Plekhanova O. Diagnosis and treatment optimization in patients with acute exacerbation of chronic obstructive pulmonary disease

Research subjects: chronic obstructive pulmonary disease (COPD). The aim of the investigation: use of objective criteria of bacterial loading for improvement of diagnostics and treatment of infectious exacerbation of COPD. Methods: clinical, instrumental, microbiological, molecular-biological, biochemical, statistic. Theoretical and practical results: the causes and clinical course's peculiarities of COPD exacerbations depending on the stage of disease are presented in the work. The major pathogens of acute COPD exacerbation and their sensitivity to antibacterial drugs are determined. The verification technique of COPD exacerbation bacterial etiology by meance of sputum biochemical studies with the the total protein/trypsin ratio calculation was suggested. The possibility of fibrinogen and medium weight molecules (MSM) blood's rates use for ABT need was established. The effectiveness of antibacterial therapy by amoxicillin/clavulanat in patients with acute exacerbation of COPD was shown. Novelty: For the first time the causes and types of acute COPD exacerbation by Anthhonisen in dependence with the stage of disease were analysed. The spectrum of pathogens in patients with COPD exacerbation at the region of Pridneieprovya were studied. Their sensitivity to antibacterial drugs were determined. The strong correlation between the microbiological and biochemical markers of sputum was established: the progression of infectious inflammation in the bronchial tree accompanied by increased levels of sputum's total protein against fall in local proteolytic activity. The dependence of the fibrinogen and C-RP concentrations on the exacerbation's severity and nature was foundin COPD patients. We established that C-RP level in patients with bacterial COPD exacerbation strongly depend on duration of the pathologic process. There was not found any influence of exacerbation's bacterial nature into PCT level of serum. Implementation: articles, theses, introduction into to teaching processes at high medical schools. Sphere, sector of implementation: medicine.