M.L. SHTEINER^1,2, A.V. ZHESTKOV², N.E. LAVRENTYEVA², A.D. PROTASOV²

¹Samara State Hospital №4, 125 Michurin Str., Samara, Russian Federation, 443056

²Samara State Medical University, 89 Chapaevskaya Str., Samara, Russian Federation, 443099

Shteiner M.L. ¾ D. Med. Sc., endoscopist, Assistant of the Department of Surgery with the course of endoscopy, tel. +7-927-207-71-18, e-mail: iishte@yandex.ru

Zhestkov A.V. ¾ D. Med. Sc., Professor, Head of the Department of General and Clinical Microbiology, Immunology and Allergology, tel. (846) 260-33-61, e-mail: zhestkovav@yandex.ru

Lavrentyeva N.E. ¾ Cand. Med. Sc., Associate Professor of the Department of Occupational Diseases and Clinical Pharmacology, tel. +7-927-009-55-74, e-mail: lavrenteva.natalia@yandex.ru

Protasov A.D. ¾ Cand. Med. Sc., Assistant of the Department of General and Clinical Microbiology, Immunology and Allergology, tel. (846) 260-33-61, e-mail: crosss82@mail.ru

Clinical and endoscopic features of COPD have been analyzed in 800 patients in whom COPD exacerbation was accompanied by the endobronchial mucopurulent discharge. Two clinico-endoscopic variants of COPD were identified. One variant (685 patients, 85,6%) was characterized by production of the viscous mucous bronchial secretions containing multiple pus inclusions. In such patients the exacerbation of COPD had a typical course that quite fit into the common clinical presentation of the disease. The other variant (115 patients, 14,4%) was defined by the presence of a two-level mucopurulent discharge, i.e., the mucous fraction was produced by main bronchi while the purulent fraction by distal bronchi. In the latter case the clinical picture was not typical for COPD, i.e., the progression of dyspnea, systemic inflammatory reaction and asthenia was combined with a moderate amount of mucous easily discharged phlegm. It is such a combination of symptoms that enables to suspect a given variant of endobronchial inflammation as a component of COPD exacerbation on the whole.

Key words: endobronchitis, mucopurulent discharge, two-level discharge, mucous fraction of bronchial discharge, purulent fraction of bronchial discharge.

REFERENCES

1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (GOLD). Updated, 2014. 80 p.
2. Federal’nye klinicheskie rekomendatsii po diagnostike i lecheniyu khroniche-skoy obstruktivnoy bolezni legkikh [Federal guidelines for the diagnosis and treatment of chronic obstruc-tive pulmonary disease]. Moscow: Rossiyskoe respiratornoe obshchestvo, 2014. 41 p.
3. Avdeev S.N. Chronic obstructive pulmonary disease: acute. Pul’-monologiya, 2013, no. 3, pp. 5-19 (in Russ.).
4. Stanford R.H., Shen Y., McLaughlin T. Cost of chronic obstructive pulmonary dis-ease in the emergency department and hospital: an analysis of administrative data from 218 US hospitals. Treat. Respir. Med,2006, vol. 5, pp. 343-349.
5. Aaron S.D., Donaldson G.C., Whitmore G.A. et al. Time course and pattern of COPD exacerbation onset. Thorax, 2012, vol. 67, pp. 238-243.
6. Pawels R., Calverty P., Buist A.S. et al. COPD exacerbations: the importance of a standard definition. Respir. Med, 2004, vol. 98, pp. 99-107.
7. Celli B.R., MacNee W. ATS/ERS Task Force. Standards for the diagnosis and treat-ment of patients with COPD: a summary of the ATS/ERS position paper. Eur. Respir. J, 2004, vol. 23, no. 6, pp. 932-946.
8. Anthonisen N.R., Manfreda J., Warren C.P. et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann. Intern. Med, 1987, vol. 106, no. 2, pp. 196-204.
9. Leshchenko I.V., Baranova I.I. Biomarkers of inflammation in chronic ob-structive pulmonary disease. Pul’monologiya, 2012, no. 2, pp. 108-117 (in Russ.).
10. Tsoumakidou M., Tzanakis N., Siafakas N.M. Induced sputum in the investigation of airway inflammation of COPD. Respir. Med, 2003, vol. 97, pp. 863-871.
11. Kelly M.M., Keatings V., Leigh R. et al. Analysis of fluidphase mediators. Eur. Respir. J, 2002, vol. 20 (Suppl. 37), rr. 24-39.
12. Chung K.F., Caramori G., Groneberg D.A. et al. Airway obstruction in chronic ob-structive pulmonary disease. NEJM, 2004, vol. 351, rr. 1459-1461.
13. Avdeev S.N. Systemic effects in patients with COPD. Vrach, 2006, no. 12, pp. 3-8 (in Russ.).
14. Taube C., Holz O., Mucke M. et al. Airway response to inhaled hypertonic saline in patients with moderate to severe chronic obstructive pulmonary disease. Amer. J. Respir. Crit. Care Med, 2001, vol. 164, pp. 1810-1815.
15. Lemoine J.M. Les bronchites chronigues. Bronches, 1965, vol. 15, no. 2, pp. 129-142.
16. Lukomskiy G.I., Shulutko M.L., Vinner M.G., Ovchinnikov A.A. Bronkhopul’-monologiya [Bronhopul monologue]. Moscow: Meditsina, 1982. 399 p.
17. Chernekhovskaya N.E. Bronchoscopy in the diagnosis of COPD. Atmosfera: pul’mo-nologiya i allergologiya, 2003, no. 4, pp. 25-27 (in Russ.).