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Sarcoidosis – lung disease

Systemic lung disease, characterized by the formation of granules in the lung tissue, is accompanied by cough, chest pain, weakness, fever.
Sarcoidosis is a more frequent disease than is commonly thought. The incidence of sarcoidosis in the world ranges from 11 to 640 per 100,000 people. The disease develops at any age, even after 70 years, but the peak of sarcoidosis is 40 years. It was believed that women suffer from sarcoidosis more often than men. However, apparently, it is not so: women simply have more pronounced symptoms of the disease, which means they are more likely to see doctors.

The cause of sarcoidosis is unknown, so there is still no exhaustive definition of the disease. The main finding is sarcoid granulomas (epithelioid cell granulomas without caseosal necrosis).

Complaints

Sarcoidosis - lung disease

In more than 90% of cases, the lungs or intra-thoracic lymph nodes are affected, but there are no complaints, at least not at an early stage. Even with extensive lung damage (chest X-ray) there may be no breathlessness or coughing. Dyspnea and other complaints usually occur at an advanced stage of the disease.

The first manifestation of sarcoidosis may be eye damage. Iridocyclitis, chorioiditis, conjunctivitis and lacrimal gland affection with xerophthalmia (dry eyes) are noted in 25% of cases. Approximately 20% of patients have the first sarcoidosis: plaques from orange-pink to brown color. Approximately 10% of patients suffer from the nervous system. Sarcoidosis may be suspected of impaired pituitary function or hypercalcemia (increased calcium levels). In addition, manifestations of sarcoidosis are hepatosplenomegaly (increase in the liver and spleen), bone damage (more often phalanges of the fingers) and symmetrical lesions of the joints. Significant pathology of the heart is rare, but in some cases there are violations of heart rhythm, cardiomyopathy. In 10% of patients, especially those with extensive affection of lymph nodes, there is a fever.

Stages

The stages of sarcoidosis are determined from the data of chest X-ray.
Stage I: bilateral increase in bronchopulmonary lymph nodes.
Stage II: Bilateral enlargement of bronchopulmonary lymph nodes and diffuse lesions of the pulmonary parenchyma, reticular remodeling of the lung pattern, but sometimes multiple focal or biliary shadows.
Stage III: Affection of the pulmonary parenchyma without enlargement of bronchopulmonary lymph nodes.
The probability of spontaneous remission (self-recovery) at stages I, II and III is 80, 50 and 30% respectively.

Diagnostics

Sarcoidosis - lung disease

In 90% of patients the disease is limited to lesions of the intra-thoracic lymph nodes and lungs and often runs asymptomatically. In such cases, radiological changes may be an accidental finding, for example, during a prophylactic examination or examination for another disease. As already mentioned, the first manifestation of sarcoidosis may be lesion of other organs. In any case, before making a diagnosis, the doctor must obtain histological confirmation of sarcoidosis.

Treatment

Despite the fact that glucocorticoids have been used for over 45 years, there is still no consensus on the advisability of their treatment for lung sarcoidosis. Practice shows that glucocorticoid treatment is justified in all patients with stages II and III, if within 6-12 months there are no signs of spontaneous remission or there are signs of deterioration (according to radiography and examination of respiratory function). As a rule, taking 40 mg of prednisolone a day is sufficient.
Although some specialists recommend starting treatment only when there are complaints, studies have shown that shortness of breath appears in the irreversible phase of the disease. Therefore, it is better to prescribe glucocorticoids before complaints occur to prevent the development of irreversible changes.
Most specialists adhere to the following indications for prescription of glucocorticoids: 1) uveitis (begin with local treatment), 2) hypercalcemia, 3) myocardial damage (especially cardiomyopathy), 4) neurological disorders. If glucocorticoids are contraindicated for any reason, the following drugs are recommended: methotrexate, chloroquine, azathioprine and oxyphenbutazone.

Observation

Surveillance of sarcoidosis patients necessarily includes regular chest X-rays and examination of external respiration function (spirometry). The frequency of examination depends on the course of the disease, as well as the preferences of the attending physician. The course of sarcoidosis can be assessed by the activity of angiotensin-converting enzyme in the blood. The frequency of relapse after treatment of patients with stages II and III is about 25%. Therefore, at the end of treatment, patients should be monitored for several years. The probability of relapse is significantly reduced, if for more than a year the condition remains stable and there are no signs of sarcoidosis activity.

Lung diseases: important facts that need to be known

Medicine knows many diseases associated with our lungs and other respiratory system organs. Some of these diseases are chronic, some are fatal and some can be quickly treated. What should you know about lung diseases?

Lung diseases: important facts that need to be known

Medicine knows many diseases related to our lungs and other respiratory system, ranging from bronchitis, asthma of varying intensity, chronic lung disease, to deadly diseases – lung cancer and idiopathic pulmonary fibrosis. Some of these diseases are chronic, some are fatal, and some can be quickly treated.

As with the treatment of any other disease, the wrong diagnosis and improperly appointed treatment can lead to significant deterioration of health. Some of the respiratory illnesses are widespread, especially in the cold winter, while others are considered rare and poorly understood.

What is known about respiratory diseases?

Lung diseases: important facts that need to be known

The most common childhood disease is bronchial asthma. About 5%-10% of children suffer from severe chronic forms of asthma, which is characterized by severe inflammation of the respiratory tract and is accompanied by prolonged seizures of breathing difficulties.
Some of the lung diseases are chronic, and medicine still does not know the methods that would lead to their complete cure. However, recent medical research has led to the emergence of new drugs and treatments that can significantly improve patients’ quality of life. For example, a real breakthrough was the emergence of new drugs to treat pulmonary fibrosis. New drugs change the course of the disease, improve the quality of life of patients and help slow down the rate of deterioration. New drugs have also appeared against lung cancer.
Lung diseases may manifest themselves at a very early age. Chronic obstructive pulmonary disease is considered a disease of the elderly, and is usually diagnosed at the age of 50-60 years. But it is important to know that much of these diagnoses were made at a late stage, when the disease is already difficult to treat. The first symptoms of the disease may appear at the age of + 40 years.
The condition worsens in the cold season: most often the symptoms of respiratory illness are exacerbated in autumn and winter. In cold air promotes asthmatic reactions and breathing difficulties. This rule is common for almost all lung diseases.
Passive smoking can also cause respiratory diseases. For a long time, there was a widespread perception that only people who smoke are susceptible to respiratory diseases. Research shows that for a number of diseases (obstructive pulmonary disease, pulmonary fibrosis, and lung cancer), smoking remains a major development factor. But to date, it has been found that both the above diseases and other lung diseases can also be diagnosed in people who have never smoked in their lives, but are constantly in a smoking environment, being passive smokers.
There are products that provoke sputum and cough. In particular, we are talking about dairy products. Although there is still no consensus in the medical community on whether or not to avoid dairy products for patients with asthma or lung disease, the general recommendation remains to limit the daily diet of products that cause mucus and sputum. Such products include milk, citrus fruits, bananas, and peanuts.
Personal approach to the treatment of each patient is a very important component of therapy, especially today, when there are a variety of modern techniques and developments that can significantly improve the quality of life of patients with the most severe, chronic respiratory diseases. Medicines, including biological drugs, are selected strictly individually, so the use of drugs that are incompatible with the patient’s body can lead to serious complications.

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a disease of the lungs, characterized by a chronic restriction of air flow in the respiratory tract. Symptoms worsen with time. Dyspnea during physical activity gradually turns into dyspnea at rest. This disease is often not diagnosed and can be dangerous to life. Previously, COPD was often called the terms “chronic bronchitis” and “emphysema”.

Risk factors

Chronic obstructive pulmonary disease

The main cause of COPD is tobacco smoke (including secondary smoke inhalation or secondhand smoke). Other risk factors include: indoor air pollution (e.g., through the use of solid fuels for cooking and heating); air pollution; dust and chemicals in the workplace (fumes, irritants and fumes); frequent infections of the lower respiratory tract in childhood.
In the past, men were more likely to be affected by COPD, but because in high-income countries the prevalence of smoking among women is as high as among men, and in low-income countries women are more likely to be affected by indoor air pollution (e.g., from solid fuels for cooking and heating), today men and women are almost equally affected.
More than 90 percent of deaths from COPD occur in low- and middle-income countries, where effective strategies to prevent and control the disease are not always implemented or available.

Symptoms

Chronic obstructive pulmonary disease develops slowly and is usually manifested in people older than 40-50 years. The most common symptoms of COPD are shortness of breath (“air shortage”), chronic cough and sputum separation. As the health condition worsens, the patient may have difficulty even doing the usual daily activities, such as climbing a small flight of stairs or carrying a suitcase. In addition, patients often have exacerbations, that is, serious episodes of severe shortness of breath, cough and sputum separation, which last from a few days to several weeks. These episodes can lead to a marked decrease in work capacity and the need for emergency medical care (including hospitalization), and sometimes death.

Diagnosis and Treatment

Chronic obstructive pulmonary disease

Usually, the suspicion of chronic obstructive pulmonary disease arises in people with the symptoms described above. The diagnosis can be confirmed by a breath test called spirometry, which measures how much air a person can exhale at a time with maximum force and how quickly.
Chronic obstructive pulmonary disease is incurable. However, available medications and physiotherapy can alleviate symptoms, increase the ability to bear the load and improve quality of life, as well as reduce the risk of death. The most effective and cost-effective treatment for COPD among smokers is smoking cessation.
The availability of opportunities to diagnose and treat COPD depends on the degree of resource availability. WHO has published guidelines with specific recommendations for COPD management in primary health care settings and resource-constrained settings.

WHO activity

WHO’s work on COPD is part of the organization’s overall efforts to prevent and control non-communicable diseases. The goals of WHO are: to raise awareness of the global epidemic of non-communicable diseases; create a healthier environment, especially for poor and disadvantaged populations;
reduce common risk factors for non-communicable diseases, such as tobacco use, poor nutrition and physical inactivity; preventing premature death and preventable disability due to major non-communicable diseases.
The WHO Framework Convention on Tobacco Control was developed in response to the globalization of the tobacco epidemic to protect billions of people from the harmful effects of tobacco. It is the first global health agreement concluded by WHO and ratified by more than 180 countries.

Chronic bronchitis

Chronic bronchitis is a chronic inflammation of bronchitis resulting from prolonged acute bronchitis (e.g. after measles or flu) or long-term exposure of the mucous membrane of bacteria to bronchitis (e.g. after the passage of measles or flu), Haemophilus influenzae, Streptococcus pneumoniae) or viruses (e.g. RS-virus, adenoviruses), physical and chemical factors (smoking, cooling the respiratory tract, dusting the air with industrial waste, etc.). etc.), so says Dr. Denis Slinkin.

It is now proven that chronic bronchitis develops in almost 100% of cases among smokers. Chronic inflammation may be accompanied by metaplasia of the epithelium, resulting in a decrease in the number of cells with eyelashes. With constant exposure to cigarette smoke may dysplasia epithelium, uthe development of malignant tumors.

In the clinic, exacerbations of the disease are combined with periods of remission. Most patients with chronic bronchitis develop pulmonary emphysema. Complications of chronic bronchitis are right ventricular failure and lung failure, so says Dr. Denis Slinkin.

Morphological changes

Dr. Denis Slinkin

Dr. Denis Slinkin will assert that in the early stages of the disease chronic bronchitis of infectious nature may initially have a local nature, there is inflammation of respiratory bronchitis with a diameter of less than 2 mm. Chronic inflammation may lead to destruction of the bronchial wall and surrounding elastin fibres, which leads to the development of centrolobular emphysema. Reduced air pressure and pliability of the bronchial walls, together with blockage of the lumen by slime, lead to significant difficulties in air passage through the airways. Chronic bronchitis and emphysema are usually observed simultaneously in different proportions.