Uloga liječnika obiteljske medicine u praćenju bolesnika s kroničnom opstruktivnom plućnom bolesti

master's thesis

• Title (english): The role of family physician in monitoring patients with chronic obstructive pulmonary disease
• Author: Marija Lebo
• Mentor: Ksenija Kranjčević (mentor)
• Committee member: Goranka Petriček (predsjednik povjerenstva)
• Committee member: Venija Cerovečki Nekić (član povjerenstva)
• Committee member: Ksenija Kranjčević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Family Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Public Health and Health Care; Family Medicine

Abstract

Kronična opstruktivna plućna bolest (KOPB) progresivna je upalna bolest koja zahvaća dišne puteve i plućni parenhim. Glavni rizični čimbenici za KOPB su pušenje, pasivno izlaganje duhanskom dimu te profesionalna izloženost organskim i anorganskim prašinama. Kronični upalni odgovor, koji je kod pacijenata s KOPB-om modificiran, uzrokuje patološke promjene dišnih puteva, plućnog parenhima i plućnih krvnih žila. Ove promjene dovode do sužavanja dišnih puteva, a posljedično i do ograničenja protoka zraka. Najčešći simptom KOPB-a je zaduha, a moguća je i pojava kašlja, a napredovanjem bolesti pacijenti sve teže podnose tjelesni napor. Zlatni standard u dijagnosticiranju i praćenju KOPB-a je spirometrija. Nakon dijagnoze, potrebno je procijeniti u kojoj se GOLD skupini po težini simptoma i opstrukcije pacijent nalazi, a zatim prema tome prilagoditi terapiju. U procjeni stadija bolesti koriste se i razni upitnici. Egzacerbacije KOPB-a i komorbiditeti koji ga prate pogoršavaju kliničku sliku, cjelokupno pacijentovo zdravlje i kvalitetu života. Terapija KOPB-a temelji se na bronhodilatatorima, a u nekim slučajevima dodaju se inhalacijski kortikosteroidi. Nefarmakološke metode uključuju prestanak pušenja kao najvažniju mjeru, plućnu rehabilitaciju, cijepljenje protiv gripe i pneumokoka, edukaciju o samozbrinjavanju bolesti i terapiju kisikom u pojedinih pacijenata.
U praćenju pacijenata koji boluju od KOPB-a liječnici obiteljske medicine imaju ključnu ulogu. Dugogodišnje poznavanje pojedinog pacijenta i njegovog odnosa prema vlastitoj bolesti prednost je koju nemaju specijalisti na sekundarnoj ili tercijarnoj razini zdravstvene zaštite. Ipak, i liječnici obiteljske medicine suočavaju se s brojnim problemima u praćenju, poput nedostatka vremena za kvalitetne konzultacije te nesuradljivosti i zanemarivanja bolesti od strane samog pacijenta.

Abstract (english)

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory disease that affects the airways and lung parenchyma. The main risk factors for COPD are smoking, passive exposure to tobacco smoke and occupational exposure to organic and inorganic dusts. The chronic inflammatory response, which is modified in patients with COPD, causes pathological changes in the airways, pulmonary parenchyma, and pulmonary blood vessels. These changes lead to narrowing of the airways and consequently to the restriction of the airflow. The most common symptom of COPD is dyspnea, but coughing is also frequent. As the disease progresses, patients find it increasingly difficult to tolerate physical exertion. Spirometry is the gold standard in diagnosing and monitoring COPD. After the COPD is diagnosed, it is necessary to assess patient's GOLD group regarding the severity of the symptoms and airflow obstruction and to adjust therapy. Various questionnaires are also used to assess the stage of the disease. Exacerbations of COPD and the comorbidities worsen the clinical picture, the health status and patient's quality of life. COPD treatment includes various bronchodilators, and in some cases inhaled corticosteroids are prescribed. Nonpharmacological therapy consists of smoking cessation as the most important step, pulmonary rehabilitation, influenza and pneumococcal vaccination, self-management education and oxygen therapy. Family physicians play the key role in monitoring patients with COPD. Long-term knowledge of an
individual patient and his attitude towards his own disease is an advantage that specialists at the secondary or tertiary level of health care do not have. However, family physicians also face a number of problems during the monitoring, such as lack of time for quality consultations, non-cooperative and unmotivated patients.

• Keywords: KOPB; obiteljska medicina; zaduha; pušenje
• Keywords (english): COPD; dyspnea; smoking; family physician
• Language: croatian
• URN:NBN: urn:nbn:hr:105:068165
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-04-12 08:37:17