Сomplex assessment of the degree of chronic obstructive pulmonary disease copd severity on out-patient visit

Аim. Analysis of the possibility and reasonability of a comprehensive assessment of clinical condition of patients with chronic obstructive pulmonary disease (COPD) on outpatient visit in conditions of a small territorial municipal polyclinic.

Materials and Methods. The study was carried out on the base of municipal Outpatient clinic №12 (total adult population 7177 people) of Ryazan from October 2012 to December 2014. In history taking, positive family history, existence of unfavorable factors that could provoke development and progress of the disease, coughing episodes in history, phase of the disease, medicinal treatment were evaluated. This was followed by a screening epidemiological examination (questionnaire). In result, an observation group was formed (n=50, aged 19-81 years, mean age 56.1±2.3 years) from patients with chronic respiratory symptoms (cough, dyspnea) seeking medical care, where screening spirography, evaluation of the degree of severity of COPD according to GOLD 2014 were conducted, and four observation groups (A, B, C, D) were formed.

Results. COPD was confirmed in 100% of patients of the observation group, of them the 1^st stage COPD was found in 18.7% of cases, 2^nd – in 43.3% of cases, 3^rd– in 30.0%, 4^th – in 8.0%. The number of exacerbations was 1-8 per year. The most common concomitant diseases were ischemic heart disease (53.2%), arterial hypertension (74.3%), chronic gastroduodenitis (34.5%). A combination of 2 or more chronic diseases was observed in 31% of cases. Depending on the degree of airflow rate limitation, symptoms (mMRC results), history of exacerbations, patients were divided into the following groups according to GOLD 2014: group A – 59 patients (39.3%), group B – 30 patients (20.0%), group C – 29 patients (19.0%), and D – 32 patients (21.7%). There were no statistically significant differences between the groups in age, gender and smoking status (p>0.05).

Conclusion. The analysis showed a possibility and convenience of using stratification of patients with COPD by the degree of severity of the disease (according to GOLD 2014) with the aim of individualization of further management of such patients.