КАЧЕСТВЕННАЯ И КОЛИЧЕСТВЕННАЯ ХАРАКТЕРИСТИКА ОДЫШКИ У БОЛЬНЫХ ПРОГРЕССИРУЮЩИМ ФИБРОТИЧЕСКИМ ФЕНОТИПОМ ИНТЕРСТИЦИАЛЬНЫХ БОЛЕЗНЕЙ ЛЕГКИХ, АССОЦИИРОВАННЫХ С СЕРДЕЧНО-СОСУДИСТЫМИ ЗАБОЛЕВАНИЯМИ

Abstract

Aim. Analysis of quantitative and qualitative parameters of dyspnea in patients with the fibrotic phenotype of interstitial lung disease associated with coronary artery disease. Material and methods. We examined 49 patients. Among those were 9 patients with idiopathic pulmonary fibrosis, 25 patients with chronic variant of hypersensitive pneumonitis, and 14 patients with nonspecific interstitial pneumonia. The main group consisted of 25 patients with interstitial lung diseases and coronary heart disease; comparison group consisted of 24 patients without ischemic heart disease. Clinical symptoms, questionnaire results, and instrumental study data were analyzed. Results and discussion. Patients with coronary heart disease experienced increased dyspnea earlier (after 3,21 days) than patients without it (after 7,18 days; p<0,05). On functional examination, a significant decrease in pulmonary diffusion capacity was recorded in cardiac patients, p<0,05. Presence of coronary heart disease was accompanied by intensification of dyspnea according to Borg scale, decrease of distance walked in 6 min, significant decrease in pulse oximetry indices (by 7,94% in the main group and by 3,26% in the comparison group). On computed tomography, the severity of «frosted glass» was statistically higher in patients with coronary heart disease, p<0,05. Pulmonary hypertension, changes of right heart sections were observed in both groups of patients, left ventricular hypertrophy was observed only in patients of the main group. Patients with «isolated» phenotype of interstitial lung disease complained of heaviness, shortness of breath, patients with coronary heart disease complained of compression, tightness in chest, patients with pulmonary heart disease and heart failure had combination of these sensations. Conclusion. In patients with interstitial lung diseases, associated with coronary heart disease, dyspnea intensification reflects progression of lung disease, development of heart failure, and chronic pulmonary heart disease. Study of quantitative and qualitative characteristics of dyspnea is a way to specify the origin of dyspnea at the stage preceding specialized instrumental diagnostic methods.