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COPD: causes, classification, diagnosis, how to treat and prevent

COPD (chronic obstructive pulmonary disease) is a disease that develops as a result of an inflammatory reaction to certain environmental stimuli, with lesions of the distal bronchi and developed emphysema, and which manifests itself as a progressive decrease in the speed of air flow in the lungs, an increase in respiratory failure, and other lesions organs.

In Russia, 11 million people suffer from chronic obstructive pulmonary disease (COPD) and the number of cases is constantly growing.

The air, passing through the trachea and bronchi, enters the lungs. Normally, the bronchi have a large lumen through which the air passes freely, the gas exchange is excellent.

Medical statistics says: at least 80% of smokers have chronic obstructive pulmonary disease. It is the vessels that suffer in smokers in the first place.

What's happening

Chronic - that goes long and, as a rule, slowly.

Obstructive - a violation of the air passage.

The bronchial tree at the base is much wider than at the periphery. When the air runs through the bronchi, at first it moves fast enough, and to the periphery it slows down. The smoker air passing through the bronchi, meets obstacles. At first, the person begins to cough, the cough becomes regular. Sputum appears as stagnation develops. Then various forms of respiratory failure develop - first, it is difficult for a person to carry out his usual load, and then it becomes difficult to breathe.

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Also, due to the narrowing of the bronchi, the air is not exhaled completely. An extended exhalation leads to the formation of another pathology. As the lungs begin to shrink, and the air does not come out, there is an over-inflation of the lungs, which in medical language is called pulmonary emphysema. In the peripheral part there are large cavities that are not only not ventilated, but also poorly supplied with blood. The area of ​​sites for gas exchange decreases, hypoxia and shortness of breath develop. Outwardly, it manifests itself as a barrel chest.

COPD is the second among chronic non-communicable diseases and the fourth among causes of death, and this figure is steadily increasing. Due to the fact that this disease is inevitably progressive, it occupies one of the first places among the causes of disability, as it leads to a violation of the main function of our body - the function of respiration.

The problem of COPD is truly global. In 1998, an initiative group of scientists created the Global Initiative for Chronic Obstructive Lung Disease (Global Initiative for Chronic Obstructive Lung Disease - GOLD). The main objectives of GOLD are the wide dissemination of information about this disease, the systematization of experience, the explanation of the causes and the corresponding prevention measures. The basic idea that doctors want to convey to humanity: COPD can be prevented and treated, this postulate is even in the modern working definition of COPD.

Causes of COPD

COPD develops when a combination of predisposing factors and provoking agents of the environment.

Predisposing factors

1. Hereditary predisposition. It has already been proven that a congenital deficiency of some enzymes predisposes to the development of COPD. This explains the family history of this disease, as well as the fact that not all smokers, even with great experience, fall ill.

2. Gender and age. Men over the age of 40 suffer from COPD more, but this can be explained by the aging of the body and the length of the smoking period. There are data that now the incidence rate among men and women is almost equal. The reason for this may be the spread of smoking among women, as well as the increased sensitivity of the female body to passive smoking.

3. Any negative effects that affect the development of the child's respiratory system in the prenatal period and early childhood, increase the risk of COPD in the future. By itself, physical underdevelopment is also accompanied by a decrease in lung volume.

4. Infections. Frequent respiratory infections in childhood, as well as increased susceptibility to them at an older age.

5. Bronchial hyperreactivity. Although bronchial hyperreactivity is the main mechanism for the development of asthma, this factor is also considered a risk factor for COPD.

Provoking factors

Smoking. 90% of all COPD sufferers are smokers. Therefore, we can confidently assert that smoking is the main cause of the development of this disease. This fact must be conveyed to the maximum number of people, since smoking is the only controllable factor in the prevention of morbidity and mortality. A person cannot influence his genes, is unlikely to be able to clear the air around him, but he can always quit smoking.

Occupational hazards: organic and inorganic dust, smoke, chemical impurities. Mine workers, construction workers (cement dust), metallurgical workers, cotton producers, workers of grain drying shops, and paper production are most at risk. When exposed to these adverse factors, both smokers and non-smokers are equally affected.

Ambient air saturation with biofuel products (wood, coal, dung, straw). In areas with low civilization, this factor leads to the incidence of COPD.

Pathogenesis of COPD

Exposure to tobacco smoke and other irritating substances leads to predisposed individuals to the occurrence of chronic inflammation in the walls of the bronchi. The key is the defeat of their distal parts (that is, located closer to the pulmonary parenchyma and alveoli).

As a result of inflammation, there is a violation of the normal secretion and discharge of mucus, the blockage of the small bronchi, the infection easily joins, the inflammation spreads to the submucous and muscular layers, the muscle cells die and are replaced by connective tissue (bronchial remodeling). At the same time, the lung tissue parenchyma and the bridges between the alveoli are destroyed - emphysema develops, that is, the airglow of the lung tissue. The lungs as if inflated with air, decreases their elasticity.

The small bronchi on the exhale do not do well - the air hardly escapes from emphysematous tissue. Normal gas exchange is disturbed, as the volume of inhalation also decreases. As a result, the main symptom of all patients with COPD occurs - shortness of breath, especially aggravated by movements, walking.

Chronic hypoxia becomes a consequence of respiratory failure. The whole body suffers from it. Prolonged hypoxia leads to a narrowing of the lumen of the pulmonary vessels - pulmonary hypertension occurs, which leads to an expansion of the right heart (pulmonary heart) and the adherence of heart failure.

Why is COPD isolated into a separate nosology?

Awareness of this term is so low that most patients already suffering from this disease do not know that they suffer from COPD. Even if such a diagnosis is made in medical records, the habitual “chronic bronchitis” and “emphysema” still prevail in the everyday life of both patients and doctors.

The main components in the development of COPD really are chronic inflammation and emphysema. So why then is COPD highlighted in a separate diagnosis?

In the name of this nosology, we see the main pathological process - chronic obstruction, that is, the narrowing of the airway lumen. But the process of obstruction is also present in other diseases.

The difference between COPD and asthma is that obstruction is almost or completely irreversible in COPD. This is confirmed by spirometric measurements using bronchodilators. In case of bronchial asthma, after application of bronchodilators, there is an improvement in FEV1 and PSV indicators by more than 15%. Such obstruction is treated as reversible. With COPD, these numbers do not change much.

Chronic bronchitis may precede or accompany COPD, but it is an independent disease with well-defined criteria (prolonged cough and sputum hypersecretion), and the term itself involves only the bronchi. When COPD affects all the structural elements of the lungs - the bronchi, alveoli, blood vessels, pleura. Chronic bronchitis is not always accompanied by obstructive disorders. On the other hand, there is not always an increased sputum in COPD. That is, in other words, there may be chronic bronchitis without COPD, and COPD does not quite fall under the definition of bronchitis.

Thus, COPD now is a separate diagnosis, has its own criteria, and in no way case replaces other diagnoses.

Diagnostic criteria for COPD

One can suspect COPD if there is a combination of all or several signs, if they occur in persons older than 40 years:

  1. Shortness of breath. Dyspnea in COPD - gradually increasing, aggravated by physical activity. It is dyspnea that is usually the first reason to go to a doctor, although in fact this means a far-reaching and irreversible pathological process.
  2. Cough. Cough with COPD is chronic, usually with sputum, but may be unproductive. Cough usually appears a few years before shortness of breath, is often underestimated by patients, it is considered commonplace in smokers. However, it should be noted that COPD can occur without coughing.
  3. The combination of progressive dyspnea and cough with the influence of aggressive factors: smoking, occupational hazards, smoke from home heating stoves. There is such a thing as an index of smoking: the number of cigarettes smoked per day is multiplied by 12. When this indicator is above 160, the patient is confidently included in the risk group for COPD.
  4. Combination of symptoms with a hereditary history.
  5. Wheezing and listenable wheezing. This symptom is intermittent and does not have such diagnostic value as in bronchial asthma.
  6. If a patient has COPD, a spirometry examination is performed.

A reliable confirmation of COPD is a spirometric indicator of the ratio of the forced expiratory volume for 1 s to the forced vital capacity of the lungs (FEV1 / FVC) conducted 10-15 minutes after the use of bronchodilators (beta sympathomimetics of salbutamol, berotec, or 35-40 minutes after short-acting anticholinergics –Pratropium bromide). The value of this indicator <0.7 confirms the limitation of the air flow rate and, in combination with proven risk factors, is a reliable criterion for the diagnosis of COPD.

The remaining indicators of spirometry - peak expiratory flow rate, as well as the measurement of FEV1 without a test with bronchodilators can be carried out as a screening examination, but do not confirm the diagnosis of COPD.

Among other methods prescribed for COPD, in addition to the usual clinical minimum, we can note the chest X-ray, pulse oximetry (determination of blood oxygen saturation), the study of blood gases (hypoxemia, hypercapnia), bronchoscopy, chest CT, sputum examination.

Classification of COPD

There are several classifications of COPD by stages, degrees of severity, clinical options.

The classification by stages takes into account the severity of symptoms and spirometry data:

  • Stage 0. Risk group. The impact of adverse factors (smoking). No complaints, lung function is not impaired.
  • Stage 1. Easy for COPD.
  • Stage 2. Moderate for COPD.
  • Stage 3. Severe Current.
  • Stage 4. Extremely severe.

In the last report GOLD (2011) it was proposed to exclude the classification by stages, the classification by degrees of severity remains, based on the FEV1 indicators:

In patients with FEV1 / FZHEL <0.70:

  • GOLD 1: Light FEV1 ≥80% due
  • GOLD 2: Moderately severe 50% ≤ FEV1 <80%.
  • GOLD 3: Heavy 30% ≤ FEV1 <50%.
  • GOLD 4: Extremely severe FEV1 <30%.

It should be noted that the severity of symptoms does not always correlate with the degree of bronchial obstruction. Patients with mild obstruction may be disturbed by rather severe shortness of breath, and, conversely, patients with GOLD 3 and GOLD 4 may feel quite satisfactory for a long time. To assess the severity of dyspnea in patients, special questionnaires are used, the severity of symptoms is determined in points. It is also necessary in the evaluation of the course of the disease to focus on the frequency of exacerbations, the risk of complications.

Classification

The experts of the international program Global Initiative on Chronic Obstructive Pulmonary Disease (GOLD - Global Strategy for Chronic Obstructive Lung Disease) distinguish the following stages of COPD:

  • Stage I - easy COPD. At this stage, the patient may not notice that his lung function is impaired. Obstructive disorders - the ratio of FEV1 to the forced vital capacity of the lungs is less than 70%, FEV1 is more than 80% of the proper values. Chronic cough and sputum production are usually, but not always.
  • Stage II - moderately severe COPD. This is the stage at which patients seek medical care for shortness of breath and exacerbation of the disease. It is characterized by an increase in obstructive disorders (FEV1 is more than 50%, but less than 80% of the proper values, the ratio of FEV1 to the forced vital capacity of the lungs is less than 70%). There is an increase in symptoms with dyspnea that occurs during exercise.
  • Stage III - Severe COPD. It is characterized by a further increase in airflow restriction (the ratio of FEV1 to forced vital capacity of the lungs is less than 70%, FEV1 is more than 30%, but less than 50% of the proper values), increase in shortness of breath, frequent exacerbations.
  • Stage IV - an extremely difficult course of COPD. At this stage, the quality of life deteriorates markedly, and exacerbations can be life threatening. The disease acquires a disabling course. It is characterized by extremely severe bronchial obstruction (the ratio of FEV1 to forced vital capacity of the lungs is less than 70%, FEV1 is less than 30% of the proper values, or FEV1 is less than 50% of the proper values ​​in the presence of respiratory failure). Respiratory failure: paO2 less than 8.0 kPa (60 mm Hg) or oxygen saturation less than 88% with or without RaCO2 more than 6.0 kPa (45 mm Hg). The development of a pulmonary heart is possible at this stage.

Therefore, this report proposes, on the basis of analysis of subjective symptoms, spirometry data and the risk of exacerbations, to divide patients into clinical groups - A, B, C, D.

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Practitioners still distinguish clinical forms of COPD:

  1. Emphysematous variant of COPD. From complaints in such patients dyspnea prevails. Coughing is less common, sputum may not be. Hypoxemia, pulmonary hypertension come late. Such patients, as a rule, have low body weight, skin color is pink-gray. They are called "pink puffers".
  2. Bronchitis option. Such patients complain mainly of cough with sputum, dyspnea worries less, they quickly develop a pulmonary heart with a corresponding pattern of heart failure, sinus syndrome, edema. Such patients are called "blue swellings."

The division into emphysematous and bronchitis variants is rather conditional, mixed forms are more often observed.

During the course of the disease, a stable flow phase and an acute phase are distinguished.

Exacerbation of COPD

An exacerbation of COPD is an acutely developing condition, when the symptoms of a disease go beyond its normal course. There is an increase in shortness of breath, coughing and deterioration in the general condition of the patient. Conventional therapy, which he used earlier, does not eliminate these symptoms to his usual state, a dose change or treatment regimen is required. Usually hospitalization is required for exacerbations of COPD.

Diagnosis of exacerbations is based solely on complaints, anamnesis, clinical manifestations, and can also be confirmed by additional studies (spirometry, complete blood count, microscopy and bacteriological examination of sputum, pulse oximetry).

The causes of exacerbation are most often respiratory viral and bacterial infections, less often other factors (exposure to harmful factors in the surrounding air). A normal ARD in a patient with COPD is an event that significantly reduces lung function, and returning to the initial state may take a long time or stabilization will occur at a more severe degree of the disease.

The more frequent the exacerbations, the worse the prognosis of the disease and the higher the risk of complications.

Complications of COPD

Due to the fact that patients with COPD exist in a state of constant hypoxia, they often develop the following complications:

  • Acute and chronic respiratory failure.
  • Pneumonia
  • Cardiovascular complications. Here it should be noted as the formation of chronic pulmonary heart, and the emergence or aggravation of coronary artery disease, atherosclerosis, arterial hypertension.
  • Osteoporosis.
  • Muscular dystrophy.
  • Metabolic syndrome.
  • Depression.
  • Lung cancer.
  • Spontaneous pneumothorax.

Treatment of COPD

The basic principles of therapeutic and preventive measures in COPD:

  1. Quitting smoking. At first glance, the simplest, but most elusive moment.
  2. Pharmacotherapy. Early onset of basic drug treatment can significantly improve the patient’s quality of life, reduce the risk of exacerbations and increase longevity.
  3. The scheme of drug therapy should be selected individually, taking into account the severity of the course, patient's adherence to long-term treatment, availability and cost of medicines for each specific patient.
  4. Patients with COPD should be offered vaccines against influenza and pneumococcal infections.
  5. Proved a positive effect of physical rehabilitation (training). This method is under development until there is an effective therapeutic program. The easiest way to offer the patient is to walk for 20 minutes daily.
  6. In the case of a severe course of the disease with severe respiratory failure, prolonged inhalation of oxygen as a means of palliative care can improve the condition of the patient and prolong life.

To give up smoking

It has been proven that quitting tobacco smoking has a significant impact on the course and prognosis of COPD. Despite the fact that chronic inflammation is considered irreversible, stopping smoking slows down its progression, especially in the early stages of the disease.

Tobacco addiction is a serious problem that requires a lot of time and effort not only for the patient, but also for doctors and relatives. A special long-term study was conducted with a group of smokers who suggested various activities aimed at combating this addiction (conversations, persuasions, practical advice, psychological support, visual agitation). With such expenditures of attention and time, it was possible to achieve quitting smoking in 25% of patients. Moreover, the longer and more often conversations are held, the greater the likelihood of their effectiveness.

Anti-tobacco programs become national tasks. It has become necessary not only to promote healthy lifestyles, but also legal punishment for smoking in public places. This will help to limit the harm at least from passive smoking. Tobacco smoke is especially harmful for pregnant women (both active and passive smoking) and children.

In some patients, tobacco addiction is akin to drug addiction, and interviewing in this case will not be enough.

In addition to agitation, there are also medical ways to combat smoking. These are nicotine replacement pills, sprays, chewing gums, skin patches. The effectiveness of certain antidepressants (bupropion, nortriptilin) in the formation of long-term smoking cessation has also been proven.

A former smoker may be considered a person who does not smoke for more than 6 months.

Pharmacotherapy COPD

Drug therapy for COPD is aimed at eliminating symptoms, preventing exacerbations and slowing the progression of chronic inflammation. It is impossible to completely stop or cure the destructive processes in the lungs with existing drugs today.

The main drugs used to treat COPD are:

  • Bronchodilators.
  • Corticosteroid hormones.
  • Expectorant.
  • Phosphodiesterase-4 inhibitors.
  • Immunomodulators.
  • Bronchodilators

Bronchodilators used for the treatment of COPD, relaxes the smooth muscles of the bronchi, thereby expanding their clearance and facilitate the passage of air on the exhale. It has been proven that all bronchodilators increase exercise tolerance.

Bronchodilator drugs include:

  1. Short-acting beta-stimulants (salbutamol, fenoterol).
  2. Beta-stimulants of long-acting (salmoterol, formoterol).
  3. Short-acting anticholinergics (ipratropium bromide - atrovent).
  4. Cholinolytics of long-acting (tiotropium bromide - spirit).
  5. Xanthines (aminophylline, theophylline).

Almost all existing bronchodilators are used in inhalation form, which is a more preferable way than ingestion. There are different types of inhalers (metered aerosol, powder inhalers, inhalers activated by inhalation, liquid forms for nebulizing inhalations). In severe patients, as well as in patients with intellectual inhalation disorders, it is better to pass through a nebulizer.

This group of drugs is the main one in the treatment of COPD, used at all stages of the disease as monotherapy or (more often) in combination with other drugs. For continuous therapy, the use of long-acting bronchodilators is preferable. If you need the appointment of short-acting bronchodilators, preference is given to a combination of fenoterol and ipratropium bromide (berodual).

Xanthines (aminophylline, theophylline) are used in the form of tablets and injections, have many side effects, are not recommended for long-term treatment.

Glucocorticosteroid hormones (GCS)

GCS is a powerful anti-inflammatory agent. Used in patients with severe and extremely severe, as well as appointed by short courses with exacerbations in the moderate stage.

The best form of application is inhaled GCS (beclomethasone, fluticasone, budesonide). The use of such forms of corticosteroids minimizes the risk of systemic side effects of this group of drugs that inevitably arise when they are taken orally.

GCS monotherapy is not recommended for patients with COPD, more often they are prescribed in combination with long-acting beta-agonists. The main combined drugs: formoterol + budesonide (simbicort), salmoterol + fluticasone (seretid).

In severe cases, as well as in the period of exacerbation, systemic GCS –prednisolone, dexamethasone, kenalog can be prescribed. Long-term therapy with these agents is fraught with the development of severe side effects (erosive and ulcerative lesions of the gastrointestinal tract, Itsenko-Cushing's syndrome, steroid diabetes, osteoporosis, and others).

Bronchodilators and GCS (or more often their combination) are the main most available drugs that are prescribed for COPD. The doctor selects the treatment regimen, doses and combinations individually for each patient. In the choice of treatment, not only the recommended GOLD schemes for different clinical groups matter, but also the patient’s social status, the cost of drugs and its availability for a particular patient, ability to learn, motivation.

Other drugs used in COPD

Mucolytics (sputum thinning agents) are prescribed in the presence of viscous, difficult-to-cough sputum.

Phosphodiesterase-4 inhibitor roflumilast (Daxas) is a relatively new drug. It has a prolonged anti-inflammatory effect, is a kind of alternative to SCS. Used in tablets of 500 mg 1 time per day in patients with severe and extremely severe COPD. Its high efficacy has been proven, but its use is limited due to the high cost of the drug, as well as a rather high percentage of side effects (nausea, vomiting, diarrhea, headache).

There are studies that the drug fenspiride (Erespal) has an anti-inflammatory effect similar to GCS and can also be recommended for such patients.

From physiotherapeutic methods of treatment, the method of intrapulmonary percussion ventilation of the lungs spreads: a special apparatus generates small volumes of air that are fed into the lungs with rapid jolts. From such a pneumomassage is the straightening of the collapsed bronchi and improvement of ventilation.

Treatment of COPD exacerbation

The purpose of the treatment of exacerbations is the maximum possible relief of the current exacerbation and prevention of their occurrence in the future. Depending on the severity, exacerbations can be treated on an outpatient or inpatient basis.

Basic principles of treatment of exacerbations:

  • It is necessary to properly assess the severity of the patient’s condition, eliminate complications that may mask under exacerbations of COPD, and timely refer for hospitalization in life-threatening situations.
  • In case of exacerbation of the disease, the use of short-acting bronchodilators is preferable to long-term. Doses and frequency of reception, as a rule, increase in comparison with usual. It is advisable to use spacers or nebulizers, especially in heavy patients.
  • In case of insufficient effect of bronchodilators, intravenous administration of aminophylline is added.
  • If monotherapy was previously used, a combination of beta-stimulants with anticholinergics (also short-acting) is used.
  • If there are symptoms of bacterial inflammation (the first sign of which is the appearance of purulent sputum), broad-spectrum antibiotics are prescribed.
  • Connection of intravenous or oral administration of glucocorticosteroids. An alternative to the systemic use of GCS is inhalation of pulmicort via a nebulizer, 2 mg twice a day after inhalation of berodual.
  • Dosed oxygen therapy in the treatment of patients in the hospital through nasal catheters or a Venturi mask. The oxygen content in the inhaled mixture is 24-28%.
  • Other activities - maintaining water balance, anticoagulants, treatment of associated diseases.

Care for patients with severe COPD

As already mentioned, COPD is a disease that is steadily progressive and inevitably leads to the development of respiratory failure. The speed of this process depends on many things: the patient’s refusal to smoke, adherence to treatment, the patient’s material resources, his mental abilities, and the availability of medical care. Starting with a moderate degree of COPD, patients are referred to MSEC for a disability group.

Patient with COPD

With an extremely severe degree of respiratory failure, the patient cannot perform even the usual household workload, sometimes he cannot take even a few steps. Such patients need constant care. Inhalation of the sick is carried out only with the help of a nebulizer. Considerably facilitates the state of many hours of low-flow oxygen therapy (more than 15 hours a day).

For this purpose, special portable oxygen concentrators have been developed. They do not require refilling with pure oxygen, but concentrate oxygen directly from the air. Oxygen therapy increases the life expectancy of such patients.

Prevention of COPD

COPD is a preventable disease. It is important that the level of prevention of COPD depends very little on the medical profession. The main measures should be taken either by the person himself (quitting smoking) or the state (anti-tobacco laws, environmental improvement, propaganda and promotion of a healthy lifestyle). It has been proven that the prevention of COPD is economically beneficial by reducing the incidence and reducing the disability of the working-age population.

Folk remedies for COPD

Recipe. Primrose root from COPD

Expectorant. It is taken as a decoction. For its preparation, it is necessary to take 40 g of primrose roots (primula drug) to 1 liter of water, boil a little and put it to infuse.

Take 3 tablespoons with meals 3 times a day. You can also combine this broth with young viburnum bark. To do this, take 2 teaspoons of viburnum, add boiling water to a glass and let it stand. After both decoctions are ready to connect them equally during the reception.

This popular treatment of COPD will be effective so as not to cause the occurrence of the disease. This method of treatment of COPD is suitable for those who have a disease caused by smoking, and for those who have it as an occupational disease.

Recipe. Highlander bird vs. COPD

Means is taken in the form of a decoction of 20.0 - 200.0 3 times a day with meals and 1 tablespoon, if you talk about summer time, you can take fresh juice, just 3 times a day no more than 20 drops at one time . You can combine this decoction to improve the effect with coltsfoot, or the flowers of black elderberry. This popular treatment of COPD is considered one of the most effective.

Recipe. Coltsfoot helps with COPD

Used as a decoction. 10 g of coltsfoot add to 200 ml of boiling water, let it brew. Take 2-3 tablespoons throughout the day every 2 hours. You can also make compresses from this plant. To do this, on the chest adjust compress from the cake remaining from the decoction and put in gauze. The main thing is that it is still warm. It is then that the treatment of patients with COPD will be really effective.

Recipe. Root of elecampane from COPD

To prepare this broth, you must take 20 grams of elecampane per cup of boiling water, add a spoonful of honey. Cover and steep. Take 1 tablespoon before meals three times a day. You can also use the tincture, as it has a not so strong smell. For e preparation you can use alcohol or vodka. It is necessary to take 100 g of alcohol, add 25 g of roots there, take this tincture of 25 drops 3 times a day. In this case, COPD treatment with folk remedies will be almost always effective.

Recipe. COPD and black elderberry

Elderberry can be used not only in the composition of decoctions or tinctures, but also independently. To prepare the broth, you must take 20 g of black elderberry, combine with a glass of boiling water, and insist in a warm place for 20 minutes. Take ¼ cup 15 minutes before meals 3-4 times a day. You can also add honey to the broth, one teaspoon per glass of broth. With honey, the treatment of patients with COPD will be even better. After all, even modern treatment of COPD is difficult to imagine without honey.

Recipe. Medunitsa medicinal or pulmonary herb from COPD

Excellent expectorant and enveloping agent, used in the form of decoction. In order to make a decoction, you must take 10g of medicinal or pulmonary mellitus into a glass of boiled water. Give the broth to insist. Take 3 times daily before meals and 1 tablespoon. This popular method of treatment of COPD is also effective for bronchitis.

Recipe. Comfrey root of COPD

To eat the comfrey root, you need to brew it in milk. To do this, you need to take half a liter of hot milk, add 20 g of roots to it - this is about one and a half tablespoons, put in the oven for 6-7 hours, so that all this can be steamed, without fire or boiling. Take 3 times a day and 1 tablespoon. Such traditional methods of treatment of COPD have always been and will be effective.

Recipe. Large plantain leaves from COPD

Take in the form of a decoction. To make it, you need to take 10g of the leaves of the plantain, pour a glass of boiling water and let it stand in a warm place for 30 minutes. You can take 3-4 times a day and 1 tablespoon. You can also take in the form of tincture or in the form of canned juice for 20% alcohol 20 drops 3 times a day. After this method, COPD diagnosis and treatment at the doctor will not be so important.

Recipe. From COPD will help the ball eucalyptus leaves

The leaves of eucalyptus ball are used in the form of a decoction. To prepare it, you need to take 10g of eucalyptus, pour a glass of boiling water over it, take 1 tablespoon 3 times a day. You can also use as a tincture of 25 drops 3 times a day. In this case, COPD treatment with folk remedies eucalyptus can be used even for smokers. After all, even the modern treatment of COPD includes this plant.

Another equally effective remedy against chronic obstructive pulmonary disease is also prepared from herbal ingredients. For preparation, you need to take in equal proportions chag, thyme grass, St. John's wort, calamus, plantain, agrimony, burdock roots, and birch leaves. All components should be crushed and then mixed. A few teaspoons of the resulting collection is to pour 200 ml of boiling water and let stand for a while. The finished composition must be taken, as in the previous recipes. The course of such therapy is from 1.5 to 2 months.

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