Клініко-біологічний аспект концептуальних засад і діагностика раннього хронічного обструктивного захворювання легень

Abstract

SummaryThe problem of timely diagnosis of chronic obstructive pulmonary disease (COPD)remains relevant. The priority of timely diagnosis is to reduce mortality and morbidity.COPD is often detected very late. Only 5 years before diagnosis, the possibility ofCOPD diagnosis was missed in 85% of cases. Global late diagnosis is due to lack oftypical clinical symptoms and expectant medical tactics. Implementation of the conceptof early COPD can help to solve the problem. Early COPD is defined as a disease withminimal symptoms or no symptoms at all, which is combined with a slight restriction ofair flow. Most commonly, the development of COPD is associated with tobaccosmoking. Caused by other environmental factors, the decline in lung function from earlyadulthood forms a classic COPD. The combined influence of genetic and environmentalrisk factors leads to a decrease in lung function from birth. Such a ventilatory defectincreases genetic susceptibility, and COPD can begin during pregnancy, continue intoinfancy and early childhood, in adults, and with aging. The clinical diagnosis of earlyCOPD involves a comprehensive assessment of respiratory symptoms, environmentaland genetic risk factors for the prenatal period, childbirth, childhood and adolescence,premorbid factors as well as concomitant diseases. The criteria for early COPD includeage ≥40 years, postbroncholytic expiratory volume for the first second/forced lungcapacity <0.7, and forced expiratory volume for the first second ≥50% of the predictedvalue. High-resolution computer imaging can detect parenchymal changes andthickening of the bronchial wall before loss of lung function. The earlier diagnosis ofCOPD in the preclinical period is also ensured by the use of biomarkers. Known geneticrisk factors are mutations of the α1-antitrypsin gene, low levels of which are consideredbiomarkers of early basal emphysema and genetic COPD. Genetic risk factors that areunrelated to gene mutations relate to the heterogeneity of the primary structure ofdeoxyribonucleic acid. Single-nucleotide allelic polymorphisms of genes encoding majorpathological mechanisms are biomarkers of genetically associated COPD. Genetic riskfactor for COPD according to computed tomography is variations of the bronchial tree.Such inherited changes in the distal lung structure also a biomarker of geneticallyassociated COPD. The practical side of the diagnosis of early COPD and itsoptimization will require the development of comprehensive measures to maximize thestructure and function of the lungs in the early period of life, and now they shouldconcern measures to modify the disease in adults in the preclinical period.