1). In group II of individuals with hypertension, out of 167 respondents, 72 were identified by spirometry using COPD disease of varying severity (subgroup 5). The remaining 95 respondents had spirometry readings close to the limit on COPD. According to their indicators, they were divided into two subgroups 3, 4. In subgroup 3 - 68 respondents, their spirometry testimony was better than that in subgroup 4 - 27 respondents, for whom additional monitoring and preventive treatment should be established. Thus, as a result of the survey, out of 480 respondents, 167 with arterial hypertension were revealed and, according to the results of the screening of 334 respondents, 92 with COPD, most of 72 respondents from the group with arterial hypertension.

Further studies were carried out six months later and at the end of two years, in group I without arterial hypertension, 23 respondents with COPD disease were identified (subgroup 2). The remaining 144 respondents were healthy according to spirometry (subgroup 1). In group II of individuals with AH, out of 167 respondents, 87 were identified by spirometry with COPD disease of varying severity (subgroup 5). The remaining 80 respondents had spirometry readings close to the limit on COPD. According to the indicators, they were divided into two subgroups 3, 4. In subgroup 3 - 62 respondents, their spirometry testimony was better than that in subgroup 4 - 18 respondents, for whom additional monitoring and preventive treatment should be established. Thus, a survey of 480 respondents revealed 167 with arterial hypertension and, according to the results of screening of 334 respondents, 110 with COPD, the majority of 87 respondents from the group with arterial hypertension. Over two years, 3 respondents with COPD were added to the group of absolutely healthy. According to indications, 6 respondents moved from subgroup 3 to indications of subgroup 4, while 15 respondents moved from subgroup 4 to subgroup 5, i.e., reduced readings of FEV ₁ (FEV ₁ ) 85-80% and FEV ₁ / FVC (FEV ₁ / FVC) 75 70% say that respondents are predisposed to COPD and are borderline-testing for determining this disease in patients with arterial hypertension.

The use of the method in therapy, cardiology and pulmonology allows you to have a positive impact on improving the diagnosis of lung diseases (in particular, chronic obstructive pulmonary disease) in the presence of arterial hypertension. In addition, it allows you to start treatment on time in order to prevent COPD disease and worsen hypertension.

Spirometry indicators in patients with isolated forms of chronic obstructive pulmonary disease and arterial hypertension, and with their combination, as well as the control group (healthy subgroup 1), see table 1.

During spirometry, the indicators of forced expiratory volume for the first second FEV ₁ (FEV ₁ ) were estimated - a decrease was considered a level of less than 80%, forced vital lung capacity FVC (FVC) - a decrease was considered a level of less than 80%, and the ratio of these two indicators FEV ₁ / FVC (FEV ₁ / FVC) - a pathological deviation was considered a level of less than 0.7. Based on the FEV index ₁ , the severity of COPD is determined: mild severity - FEV ₁ ≥80% of the desired, moderate 50% ≤ FEV ₁ <80%, severe 30% ≤ FEV ₁ <50%, extremely severe FEV ₁ < 30% of due (GOLD, 2011).

The technical result provided by the claimed method consists in the possibility of predicting the risk of developing COPD in patients with hypertension before the development of the pathological process or in the early stages of the disease.

Analyzing the data in Table 1, it can be seen that two years of the survey showed that only three people fell ill in the group of healthy COPD, but in the second group with hypertension, the number of patients with COPD increased by 15 people. This replenishment came from subgroup 4, where the readings were slightly higher than the COPD test boundary. Since these respondents were not considered patients with COPD, they did not receive treatment for this disease, and over two years their testimony fell below the test boundary. Subgroup 3 also underwent changes; 6 respondents moved to subgroup 4 with lower readings than they had.

Table 1 also shows that among healthy respondents, spirometry indices are worse among healthy respondents with AH (see subgroups 3 and 1).

Among patients with COPD, spirometry indicators are also worse in respondents with COPD and hypertension (see subgroups 5 and 2).

During the clinical examination, therapists always measure blood pressure and must be sent to the ECG of an age-specific patient, taking into account complaints, but studies of the function of external respiration are rarely performed. Namely, it allows timely diagnosis of COPD in a patient with arterial hypertension. The study of the function of external respiration is not included in the program of compulsory preventive examination and the standard examination of patients with arterial hypertension. However, COPD is detected in every fourth patient with AH between the ages of 25 and 64, and the risk of mortality from CVD in patients with a decrease in the FEV ₁ values that are observed with COPD is much higher. CVDs remain one of the leading causes of death for the modern generation; one third of the world's population dies from them. In the case of the proposed method, COPD was detected in almost 50% of the respondents with hypertension. This is due to the more mature age of the subjects and their social status (men, industrial workers).

One of the directions explaining the relationship between COPD and hypertension is the concept of systemic inflammation of low gradation, which initiates and supports multiple organ pathology, in which damage to the lungs and cardiovascular system occupies a central position.

In addition, there is a hypothesis that aging itself is a certain inflammatory process, manifested by various organ disorders, while the cardiovascular and respiratory systems are most often affected (Nussbaumer-Ochsner Y., Rabe K.F. 2011).

The pathological link determining the relationship between AH and COPD is the presence of oxidative stress, whose role in the genesis of these diseases is proven (Cachofeiro V., Miana M. Et al., 2009). In COPD, oxidative stress is known to be caused both by inflammation processes and by the action of oxidants contained in cigarette smoke (Ilkovich M.M., Kuzubova N.A., 2011), and in case of hypertension, oxidative stress is closely associated with inactivation of nitric oxide, damage endothelium - an important target organ (Lee V.V., Zadionchenko BC, Adasheva T.V. et al., 2013). Oxidants, having a direct toxic effect on connective tissue, DNA, lipids, proteins, enhance the synthesis of mucus glycoconjugates by epithelial cells, damage the functions of cilia, stimulate the formation of thromboxanes, decrease the activity of surfactant, damage fibroblasts, enhance endothelial permeability, and inhibit protease inhibitors, resulting in destroys alveolar walls, extracellular membrane proteins, stimulates the synthesis of IL-8 (Malhotra D., Thimmulappa R., Navas-Acien A., et al., 2008).

Studies by DD Sin et al., (2005) show an association between a decrease in FEV of ₁ for every 10% and an increased risk of cardiovascular mortality of 28%. In patients with combined pathology of the cardiovascular system and respiratory system (AH and COPD), a high frequency of common risk factors is recorded: overweight, atherogenic dyslipidemia, hyperglycemia, systemic inflammation, oxidative stress, endothelial dysfunction, hypertension, smoking, obstructive sleep apnea sleep, worsening bronchial obstruction in the treatment of hypertension (β-blockers), which indicates the common pathophysiological processes in the formation of atherosclerosis, coronary pathology and impaired function external respiration (Shilov AM, Tarasenko O.F., Osiya A.O., 2009).

The treatment of patients with comorbid conditions is not only a medical, but also an important economic problem, since up to 90% of all health system funds are spent on treating patients older than 65 years with two or more simultaneously existing diseases.

The essence of the proposed method is illustrated by clinical examples of specific performance.

Example 1 (Group I, subgroup 1).

Patient Ch., 61 years old, does not smoke, works as a security guard at the enterprise, there were no occupational hazards. Heredity for diseases of the lungs and heart is not burdened. A history of osteochondrosis, without exacerbation. Passes prof. inspections annually. Spirometry after a bronchodilation test was within normal limits: forced expiratory volume in the first second (FEV ₁ ) = 99.5%; the ratio of forced expiratory volume in the first second and forced lung capacity (FEV ₁ / FVC) = 94.7%. Is healthy.

Patient A., 65 years old, does not smoke, engineer, did not work in hazardous work. A history of chronic gastritis, a phase of remission. Heredity for diseases of the lungs and heart is not burdened. She undergoes a medical examination once a year. Spirometry after bronchodilation test was within normal limits: FEV ₁ = 98.3%; FEV ₁ / FVC = 93.5%. Is healthy.

Example 2 (Group I, subgroup 2).

Patient D., 65 years old, does not smoke. Work experience at an industrial enterprise 36 years. Heredity for diseases of the lungs and heart is not burdened. A history of chronic cough over the past 11 years. Earlier examination of the bronchopulmonary system revealed a decrease in the FVD. For the last 2 years did not apply for medical help. During spirometry with bronchodilation test obstructive disorders were revealed: FEV ₁ = 51.7%; FEV ₁ / FVC = 58.4%. Diagnosed with COPD (J.44 in accordance with ICD-10), given recommendations for treatment, D-registration of a pulmonologist, teaching a patient with COPD at school.

Patient N., 64 years old, Work experience at an industrial enterprise for 31 years, smokes for 18 years, 1.5 packs of cigarettes per day. He has a history of chronic bronchitis for 9 years, there is no regular bronchodilator therapy. The inheritance for lung diseases is burdened on the paternal side (COPD). Earlier examination of the bronchopulmonary system revealed a decrease in the FVD. In recent years, I have not sought medical help. During spirometry with bronchodilation test obstructive disorders were revealed: FEV ₁ = 49.2%; FEV ₁ / FVC = 55.8%. Diagnosed with COPD (J.44 in accordance with ICD-10), given recommendations for treatment and smoking cessation, D-registration of a pulmonologist, teaching a patient with COPD at school.

Example 3 (Group II, subgroup 3).

Patient I., 63 years old, not a smoker, works without occupational hazards.

Heredity for diseases of the lungs and heart is not burdened. A history of hypertension for 12 years, antihypertensive drugs is not regularly taken. Over the past 6 years, notes a productive cough, periodically shortness of breath. Previously, the examination of the bronchopulmonary system did not pass. For the last 5 years I did not apply for medical help. When examined according to the results of the questionnaire, he was assigned to subgroup 3 of the risk of developing chronic obstructive pulmonary disease, a decrease in spirometry indicators was revealed: FEV ₁ = 85.8%, FEV ₁ / FVC = 86.2%. Determined by indicators in the 3rd subgroup and was observed without treatment for two years. After two years, he was transferred according to the indicators to subgroup 4 - FEV ₁ = 81.3%, FEV ₁ / FVC = 74.6%, the patient was assigned to the group with an increased risk of development - COPD, recommendations were made to reduce the risk of developing COPD, as a preventive measure treatment and follow-up, and examination every six months.

Patient L., 64 years old, not a smoker, works without occupational hazards. Heredity for diseases of the cardiovascular system is burdened by the maternal line (IHD). He has a history of hypertension for 9 years, taking antihypertensive drugs regularly. Over the past 6 years, he has occasionally noted shortness of breath when walking fast and climbing to the 4th floor. Previously, the examination of the bronchopulmonary system did not pass. A medical examination takes place annually. Spirometry after bronchodilation test was within the normal range: FEV ₁ = 92.5%; FEV ₁ / FVC = 93.8%.

Example 4 (Group II, subgroup 4).

Patient K., 64 years old, not a smoker, works without occupational hazards. Heredity for diseases of the lungs and heart is not burdened. He had a history of hypertension for 15 years, taking antihypertensive drugs regularly. Over the past 6 years, he has noted a productive cough, periodically shortness of breath when climbing stairs to the 3rd floor and walking quickly on flat terrain. Previously, the examination of the bronchopulmonary system did not pass. I did not seek medical help. During the survey according to the results of the questionnaire, he was assigned to the risk group for developing chronic obstructive pulmonary disease, and a decrease in spirometry indicators was found: (FEV ₁ = 82.5%, FEV ₁ / FVC = 73.8%). Determined by indicators in the 4th subgroup and was observed without treatment for two years. After two years, his indicators - FEV ₁ = 72.3%, FEV ₁ / FVC = 64.6%, diagnosed with COPD (J.44 in accordance with the International Classification of Diseases (ICD) - 10). Recommendations for treatment are given, D-registration of a pulmonologist, invited to study in a school of COPD patients, and annual spirometry behavior is recommended.

Patient T., 65 years old, smokes for 1.5 years 1.5 packs of cigarettes per day, works without occupational hazards. Heredity for diseases of the cardiovascular system is burdened on the maternal side (IHD, GB, PIK). He has a history of hypertension for 11 years; he does not take antihypertensive drugs regularly. Over the past 4 years, he occasionally notes coughing and shortness of breath when climbing stairs to the 3rd floor and walking quickly on flat terrain. Previously, the examination of the bronchopulmonary system did not pass. He sought medical help 3 years ago. During the examination according to the results of the questionnaire, he was assigned to the risk group for developing chronic obstructive pulmonary disease, a decrease in spirometry indicators was revealed: FEV ₁ = 81.9%; FEV ₁ / FVC = 74.2%. After two years, he was transferred according to indicators to subgroup 5 - FEV ₁ = 79.3%, FEV ₁ / FVC = 69.2%, diagnosed with COPD (J.44 in accordance with the International Classification of Diseases (ICD) - 10) , recommendations for treatment and subsequent monitoring by a pulmonologist and examination every six months are given. Recommendations on smoking cessation are given, invited to study in a school for patients with COPD, and annual spirometry behavior is recommended.

Example 5 (Group II, subgroup 5).

Patient V., 65 years old, non-smoker, work experience at an industrial enterprise 36 years. The inheritance for lung diseases is burdened on the paternal side (lung cancer), and on the cardiovascular pathology - on the maternal side (GB). He has a history of hypertension for 8 years, regularly takes antihypertensive drugs. Over the past 11 years, he has noted coughing, shortness of breath when climbing stairs to the 4th floor. Previously, the examination of the bronchopulmonary system did not pass. For the last 2 years did not seek medical help. When examined according to the results of the survey, he was assigned to the risk group for developing chronic obstructive pulmonary disease. When conducting spirometry revealed obstructive disorders: FEV ₁ = 45.9%; FEV ₁ / FVC = 54.8%. Diagnosed with COPD (J.44 in accordance with ICD-10), given recommendations for treatment, D-registration of a pulmonologist, teaching a patient with COPD at school.

Patient M., 58 years old, smokes for 18 years, 1.5 packs of cigarettes per day, works at an industrial enterprise for 13 years. Heredity for diseases of the lungs and heart is not burdened. A history of arterial hypertension is 10 years; antihypertensive drugs are not taken regularly. For 6 years, he has noted coughing in the morning, shortness of breath with SARS and climbing to the 4th floor. Previously, the examination of the bronchopulmonary system did not pass. I did not seek medical help. During the survey according to the results of the questionnaire, he was assigned to the risk group for the development of chronic obstructive pulmonary disease, while spirometry revealed obstructive disorders: FEV ₁ = 47.3%; FEV ₁ / FVC = 57.6%. Diagnosed with COPD (J.44 in accordance with ICD-10), given recommendations for treatment and smoking cessation, D - registration pulmonologist, teaching a patient with COPD at school.

Patient I., 64 years old, smokes for 1 year a pack of cigarettes a day, works without occupational hazards. Heredity for diseases of the cardiovascular system is burdened by the maternal line (IHD). He has a history of hypertension of 14 years, taking antihypertensive drugs irregularly. For 9 years, he notes coughing, shortness of breath when walking fast and climbing stairs to the 3rd floor. Previously, the examination of the bronchopulmonary system did not pass. I did not seek medical help for 5 years. During the survey according to the results of the questionnaire, he was assigned to the risk group for developing chronic obstructive pulmonary disease, while spirometry revealed obstructive disorders: FEV ₁ = 46.4%; FEV ₁ / FVC = 55.6%. Diagnosed with COPD (J.44 in accordance with ICD-10), given recommendations for treatment, smoking cessation, D-registration of a pulmonologist, teaching a patient with COPD at school.

Thus, the claimed method allows to increase the efficiency of detection of chronic obstructive pulmonary disease and to expand the scope of the method for the early diagnosis of changes in the function of external respiration, namely the early detection of risk factors for the development of chronic obstructive pulmonary disease in people with arterial hypertension, by screening patients with arterial hypertension with using spirography. From the above examples it follows that for respondents who are not patients with arterial hypertension, the test boundary values of COPD FEV ₁ (FEV ₁ ) are less than 80% and FEV ₁ / FVC (FEV ₁ / FVC) less than 70%, for patients with arterial hypertension should be considered test the boundary indicators FEV ₁ (FEV ₁ ) - 85-80% and FEV ₁ / FVC (FEV ₁ / FVC) - 75-70%, which allows them to be registered at the earlier stage of COPD and to conduct a course of treatment without waiting for deterioration COPD condition, which, in turn, exacerbates the respondent’s arterial hypertension.

Claims (1)

A method for screening the development of chronic obstructive pulmonary disease associated with the presence of arterial hypertension, which consists in performing spirometry in individuals with arterial hypertension, characterized in that, based on the performed spirometry, indicators of forced expiratory volume for the first second of FEV1 (FEV1), forced vital capacity of the lungs are determined FVC (FVC) and the ratio of these two indicators FEV1 / FVC (FEV1 / FVC) and at FEV1 (FEV1) of 85-80% and FEV1 / FVC (FEV1 / FVC) 75-70% predict the risk of development or early stage of chro obstructive pulmonary disease.