Vol. 6, Issue 4 (2017)

Author(s):
Tetyana Pertseva, Tetiana Kirieieva and Kseniia Bielosludtseva

Abstract:
Influenza viruses seemed to be important cause of severe AECOPD. But it is not clear to the end pathogenesis and clinical features of severe AECOPD during seasonal epidemics of flu. The aim was to study the features of clinical course, severity of lung disorders in patients with severe AECOPD during the 2016–2017 Influenza epidemic and to find possible predictors of lethality during severe AECOPD in this period. It was a retrospective observational study using medical histories of patients died from severe AECOPD with detected and suspected (according to anamnestic, epimiological and clinical data) Influenza A(H₁N₁), which were hospitalized in intensive care units in epidemic period of 2016–2017. It was found that patients admitted to the doctor very late, worsening started with febrile and hyperfebrile temperature before hospitalization, great weakness, dry cough; among clinical symptoms acute respiratory failure prevailed; additional symptoms were cachexia and decompensation of cardiovascular comorbidity. Other features of lethal severe AECOPD were very low parameters of external breathing. According to chest CT-scans most died patients had severe changes of bronchi and lung parenchyma such as chronic bronchitis, lung emphysema, bronchoecstasies and bulls. One of the most severe complication was pneumothorax. The mortality of patients with severe AECOPD depends on too late hospitalization, lack of anti-inflammatory treatment and absence of preventive vaccinations. Severe lung function disorders in anamnesis are the most significant predictor of mortality in patients with COPD during epidemic seasons and should be indicators of early intensive treatment with oxygenation. The key point in the treatment of virus-associated severe AECOPD is early, sufficient and adequate oxygen therapy taking into account the high risk of pneumothoraxes which significantly aggravates the course of disease.