Chronic Respiratory Diseases

malattie-respiratorie-croniche_1The OCBP (obstructive chronic bronchopneumopathy) is one of the most serious chronic diseases, both for its diffusion and its consequences. It is characterized by an irreversible, or only partially reversible, obstruction of the respiratory ways; it reveals itself through a difficulty breathing, which worsens in time, and is accompanied with a cough and phlegm. Usually, OCBP is diagnosed when the symptoms are present for at least 3 months per year for 2 consecutive years (OMS). In Italy, the disease hits about 5% of the population, up 20% in people over 60; furthermore, differently from other pathologies, this disease is constantly increasing, to such a point that it is the fourth chronic disease after arthrosis, hypertension and allergic diseases. The greatest concern is the mortality it causes. Even this contrasts other clinical conditions;, between 1965 and 1998, for the  coronaropathy mortality rate decreased 59%, 64% for heart attacks and 35% for other cardio-cerebrovascular diseases, but in the case of the OCBP, there was an increase of 163%. It is calculated that OCBP causes about one million victims in the world, 18 thousand of which are in Italy. This means that, every day in our country, between 50 and 60 people, 2-3 per hour, die because of OCBP.

malattie-respiratorie-croniche_2Between 70% and 80 % of people suffering from OCBP are smokers. This datum is not a surprise: smoking is the main cause of this disease together with atmospheric pollution and “indoor” pollution due to passive smoking and, above all in developing countries, to  combustion in domestic environment. Along with a rare genetic form, due to the deficiency of the production of a particular protein, there is a certain difference in the individual predisposition to develop the disease, which explains why not all smokers will be condemned to have COBP. The early detection of the disease is extremely important and this can be done with a simple examination that measures the quantity of air breathed in and out from the lungs and the time necessary to do it. This allows for the identification of any decreased capacity of the respiratory ways, revealing if there is an obstruction to the air flow that may be treated with pharmaceutical drugs. Differently from asthma, a typical characteristic of the OCBP is that the obstruction is not reversible. Any person with difficulty breathing, or a person who is affected by a persistent cough with phlegm, especially if the person is a smoker, should go to the doctor. In fact, the diagnosis is too often too late because the symptoms are underestimated by the patient who thinks they are due to smoking. Actually, a precocious diagnosis is fundamental because it prevents the disease from worsening and allows the management of the symptoms with an improvement to the quality of life. The first recommendation is not to smoke, but there are other preventive and effective interventions. A fundamental measure is to get the flu shot. There are countless studies that prove the importance of this measure as well as other studies that confirm the efficiency of the anti-pneumococcal vaccination. This vaccination is important to protect the patient suffering from COBP because it helps to prevent acute phases and contributes in fighting the progression of the disease. The anti-pneumococcal vaccination reduces the risk of pneumonia. Research carried out a few years ago in the USA on an elderly population suffering from BPCO (1) showed that the anti-pneumococcal vaccination was able to reduce the hospitalization for pneumonia by 43% of patients and the mortality by 29%, and its benefits add to those of the flu shot. In fact, the vaccination allows the reduction of the risk of infective complications, which are one of the elements responsible for the new acute phases. This is another characteristic of the disease, which has moments of particular gravity with subsequent hospitalization of the patient. Therefore, to limit the risk, it is important that the patient gets vaccinated, leads a “healthy” life, doesn’t smoke, is attentive to the atmospheric pollution and avoids going out on days when the air is worse. Furthermore, it is important to carefully follow the prescribed therapies, also because it was observed that one of the factors responsible for the sudden changes of clinic symptomatology is due to the irregularity in following the treatment.

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