EUROMEDICA  Hanover 23-24  Mai 2011	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover

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The considerable success in diagnostics and treatment of the widespread diseases of modern world as a chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) has been achieved at the present time. However, problem remains extremely urgent. CHD in the industrially developed countries is one of the most common diseases and on the first place among the causes of death. COPD is disease with the large prevalence and fast developing of disability and high mortality.

Purpose of the study: to estimate value of diffusing capacity for carbon monoxide (DLCO) in patients with chronic heart failure (CHF) and CHD in association with COPD at different stages of disease.

Methods and Results. There were included in the study 73 patients with CHF and CHD in association with COPD (45 men and 28 women) with the stable symptomatology COPD for at least 6 month. There were 14 patients with CHF New York Heart Association (NYHA) class I, 43 patients with CHF NYHA class II, 16 patients CHF NYHA class III. All patients received standard therapy with loop diuretics, angiotensin converting enzyme inhibitor or angiotensin II receptor antagonist and beta-adrenoblockers in the optimum dosages in the case of absence of contraindications to them. Above mentioned therapy was constant and did not change at least 8 weeks before a study. For the comparison, in control group were included 30 people with the CHD without the signs of CHF and with the decreased lung ventilation typical for COPD. There were performed assessing of lung ventilation which includes spirography, bodyplethismography for evaluating of the volumes of lungs and measurement of the lung diffuse capacity by the single breath method. All these examinations were performed for all patients of both groups on a pulmonary complex Master Lab Pro, Jaeger, Germany.

Examination of lung ventilation revealed decreased DLCO and lungs volumes such as forced expiratory volume during first second, slow vital capacity and alveolar volume as a result of the pneumosclerotic and emphysematous processes of lungs. In patients with the CHF and coronary heart disease in association with COPD the DLCO was decreased more significant compared to the patients of control group. It was characterized by reduction in the general and corrected DLCO and by expressed alveolar hypoventilation.

At patients with combined pathology with CHF NYHA class I the DLCO was higher comparing to the control group patients without CHF. At those patients molecular diffusion of carbon monoxide (CO) through the alveolocapillary membrane in the majority of the cases still remained in normal condition. This increase was determined with an increase in the chemical reaction of CO with the blood of the capillaries of lungs as a result of an increase in the volume of the pulmonary blood. In proportion to the increase of interstitial lung oedema and as the result of developing of the pulmonary vessels damage DLCO became equal to the control group. It was probably due to the gradually developing of thickening of alveolar-capillary membrane and as a result the reduction in the molecular diffusion of CO. More frequent this equality coincides with CHF NYHA class II. However in progression of CHF the DLCO decreases due to the progression of reduction of molecular diffusion of CO through the alveolar-capillary membrane. That happens in patients with combined pathology with CHF NYHA class III. However at this moment the chemical reaction of CO with the blood of the capillaries of lungs compensatory grows and exceeds the same in patients with CHF NYHA class II.

Conclusions. Molecular diffusion of CO through the alveolocapillary membrane highly correlates with functional class by NYHA. Gas transfer decreasing in patients with such combined pathology is reflecting reduction in alveolar–capillary membrane diffusing capacity.