The differential diagnosis bronhoobstruktiv syndrome. The urgent help

Stages, time
Activities
Teacher	Students
Stage 1 Prodrome (5 min)	1.Rasskazyvaet lectures on the subject, objectives, and plans	1. Listen
Stage 2 Actualization (added value) of knowledge (20 min)	2.1. In order to enhance the mainstreaming (increasing value) of student asks the questions: 1. Define the terms of biofeedback? 2. List the diseases associated with BFRs. 3. List risk factors for BOS. 4. List of drugs used to treat BOS syndrome. Conducts surveys 2.2. Screening, offers students acquainted with the aims and objectives of the lecture. Slide number 1	2.1. Respond to questions 2.2. Learn the slide № 1 2.3.Izuchayut slide number 2 Highlights written in the notebook
Stage 3 Main (Information) (55 min)	3.1. Introduces students to the lecture material, significant themes and principles of intelligent cultural identity, in particular GP-teacher. In order to enhance the mainstreaming of knowledge to do quick survey of students: 1. 1 point plan lecture: Define terms BOS syndrome? 2. To 2-point plan lecture: List the causes and risk factors leading to the SPU. 3. On 3-point plan lecture: List different pathogenetic mechanisms BOS syndrome? 4. To 4-point plan lecture: Tell highlights classification BFRs. 5. At 5-point plan lecture are common differential diagnostic signs BOS syndrome. 6. To 6-point plan lecture: List the clinical manifestations and course of disease, occurring c BOS syndrome. 7. To 7-point plan lecture: What are the main methods of diagnosis of diseases involving biofeedback. 8. 8-point plan lecture: List the main principles of treatment, prevention, and clinical examination of patients with BOS syndrome. Turning to the important points lectures, offers write the main position in the notebook 3.1. Together dismantled listen lecture material, ask questions	3.1. Together dismantled listen lecture material, ask questions
Stage 4 final (10 min)	4.1. Ask a question: 1. List the most common diseases associated with BOS syndrome. 2. Tell modern classification of BFRs. 3. What are the basic principles of treatment and prevention in patients with BOS syndrome. 4.2. Gives the task for independent work of students: Bronchial obstruction.	4.1. Answer questions 4.2. Listen and write

The Chronic obstructive disease light - a collective notion, which unites the group of the chronic diseases of the respiratory system: chronic obstructive bronchitises (HOB), emphysema light (EL), bronchial asthma(BA) of the heavy current. HOBL consider and as with sign of terminal respiratory insufficiency OFV1 <1,5 l or 30% from due value i.e. progressive disease, led to loss of the reversible component to bronchial obstruction, pulmonary heart. The Reasons HOBL: beside 90% HOB, around 1% emphysema light beside 10% BA heavy current.
"Chronic obstructive disease light (HOBL) - a collective notion, uniting chronic ecological mediated inflammatory diseases rispiretion systems with primary defeat division of the respiratory ways with partly reversible bronchial obstruction, which are characterized progrisseve and growing chronic respiratory insufficiency".
Categorization HOBL on degree of gravity
The Degree to gravity : light: the Main clinical signs: changeable cough, shortness of breath under intensive physical load only or is absent. The Functional factors: OFV1> 70% from due values. The Three-dementional factors normal.
Average: the Main clinical signs : constant cough the most denominated on morning, scanty phegm, shortness of breath under moderate physical load. Diffused dry wheezes. The Functional factors: OFV1 - 50-69% from due values, increase to remaining capacity light, транзиторные episodes гипоксии, signs of the overloading right division heart.
Heavy: the Main clinical signs: constant cough, shortness of breath at rest, cyanosis, participation of the auxiliary musculature in breathing, remote wheezes, signs правожелудочковой to insufficiency. The Functional factors: OFV1 less 50% from due values, gipoksiya signs pulmonary heart, fatigue of the respiratory musculature,eritrositos.
Factors of the risk HOBL
The External factors: smoking, professional contamination surrounding air, low social-economic position, infection, deficit of the vitamin S.VNUTRENNIE factors: deficit but- аntirepsiyа, bronchialgiperaktive, household nature of the disease, genetic .
The Reasons HOBL: beside 90% HOB, around 1% emphysema light beside 10% BA heavy current.
THE BRONCHIAL ASTHMA (BA) - chronic inflammatory disease of the respiratory ways (mainly bronchi) with their reversible obstruction, revealing fit of the difficulty in breathing or asthmatic status. Sick BA characterizes high реактивность (giperakvite)bronchi in response to action of the different irrotants, which beside sound people does not cause the to reactions.
As a result of increase the number by sick chronic diseases light, of the population, soiling the air ambience, broad use antibiotic, vaccines, wheys and t. d. is noted growing to diseases by bronchial asthma, which occasionly becomes the reason to deaths. On and the form BA affect the climate and natural particularities of the region.
Etiologiya and potogenez. BA - an etiologiya and patogenez lumpy disease. Etiologicheskie factors BA are divided on ekzogen and endogen. To the most wide-spread ekzogen by factor pertain: 1) аllergization populations (urbanizetion); 2) soiling the air ambience; 3) introduction to chemistries in agriculture, industry and; 4) broad use antibiotic, vaccines, wheys and others; 5) climatic and natural particularities of the region (for instance, cool and damp climate, abudance of the flowering plants, and others.). Endogennymi etiologiya factor BA are different infectious-inflammatory diseases organ breathings (quiping pneumonia, sharp and chronic bronchitises), innate or gained defects and breaches иммунной, endocrine, nervously-psychic, нейрогуморальной and other systems of the organism. In base BA can be different specific and
Innate or gained an pathogen mechanisms. The Main manifestation BA are in greater or smaller degree expressed of the breach to bronchial passability, t. e. (spontaneous or as a result of treatments) bronchial obstruction. Beside some sick with heavy current BA develops steadfast, to usual syndrome - an asthmatic status. The reason of the asthmatic status be the sharp infections and intensifications chronic infection upper respiratory ways, of the device, viral diseases, unjustified reduction of the dose or cancelling of the facilities, surplus using sleeping pill, and preparation, using of the facilities (the aspirin, preparation, facilities (tripsin,xemotripsin), antibiotic,sulfanilamid.
The Clinical picture and diagnosis. The Clinical picture BA varied: from rare manifestations before long and nerve-racking fit of the difficulty in breathing. The Central place in clinical picture BA occupy the asthmatic fits. They approach usually in the night, often unexpectedly, sometimes after unclear harbinger in the manner of sensations of the uneasiness in bosom, labored breathings. At the beginning initially diseases fits difficulties in breathing by most short - from several minutes before ; hereinafter they become more long-lasting, stubborn, delaying on integer day and going in asthmatic status sometimes. Often during fit (usually by the end of) with cough stands out the small quantity mucous, tractile phegm. In her(its) sometimes manages to consider spiral slime (the spirals Kurshmanna) and mold small bronchi. Under all clinics variant stand out light, average and heavy degree BA. The Lung episodic current BA:o fits of the difficulty in breathing short and, appear not more often 1-2 once at week; o night not more often 2 once at month; o in period general state is not broken; o factors to functions of the external breathing - PSV or OFV, -not less 80 % from due; o day allowance of the fluctuation PSV or OFV do not exceed 20 %; o after (at intensification) to factors PSV and OFV, return to normal importances. Srednetyazheloe current BA: o daily; o need of the daily acceptance r2 of the short action; o night more 1 times at week; o intensifications break the physical activity and dream; o PSV or OFV form 60-80 % from due values; o day allowance of the fluctuation PSV more than 30 %. The Heavy current BA: o constant with ntensifications; o physical activity is limited; o nighto factors PSV or OFV| less 60 % from due; o day allowance of the fluctuation PSV more than 30 %. Beside patient with any degree of gravity (even light) can develop heavy and even threatenning lifes of the intensification.
The Generally accepted to categorizations of the bronchial asthma to date does not exist because of variety of the reasons, her(its) causing, and not infrequent multifunction influence of the miscellaneous factor. Stand out the following main forms a disease: allergic, and mixed. Mechanism lies In base allergic BA with surplus product IgE. This brings about massaged surge by obese hutch under any contact sick with "guilty". Allergic BA more often appears beside people with burdened household or personal аnamnez , begins at baby age usually, beside such sick - positive skin and provocative tests with, increased level general and specific IgE, there are other allergic manifestations (allergicrinit, conjunctivitis, atonicdermatit). At to bronchial asthma does not manage to reveal the to determined. Begin disease accounts for more mature age, and activate factor, as well as "perpetrator of" intensification is most often carried viral infection. After several days following begin viral disease appear the shortness of breath, cough, fits of the difficulty in breathing, which can be saved from several days before several months. The Patients, which disease bears the marks allergic and of the asthma, pertain to group of the mixed form BA. The Reliable diagnostics BA possible only by exceptions secondary syndrome (BS). Secondary BS most often meets at disease г(anafilaktic shock. disease), disease (system red lupus,), infectious-inflammatory disease device (bronchitis, pneumonia, tuberculosis), pathological process (malignant and to tumors, in consequence of tuberculosis, burn of the respiratory ways), disease and pathological conditions, which cause reflex bronchi (hysteria, mechanical irritation wanderring nerve, передозировка вагостимуляторов, for instance р- anesthesia), disease of the system conditionning е of the breach in evice (primary years arterial, тpulmonary artery, stagnant insufficiency), and others
The Treatment. The General program of the treatment sick BA must comprise of itself: 1) educational program; 2) estimation and monitoring degree to gravity disease; 3) exception factor, provoking intensification disease, or checking on them; 4) development individual scheme treatments; 5) plan development of the treatment of the intensification disease, urgent терапию at fit of the difficulty in breathing and (or) asthmatic status; 6) observation. The Successful treatment sick BA in depends on well-timed eliminating the contact with or reductions of their influence. Eliminaciya allergen it is enough efficient degree in checking to gravity disease. The Individual scheme treatments is defined in the first place by degree to gravity BA. The Purpose medication is conducted in the manner of four steps with increasing and by effect. The Step of the treatment corresponds to the degree to gravity BA: the first - a light degree BA, the second and (or) third - average gravity BA, quarter - a heavy degree BA. The Base base form the нестероидные an facility (and sodium) and ingaletion . Kromoglikat and sodium are used under light and some forms asthmas. The Step 1. The Lung episodic current diseases. On this step there is no need to in purpose base and treatment forms from action (avoid the influences a trigger) and fit by means of (52- of the short action. Possible preventive using r2 r sodium before physical load or influence other provoking factor. The Step 2. The Lung current BA. Such condition requires undertaking constant otherwise disease will progress. Begins the base treatment with or (particularly in age) sodium. Under insufficient effect follows to move to in low dose or combine them with The Alternative this preparation on given step can be teofilin prolonged actions (concentration 5-15 mkg/ml) or preparations. R2-аgonits short action are recommended For fit of the difficulty in breathing. Frequent their acceptance (daily) points to need of the reinforcement base . The Step 3. Srednetyazheloe current BA. Protivovospalitelinaya base therapy beside these sick includes in average dose or combination of the low doses these preparation with r2- of the long action .Possible change r2 f the long action prolonged teofilin. As alternatives can be used preparations (the bromide) or their combination with R2, particularly under bad transplantability r2- or accompanying chronic bronchitis, as well as beside elderly. The Insufficient effect conducted base can require on this step of the using and high doses The Step 4. The Heavy current BA. Protivovospalitelinaya therapy forms from: o regular using in high dose; o long acceptance inside (usually not more than 60 mg prednezalon at day); o acceptance long acting (r2- long action or prolonged teofillin). Under expressed side reaction on these possible change them or combination with (the bromide). As symptomatic facility for fit are used r2-агонисты short action, but not more than 3-4 once in day (the possibility). If required more frequent acceptance r2 is required checking. The Additional medical program under infectious hung variant of the allergic asthma comprises of itself undertaking directed on increasing organism to infection of the respiratory ways, as well as use some modern and facilities. To the last pertain Т-aktivin, to a lesser extent timalin, dekaris, under some forms sometimes helpinterferon, preparations of the group . Reasonable undertaking bacterial vaccine or complex, product to vital activity bacteria In sharp phase of the disease necessary to liquidate the inflammatory process in organ of the breathing. Are they For this purpose fixed antibiotics, as well as and the other preparations. Of no small importance importance in complex терапии sick BA has a symptomatic treatment. So, for improvement to functions bronchial tree and reduction to viscosity of the phegm are used coughing up facility. They Are Recommended preparations, which act directly on shell bronchi (the essential oils, sodium and others); the preparations (reflex - through belly and emetic centre - intensify the bronchial secretion: extract root, sheet mother, plantain) and mukoltic .For improvement of the saturation arterial shelters by oxygen is used Sick 24-28 % oxygen-air mixture through nose by means of Т- tubes. The Efficient by methods of the symptomatic treatment sick with BA are a respiratory atheletics, massage of the thorax, drainage,. Under fit of the difficulty in breathing in condition branches are used з, medical , artificial ventilation light (operated breathing). The Urgent help at fit of the difficulty in breathing and asthmatic status. The Light fit of the difficulty in breathing can be acceptance inside tablets eufillin or, but- or golidor, 30-60 drops. Can be efficient distracting actions (the conversation with sick, hot foot bath, or banks on back). Sometimes for fit it is enough of derived adrenaline о (astmopen). Srednetyazhelyy fit of the difficulty in breathing in most cases 0,1 % solution of adrenaline, carried in dose 0,5-1 ml subdermal or in the manner of aerosol. The Action of adrenaline approaches through 2-3 mines and lasts around 1 ch so some sick necessary to enter his(its) again (before 10 once in day). For conservation actions simultaneously with adrenaline reasonable to enter 5 % solution efidrin in dose 0,5-1 ml subdermal or the action his(its) approaches later and lasts several hours. Entered simultaneously with adrenaline, efidrin intensifies and prolongs the action of adrenaline. At presence of the contraindications to introduction of adrenaline (raised sensitivity), at disease and IBS possible to use some his(its) derived - (the iprodol ), Alupent is used in the manner of inection (0,5 mg), aerosol (2 % and 5 % solutions, before 1 mg). The Modern (theberotek,ventolin ) are used in the manner of aerosol. At effect from adrenaline and his(its) derived is used eufillin (aminafillin,difillin) in the manner of 2,4 % solution, on 10 ml intravenous slowly. Under side influence эуфиллина (the sickness, retching, pain in heart) are simultaneously used solutions: 2 % - папаверина, 2 ml, 2 % -ношпы, 2 ml, 1 % - an dibazol, 4-6 ml. Under night fit of the difficulty in breathing and possible vastly to perfect the condition by sick subdermal introduction 1 ml 0,2 % solution platfillin or 0,5-1 ml 0,1 % solution of the atropine, beside some sick, particularly at syndrome, good effect gives inhalation a nitrous oxide in mixture with oxygen at device for gas anesthesia. Under heavy fit of the difficulty in breathing, not said and threatenning move over to to whom, necessary to cause the specific crew fast medical help. On stage sick follows to enter intravenous adrenaline, eufillin in usual dosage, - 0,5 mg in 1 ml solution sodium chloride during 5 mines slowly or 5-20 mg in 250 mg 5 % solution of the glucose at the speed of 10-15 drops at minute, ipradol- 1-2 ampules intravenous during 5 mines. At the same time intravenous are entered hormones -prednezalon, 30-60 mg, orgidrokartizon, 100-250 mg, on 250-500 ml 5 % solution of the glucose. The Asthmatic status (the ACE) is a most heavy complication BA. He presents itself quip respiratory insufficiency in consequence of obstruction of the respiratory ways, to and. The Urgent help at ACE consists of three obligatory components: кислородотерапии, инфузионной and and his(its) analogues, г hormones).
Kislorodoterapiya is conducted in the form unceasing oxygen-air mixture with comparatively small contents of the oxygen (30-40 %); therapy - by solution 5 % glucoses, solution Ringera,. The General volume - 3-3,5 l in 1-e day, in the following - from calculation 1,6 l/m2 surfaces of the body. Medikamentoznoe treatment ACE is conducted under greatly narrowed circle preparation, including under full refusal of. Intravenous are entered 15 ml 2,4 % eufillin solution on solution glucoses or chloride sodium during 4-6 mines together with 5000 ED гепарина. The Dayly dose eufillin- 1,5-2 Prednizolon are entered intravenous: from 30 before 90 mg. At декомпенсации alongside with said measure is conducted medical with bronchi, sick is translated on artificial ventilation light. During remission BA big attention must be pointed on treatment: diet, medical physical culture, sail, massage, resort treatment (the South coast Kryma, Kislovodsk, regions Prielibrusiya and others.).
CHRONIC OBSTRUKTIVNYY BRONCHITIS (HOB) - a chronic inflammation bronchi, leading to progressing breach to pulmonary ventilation and on to type and revealingcough, separation of the phegm and shortness of breath not bound споражением other organ and systems.
ETIOLOGIYA And PATOGENEZ. Etiologicheskie factors this smoking (active and passive), soiling the atmospheric air, professional , insufficiency a1, viral infections bronchi. The Main factors- breach to functions of the system local protection, structured realignment of the mucous shell bronchi and х of the ferrics, change epithelium hutch), development classical triads, and separation медиаторов inflammations and.
The Clinical picture and diagnosis. Most often sick HOB complain of cough, shortness of breath and branch of the phegm. They Vastly are less noted increasing of the temperature of the body and. The Shortness of breath the most typical HOB. She carries mainly nature, appears under significant physical load, however gradually, on measure of disease, becomes constant. The Typical shortness of breath on morning, being accompanied cough and whistling breathing. For sick HOB shortness of breath is a main by reason of the deterioration quality to lifes. Cough under HOB carries the nature an , quite often can be the with it is difficult separated by phegm, particularly matutinal. Presence to obstructions brings about HOB, emphysema light, development pulmonary heart, origin в complex and as effect last - to pneumonia. In shelters even at period of the intensification of the disease of the change can be absent. Are they Sometimes defined moderate shift й formulas to the left, small increasing SOYBEAN. Rentgenologicheskie beside majority sick long time are not revealled. Beside some sick x-rays show uneven reinforcement and deformation, as well as change sidebar pulmonary drawing in consequence of netlike, at emphysema - increasing to transparencies by pulmonary flap. Obstruktivnyy nature of the chronic bronchitis is confirmed given functional study . Diagnostic ХОБ: strictly bronchial obstruction ( the clinical manifestations and reduction OFV1 less 84% or reduction of the index TIFFNO below 88% from due values); or partial reversibility to bronchial obstruction, mportances OFV1 less than on 12% in current of the day; stable confirmed; the age as a rule, more than 50 years; the е and signs emphysemas light; steady diseases under identical treatment; revealing the disease beside smoker usually.
The Treatment sick HOB must begin on possible more early stage. It is Important to avoid all factors, conditionning irritation of the mucous shell bronchi (smoking, unbeseeming conditions of the labour, climatic zone and t. d.). The Medical actions in the first place must be directed on liquidation of the inflammatory process and to infections, correction secondary conditions and reduced organism, improvement to bronchial passability, correction. Necessary chronic centres to infections, provide the free breathing through nose. The Inflammatory process the an facility (the aspirin, ibuprofen, and others.). At intensification HOB with branch of the festering phegm follows to fix the preparations efficient first of all in respect of sticks, and microbe. In the event of light intensification with branch mucous or mucous-festering phegm possible to use the sulfa drugses of the long action, Sick with expressed sign of the inflammatory process antibiotics are fixed with provision for sensitivity. Correctness of the choice of the preparation is confirmed by result of the treatment. Are they Most often fixed penicilins (prolonged actions and others Course of the treatment - 2 нед, sometimes more (before 20 dn). The more efficient of the infusing the warmed solution r (on course of the treatment 10-12 pottings). Positional drainage and vibratory massage of the thorax are executed After each procedure. For recovering the bronchial passability are fixed preparations long action - channel of the current calcium. The Efficient preparations of the multifunction action - and others Best phegms promote the coughing up facility (the extract термопсиса, motherи- thyme, plantain, tion , 3 % solution йодида potassium and others), alkaline solution, ample hot drink, acceptance of alkaline mineral water. Under viscous phegm are fixed ferment -, For dilution of the phegm are to advantage used also of the facility: 10 % solution on 2 ml or in the manner of the ингаляций of the aerosol 3 times at day, or in the manner of ингаляций of the aerosol on 4-7 mg 2-3 times at day. Drenazhnuyu function bronchi beside sick with festering HB possible to perfect by means of medical бронхоскопий (2-4 procedures with interval in 3-7 dn) with by introduction medicine (the antibiotic; theх preparation - ; the of the facilities - эфедрина, нафтизина; the antiseptic solution -.). Electric field UVCH is fixed For with the following electrophoresis (0,1 % solution), эуфиллина (5 % solution). For improvement of отхождения phegm are used iodine-electrophoresis (5 % solution) with electrophoresis and others has Not forfeited its importances an using different distracting facilities (the , bank, warm foot baths and t. d.). Under стихании phenomenas of the intensification of the disease, usually with 4-6-go day from begin diseases, are fixed of the procedure (UFO, токи UVCH, electrophoresis of novocaine, chloride calcium to thorax). For improvement of the bronchial passability and reconstruction дренажной to functions bronchi are fixed massage of the thorax and medical physical culture, including постуральный drainage. Sanatorno-resort treatment under HB is conducted at warm dry time of the year on climatic resort of the South coast Kryma, среднегорья (Kislovodsk, Teberda) or in local санаториях (Bobruysk, Narochi).
THE EMPHYSEMA LIGHT. In practical medicine by term "emphysema light" is marked any increase воздушности light, which can be functional (sharp ballooned light), компенсаторным (the викарным), senile (атрофическим), chronic субстанциальным (obstructionist) and others Most often meeting forms of the emphysema light are divided on two greater groups - необструкционные and obstructionist emphysemas light. Under emphysema are absent the phenomenas to obstructions terminal nd small bronchi, but under obstructionist emphysema of the breach to ventilations, conditioned terminal and (or) обтурацисй small bronchi, make the part of the potential disease. To mphysema light pertain and senile, but to obstructionist - functional and chronic emphysema as independent form chronic obstructionist disease light. Emfizematoznoe lung reminds itself worn-out rubber, which, потеряв their own characteristic, can not grow shorter before its former volume. Emfizematoznoe lung is not fallen off, but consequently, occupies the greater volume, than sound.
Patogenez. In most cases emphysema light secondary and is due to диффузных of the diseases light, first of all chronic of the bronchitis (obstructionist, , or emphysema light). Emfizematoznyy process strikes the alveoluses, located from since inflammatory- process goes with респираторных on alveoluses to him. The Emphysema light can develop and without preceding diseases light (primary). Arising the primary emphysema first of all links with hereditary deficit alifa-1-inhibitor (alifa-1-антитрипсина), definite sign has also breaches pulmonary микроциркуляции, change characteristic, smoking and t. p. Primary emphysema under hereditary deficit alifa-1- appears beside young people so is identified the juvenile emphysema light. Essential increase sick HNZL is noted At the last years with deficit alifa-1- Primary панацинозная (панлобулярная) emphysema light evenly strikes all alveoluses, being included in segments light. Decreases the functionning surface light.
The Clinical picture and diagnosis. The Clinic of the emphysema light is basically limited с raised pulmonary fabrics, as well as симптомами respiratory and warmhearted insufficiency. The Clinical manifestations chronic true) of the emphysema light noticeably "lag behind" from so on clinical sign is diagnosed already completely ed emphysema. The Main of the complaint by sick emphysema light - a shortness of breath and raised ь. The Sick emphysema, sufferring from chronic bronchitis, complain on dry cough also, increasing with shortness of breath. For sick emphysema light outwardly typical приподнятые shoulder, short neck, horax, delivered with side, with embroilling at breath gap,. Vybuhaet breastbone. Extended and even выбухают the a gap, are smoothed or выбухают the of the area, decreases the respiratory excursion of the thorax. In act of the breathing participate the auxiliary muscles: on breath - a breastbone- and stair, on exhalation - front зубчатые and abdominal press. On exhalation sick close the mouth, bloating cheeks (the puffing). Perkutorno are defined "box packed" sound, limited mobility of the pulmonary edge, low standing and reduction to mobilities of the diaphragm, weakened breathing with escalated exhalation. They Are Listened to diffused dry, sometimes humid мелкопузырчатые wheezes. The Borders heart are defined by a narrow margin. The mass of the body falls Beside sick emphysema light that is explained by prevalence of the catabolic processes, which mainly touch the alveoluses and to a lesser extent - other fabrics. Under expressed respiratory insufficiency in shelters can be noted, increase the contents of the haemoglobin. Beside sick with primary by emphysema light is lowered level alifa-1- in whey shelters. The most typical primary emphysemas are: uniform increasing to transparencies by pulmonary flap and impoverishing pulmonary drawing, in lower division particularly, low standing of the diaphragm and "hanging heart". Under secondary to emphysema light transparency their lower division is vastly reduced in consequence of and other change. The Diaphragm usually is not displaced down, since general volume light is changed small.
The Treatment. Full curing the emphysema light impossible in connection with her(its) steady progressing current and of the structured change pulmonary fabrics. So treatment of the emphysema light is made for on fight with disease, caused her(its) development (for instance, chronic bronchitis, respiratory insufficiency, pulmonary and chronic pulmonary heart). At presence chronic bronchitis are fixed coughing up and becalming cough of the facility (codeine), of the infusion solution, ferment; under an); under pulmonary heart - warmhearted), preparations, unloading system to pulmonary artery (лазикс). Does Not follow to use the facilitators of the breathing since respiratory centre beside sick emphysema light remains function safe. Eufillin the most efficient under intravenous introduction (2,4 % solution on 5 ml in solution sodium of the chloride 2-3 times at day repeated 10-day course).The Treatment to respiratory insufficiency comprises of itself first of all obligatory refusal of smoking, using the alcohol, restriction to physical activity, education to rational breathing with participation of the diaphragm. Work is Recommended in heat premises with good ventilation and чистым by air. The Greater profit can bring the medical physical culture, which consolidates the respiratory musculature, provides the full-fledged exhalation. Emphases addresses on respiratory exercises. They Are Fixed also massage of the thorax, аэротерапия walks on become cool the air with gradual lengthening of the route.
They Are Shown courses , which allow to reduce and promote the reduction of the pressure in pulmonary artery.