{"id":18588,"date":"2014-11-26T10:33:03","date_gmt":"2014-11-26T09:33:03","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=18588"},"modified":"2014-11-26T10:35:59","modified_gmt":"2014-11-26T09:35:59","slug":"jak-predchazet-chronicke-obstrukcni-plicni-nemoci","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=18588","title":{"rendered":"Jak p\u0159edch\u00e1zet chronick\u00e9 obstruk\u010dn\u00ed plicn\u00ed nemoci?"},"content":{"rendered":"

Du\u0161nost a vlekl\u00fd ka\u0161el. To jsou z\u00e1kladn\u00ed projevy chronick\u00e9 obstruk\u010dn\u00ed plicn\u00ed nemoci, kterou u n\u00e1s trp\u00ed asi 800 tis\u00edc lid\u00ed. 2500 z nich toto onemocn\u011bn\u00ed rok co rok zabije. Jak j\u00ed p\u0159edch\u00e1zet? O tom v \u010cesk\u00e9m rozhlasu Plze\u0148 hovo\u0159il doktor Stanislav Kos.<\/strong><\/p>\n

moder\u00e1tor:\u00a0 Pane doktore, kdy\u017e to \u0159eknu \u00fapln\u011b natvrdo, tak si za chronickou obstruk\u010dn\u00ed plicn\u00ed nemoc m\u016f\u017eeme hlavn\u011b sami?<\/p>\n

Stanislav KOS: p\u0159edseda \u010cesk\u00e9ho ob\u010dansk\u00e9ho sdru\u017een\u00ed proti chronick\u00e9 obstruk\u010dn\u00ed plicn\u00ed nemoci:
\n\u0158ekl jste spr\u00e1vn\u011b hlavn\u011b. Ned\u00e1 se \u0159\u00edct v\u00fdlu\u010dn\u011b, ale hlavn\u011b sami. \u0158\u00edk\u00e1 se, \u017ee asi z t\u011bch 80 procent za to m\u016f\u017ee kou\u0159en\u00ed<\/strong>, to znamen\u00e1, \u017ee n\u00e1\u0161 \u017eivotn\u00ed styl v\u00fdrazn\u011b ovliv\u0148uje p\u0159edpoklady pro to, aby tato nemoc vznikla. Ov\u0161em je t\u0159eba tak\u00e9 \u0159\u00edct, \u017ee jsou ur\u010dit\u00e9 rodiny, ve kter\u00fdch je v\u011bt\u0161\u00ed n\u00e1chylnost k v\u00fdskytu t\u00e9to nemoci. Ned\u00e1 se \u0159\u00edct, \u017ee by byla d\u011bdi\u010dn\u00e1, ale ta n\u00e1chylnost tady je, to znamen\u00e1, kdy\u017e je\u0161t\u011b podpo\u0159\u00edme tuto n\u00e1chylnost t\u00edm kou\u0159en\u00edm, zat\u011b\u017eov\u00e1n\u00edm zevn\u00edmi \u0161kodlivinami, a to i \u0161kodlivinami z na\u0161eho b\u011b\u017en\u00e9ho ovzdu\u0161\u00ed, tak se m\u016f\u017ee ta nemoc postupn\u011b vyvinout. A je to typick\u00e9, \u017ee za\u010d\u00edn\u00e1 ve st\u0159edn\u00edch a\u017e vy\u0161\u0161\u00edch letech na\u0161eho v\u011bku.<\/p>\n

moder\u00e1tor:\u00a0 Jak jsem se d\u00edval na vyj\u00e1d\u0159en\u00ed prim\u00e1\u0159e kliniky pneumologie a hrudn\u00ed chirurgie Nemocnice Na Bulovce, doktora Norberta Pauka, tak probl\u00e9m je podle n\u011bj v tom, \u017ee nejen pacienti, ale \u010dasto ani l\u00e9ka\u0159i na mo\u017enost tohoto onemocn\u011bn\u00ed nepomysl\u00ed. Co by n\u00e1s tedy, pota\u017emo i l\u00e9ka\u0159e m\u011blo varovat?<\/p>\n

Stanislav KOS:
\nFaktem je, \u017ee prvn\u00edm p\u0159\u00edznakem, kter\u00fd pacienta k n\u00e1m p\u0159iv\u00e1d\u00ed, je pocit du\u0161nosti, \u017ee nesta\u010d\u00ed, dejme tomu, sv\u00fdm vrstevn\u00edk\u016fm p\u0159i ch\u016fzi, a\u0165 u\u017e je to rychlost ch\u016fze a nebo p\u0159i ch\u016fzi do schod\u016f, ale \u010dasto to nemocn\u00ed bagatelizuj\u00ed a p\u0159i\u010d\u00edtaj\u00ed to stoupaj\u00edc\u00edmu v\u011bku a nejdou v\u010das na vy\u0161et\u0159en\u00ed, kter\u00e9 by pomohlo velice jednoduch\u00fdm a nebolestiv\u00fdm zp\u016fsobem tuto diagn\u00f3zu bu\u010f potvrdit nebo vylou\u010dit. A je to \u0161koda, proto\u017ee to z\u00e1kladn\u00ed vy\u0161et\u0159en\u00ed je vy\u0161et\u0159en\u00ed d\u00fdch\u00e1n\u00ed nebolestiv\u00e9, kdy se d\u00fdch\u00e1 do p\u0159\u00edstroje podle pokyn\u016f vy\u0161et\u0159uj\u00edc\u00ed sestry a ty hodnoty n\u00e1m u\u017e \u0159eknou, jestli pl\u00edce a pr\u016fdu\u0161ky toho nemocn\u00e9ho jsou v po\u0159\u00e1dku a nebo jsou n\u00e1chyln\u00e9 k n\u011bjak\u00e9mu dal\u0161\u00edmu posti\u017een\u00ed.<\/p>\n

moder\u00e1tor:\u00a0\u00a0 A jak l\u00e9ka\u0159 zjist\u00ed, \u017ee jde zrovna o chronickou obstruk\u010dn\u00ed plicn\u00ed nemoc?<\/p>\n

Stanislav KOS:
\nPak se samoz\u0159ejm\u011b mus\u00ed i dal\u0161\u00ed p\u0159\u00ed\u010diny du\u0161nosti vylu\u010dovat, m\u016f\u017ee se na tom pod\u00edlet z\u00e1le\u017eitost srde\u010dn\u00ed, i onemocn\u011bn\u00ed jin\u00fdch org\u00e1n\u016f, ale nej\u010dast\u011bj\u0161\u00ed du\u0161nost b\u00fdv\u00e1 pr\u00e1v\u011b p\u0159i onemocn\u011bn\u00edch pr\u016fdu\u0161ek a srdce. Ty je t\u0159eba od sebe odli\u0161it.<\/p>\n

moder\u00e1tor:\u00a0\u00a0 Jakmile je \u010dlov\u011bk ku\u0159\u00e1k, je mu nad 40 a trp\u00ed du\u0161nost\u00ed, u\u017e by podle doporu\u010den\u00ed Norberta Pauka m\u011blo automaticky doj\u00edt k vy\u0161et\u0159en\u00ed, kter\u00e9 by uk\u00e1zalo na p\u0159\u00edpadn\u00e9 z\u00fa\u017een\u00ed pr\u016fdu\u0161kov\u00e9ho stromu. Souhlas\u00edte s t\u00edm?<\/p>\n

Stanislav KOS:\u00a0 Naprosto souhlas\u00edm. Ta spirometrie je skute\u010dn\u011b zlat\u00fdm pravidlem pro vy\u0161et\u0159en\u00ed a stanoven\u00ed diagn\u00f3zy CHOPN.<\/p>\n

moder\u00e1tor:\u00a0 Jak\u00e1 je dosavadn\u00ed praxe, to znamen\u00e1, kdy se k tomuto vy\u0161et\u0159en\u00ed v sou\u010dasn\u00e9 dob\u011b p\u0159istupuje?<\/p>\n

Stanislav KOS:
\nP\u0159istupuje se tehdy, kdy\u017e pacient p\u0159ijde a st\u011b\u017euje si na pocity hlavn\u011b du\u0161nosti a zvl\u00e1\u0161\u0165, pokud je to spojeno s ka\u0161lem, s vyka\u0161l\u00e1v\u00e1n\u00edm, pak jsou to ty hlavn\u00ed p\u0159\u00edznaky, kter\u00e9 n\u00e1m pom\u00e1haj\u00ed postavit diagn\u00f3zu. A pokud je provedena spirometrie, provedeno dal\u0161\u00ed vy\u0161et\u0159en\u00ed, dejme tomu, z\u00e1soben\u00ed tk\u00e1n\u00ed kysl\u00edkem a tak d\u00e1le, tak m\u016f\u017eeme \u0159\u00edct s velkou pravd\u011bpodobnost\u00ed, \u017ee se jedn\u00e1 o CHOPN a m\u016f\u017eeme j\u00ed za\u010d\u00edt hlavn\u011b v\u010das spr\u00e1vn\u011b l\u00e9\u010dit, proto\u017ee \u010d\u00edm d\u0159\u00edve l\u00e9\u010dba za\u010dne, t\u00edm v\u011bt\u0161\u00ed je \u00fasp\u011b\u0161nost.<\/p>\n

moder\u00e1tor:\u00a0\u00a0 Co v\u0161echno ta vy\u0161et\u0159en\u00ed obn\u00e1\u0161ej\u00ed, to znamen\u00e1, co v\u0161echno pacient absolvuje?<\/p>\n

Stanislav KOS:
\nPrakticky hlavn\u00ed vy\u0161et\u0159en\u00ed je to, \u017ee je rozhovor s l\u00e9ka\u0159em, kter\u00fd zji\u0161\u0165uje, jak\u00e9 nemoci prod\u011blal, jak dlouho trvaj\u00ed jeho pot\u00ed\u017ee, jak se projevuj\u00ed a pak se provede spirometrick\u00e9 vy\u0161et\u0159en\u00ed, eventu\u00e1ln\u011b z\u00e1kladn\u00ed vy\u0161et\u0159en\u00ed krve a t\u00edm je to vy\u0161et\u0159en\u00ed nastartov\u00e1no. A pokud je nalezena n\u011bjak\u00e1 porucha p\u0159i spirometrii, pak se pou\u017e\u00edv\u00e1 takzvan\u00fd bronchodilata\u010dn\u00ed test, to znamen\u00e1, \u017ee nemocn\u00e9mu je pod\u00e1na l\u00e1tka, kter\u00e1 roz\u0161i\u0159uje pr\u016fdu\u0161ky a provede se druh\u00e9 spirometrick\u00e9 vy\u0161et\u0159en\u00ed, kter\u00e9 uk\u00e1\u017ee, jestli ten l\u00e9k vedl k ur\u010dit\u00e9mu roz\u0161\u00ed\u0159en\u00ed pr\u016fdu\u0161ek a zlep\u0161en\u00ed n\u00e1lezu a nebo ne. A to je v\u00edcem\u00e9n\u011b pr\u016fkaz toho, \u017ee se jedn\u00e1 o z\u00fa\u017een\u00ed pr\u016fdu\u0161ek, kter\u00e9 m\u016f\u017eeme l\u00e9\u010dbou ovlivnit.<\/p>\n

moder\u00e1tor:\u00a0\u00a0 Je to p\u00e1r dn\u00ed zp\u00e1tky, co se spirometrick\u00e1 vy\u0161et\u0159en\u00ed v Plzni prov\u00e1d\u011bla v r\u00e1mci osv\u011btov\u00e9 akce. Jak to dopadlo?<\/p>\n

Stanislav KOS:
\nBylo to v sobotu v n\u00e1kupn\u00edm centru Olympia, bylo b\u011bhem toho dne vy\u0161et\u0159eno p\u0159es 130 z\u00e1jemc\u016f a asi desetina z nich m\u011bla nenorm\u00e1ln\u00ed n\u00e1lezy, bylo t\u0159eba doporu\u010dit dal\u0161\u00ed vy\u0161et\u0159en\u00ed a \u0159ada z t\u011bch nemocn\u00fdch v\u016fbec nev\u011bd\u011bla o tom, \u017ee m\u00e1 n\u011bjak\u00fd n\u00e1lez na pr\u016fdu\u0161k\u00e1ch.<\/p>\n

moder\u00e1tor:\u00a0\u00a0 Co te\u010f tedy tu desetinu \u010dek\u00e1, bere to d\u00e1le p\u0159es praktick\u00e9ho l\u00e9ka\u0159e nebo u\u017e jde rovnou ke specialistovi?<\/p>\n

Stanislav KOS:
\nTam p\u0159i vy\u0161et\u0159en\u00ed byl p\u0159\u00edtomen plicn\u00ed specialista, kter\u00fd doporu\u010dil dal\u0161\u00ed postup a pokud u\u017e ten pacient m\u00e1 v\u00fdsledek spirometrie s sebou, ten jsme ka\u017ed\u00e9mu d\u00e1vali, tak se m\u016f\u017ee p\u0159\u00edmo p\u0159ihl\u00e1sit u sv\u00e9ho plicn\u00edho l\u00e9ka\u0159e nebo u toho, kter\u00fd prov\u00e1d\u011bl vy\u0161et\u0159en\u00ed.<\/p>\n

moder\u00e1tor:\u00a0 Kter\u00e9 skupin\u011b lid\u00ed byste tu spirometrii tak\u00e9 doporu\u010dil?<\/p>\n

Stanislav KOS:
\nZ\u00e1kladn\u00ed skupina jsou ku\u0159\u00e1ci nad 40 let v\u011bku. To je ur\u010dit\u00e1 rizikov\u00e1 skupina, kde doporu\u010dujeme toto vy\u0161et\u0159en\u00ed nap\u0159\u00edklad jako z\u00e1klad i p\u0159i p\u0159edopera\u010dn\u00edm vy\u0161et\u0159en\u00ed, tak jako se vy\u0161et\u0159uje EKG, by se m\u011bla vy\u0161et\u0159it i spirometrie, abychom v\u011bd\u011bli, jestli ten pacient je schopen nap\u0159\u00edklad operace v celkov\u00e9 nark\u00f3ze nebo nen\u00ed.<\/p>\n

moder\u00e1tor:\u00a0 A tam ta cesta za\u010d\u00edn\u00e1 u praktick\u00e9ho l\u00e9ka\u0159e, kter\u00fd doporu\u010d\u00ed pacienta ke specialistovi?<\/p>\n

Stanislav KOS:
\nAno, m\u016f\u017ee to b\u00fdt, ale k plicn\u00edmu l\u00e9ka\u0159i m\u016f\u017ee j\u00edt \u010dlov\u011bk s obt\u00ed\u017eemi p\u0159\u00edmo a po\u017e\u00e1dat o vy\u0161et\u0159en\u00ed.<\/p>\n

Poslucha\u010d:\u00a0\u00a0 Byl jsem l\u00e9\u010den\u00fd na CHOPN, ale te\u010f mi byla nemoc p\u0159eklasifikovan\u00e1 na bronchi\u00e1ln\u00ed astma. Je to tak v po\u0159\u00e1dku?<\/p>\n

Stanislav KOS:
\nAno. To je zaj\u00edmav\u00e1 ot\u00e1zka, kter\u00e1, mysl\u00edm, zaj\u00edm\u00e1 nejen v\u00e1s, ale \u0159adu dal\u0161\u00edch, i se o n\u00ed diskutuje mezi l\u00e9ka\u0159i, proto\u017ee jsou to dv\u011b nemoci, kter\u00e9 jsou si velmi podobn\u00e9, maj\u00ed podobn\u00e9 p\u0159\u00edznaky, z\u00fa\u017een\u00ed pr\u016fdu\u0161ek, obt\u00ed\u017en\u00e9 d\u00fdch\u00e1n\u00ed, astma b\u00fdv\u00e1 sp\u00ed\u0161 z\u00e1chvatovit\u00e9, vyskytuje se v d\u0159\u00edv\u011bj\u0161\u00edm v\u011bku ne\u017e CHOPN, neb\u00fdv\u00e1 tam tak v\u00fdznamn\u00e1 souvislost s kou\u0159en\u00edm a je i sv\u00fdm zp\u016fsobem d\u011bdi\u010dn\u00e9. Tak\u017ee na druh\u00e9 stran\u011b se v sou\u010dasn\u00e9 dob\u011b raz\u00ed z\u00e1sada, \u017ee ob\u011b nemoci, to znamen\u00e1, CHOPN i astma se mohou vyskytovat sou\u010dasn\u011b, navz\u00e1jem se p\u0159ekr\u00fdvat, to znamen\u00e1, \u017ee m\u016f\u017ee p\u0159ech\u00e1zet jedna v druhou, obvykle je to tak, \u017ee za\u010d\u00edn\u00e1 sp\u00ed\u0161 jako astma a p\u0159ech\u00e1z\u00ed v CHOPN, ale ta l\u00e9\u010dba je na\u0161t\u011bst\u00ed velice podobn\u00e1, u astmatu k t\u011bm obvykl\u00fdm l\u00e9k\u016fm, kter\u00e9 roz\u0161i\u0159uj\u00ed pr\u016fdu\u0161ky, p\u0159id\u00e1v\u00e1me l\u00e9k protiz\u00e1n\u011btliv\u00fd, proto\u017ee kdy\u017e je tam z\u00e1n\u011btliv\u00e1 alergick\u00e1 slo\u017eka, pak je t\u0159eba p\u0159id\u00e1vat inhalovan\u00e9 kortikosteroidy. To je, d\u00e1 se \u0159\u00edct, hlavn\u00ed rozd\u00edl v t\u00e9 l\u00e9\u010db\u011b a samoz\u0159ejm\u011b potom jsou dal\u0161\u00ed postupy, pokud je prok\u00e1z\u00e1na p\u0159ecitliv\u011blost na ur\u010dit\u00e9 faktory zevn\u00edho prost\u0159ed\u00ed, dejme tomu, na prachy, pyly, srst zv\u00ed\u0159at a tak d\u00e1le, tak je mo\u017eno i proti t\u011bmto zevn\u00edm alergen\u016fm n\u011bjak\u00fdm zp\u016fsobem postupovat, ale v z\u00e1sad\u011b se ob\u011b nemoci mohou vyskytovat spole\u010dn\u011b.<\/p>\n

moder\u00e1tor:\u00a0\u00a0 Poslucha\u010d z Plzn\u011b se pt\u00e1, zdali se plat\u00ed u plicn\u00edho l\u00e9ka\u0159e za filtr pou\u017eit\u00fd p\u0159i spirometrii?<\/p>\n

Stanislav KOS:
\nTen filtr pou\u017eit\u00fd p\u0159i spirometrii je zahrnut do n\u00e1klad\u016f tohoto vy\u0161et\u0159en\u00ed, je to hrazeno ale ze zdravotn\u00edho poji\u0161t\u011bn\u00ed, nikoliv pacientem.<\/p>\n

Poslucha\u010dka:\u00a0\u00a0 P\u0159ed osmi lety mi byla diagnostikovan\u00e1 CHOPN a to jsem nikdy nekou\u0159ila. L\u00e9ka\u0159i \u0159\u00edkaj\u00ed, \u017ee nemoc je nevyl\u00e9\u010diteln\u00e1. Cht\u011bla bych se zeptat, zda od ledna budu m\u00edt n\u00e1rok na l\u00e1zn\u011b ka\u017ed\u00fd rok, kdy\u017e se zase ve zdravotnictv\u00ed n\u011bco m\u011bn\u00ed. L\u00e1ze\u0148sk\u00e1 p\u00e9\u010de mi velmi pom\u00e1h\u00e1.<\/p>\n

Stanislav KOS:
\nTak\u017ee pan\u00ed m\u00e1, d\u00e1 se \u0159\u00edct, ur\u010dit\u00fdm zp\u016fsobem sm\u016flu, pat\u0159\u00ed mezi t\u011bch 20 procent lid\u00ed, kte\u0159\u00ed nikdy nekou\u0159ili, nebyli v zakou\u0159en\u00e9m prost\u0159ed\u00ed a p\u0159esto CHOPN mohou m\u00edt. Je to, jak jsem \u0159\u00edkal, i spolupodm\u00edn\u011bno ur\u010dit\u00fdmi, dejme tomu, genetick\u00fdmi vlivy, ale co j\u00ed hlavn\u011b zaj\u00edm\u00e1 a mysl\u00edm si, \u017ee ji tady m\u016f\u017eu pot\u011b\u0161it, je nov\u00fd indika\u010dn\u00ed seznam pro l\u00e1ze\u0148skou l\u00e9\u010dbu a pokud bude spl\u0148ovat ur\u010dit\u00e9 spirometrick\u00e9 podm\u00ednky pro l\u00e1ze\u0148skou l\u00e9\u010dbu a vzhledem k tomu, \u017ee ji v minulosti absolvovala, tak je pravd\u011bpodobn\u011b spl\u0148uje, tak je znova mo\u017en\u00e9 doporu\u010dit ka\u017edoro\u010dn\u011b l\u00e9\u010dbu CHOPN i astmatu v l\u00e1zn\u00edch a obvykl\u00e1 doba l\u00e9\u010dby podle tohoto nov\u00e9ho seznamu je na 3 t\u00fddny. Tak\u017ee ano, od 1. ledna jsou ur\u010dit\u00e9 zm\u011bn\u011bn\u00e9 p\u0159edpisy a je to zase p\u0159\u00edstupn\u011bj\u0161\u00ed l\u00e1ze\u0148sk\u00e1 l\u00e9\u010dba ne\u017e byla d\u0159\u00edv.<\/p>\n

moder\u00e1tor:\u00a0\u00a0 Pokud se chronick\u00e1 obstruk\u010dn\u00ed plicn\u00ed nemoc zjist\u00ed v\u010das, je mo\u017en\u00e9 zhor\u0161ov\u00e1n\u00ed stavu v\u00fdrazn\u011b zpomalit a pot\u00ed\u017ee pacient\u016f zm\u00edrnit. Co se nasazuje za l\u00e9\u010dbu a jak\u00e1 l\u00e9\u010dba nastupuje p\u0159i t\u011b\u017e\u0161\u00edch st\u00e1di\u00edch nemoci.<\/p>\n

Stanislav KOS:
\nNa\u0161e odborn\u00e1 spole\u010dnost p\u0159ijala pr\u00e1v\u011b v lo\u0148sk\u00e9m roce ur\u010dit\u00e1 doporu\u010den\u00ed, kter\u00e1 stup\u0148uj\u00ed tu l\u00e9\u010dbu a rozd\u011bluj\u00ed ji do 4 krok\u016f nebo stup\u0148\u016f. T\u00edm z\u00e1kladn\u00edm krokem je prevence, to znamen\u00e1, vyhnout se ve\u0161ker\u00fdm \u0161kodlivin\u00e1m, kter\u00e9 by n\u00e1m mohli \u0161kodit, po\u010d\u00ednaje kou\u0159en\u00edm cigaret, zevn\u00ed zne\u010di\u0161t\u011bn\u00ed a tak d\u00e1le. Druh\u00fdm krokem je takzvan\u00e1 pau\u0161\u00e1ln\u00ed l\u00e9\u010dba, kterou by m\u011bli br\u00e1t v\u0161ichni, kte\u0159\u00ed CHOPN maj\u00ed a to jsou hlavn\u011b inhalovan\u00e9 l\u00e9ky, tam v\u017edycky zd\u016fraz\u0148ujeme, \u017ee ty inhalovan\u00e9 l\u00e9ky jsou jen tehdy \u00fa\u010dinn\u00e9, kdy\u017e jsou inhalovan\u00e9 spr\u00e1vn\u011b. A ta technika inhalace, m\u00e1me vyzkou\u0161eno na des\u00edtk\u00e1ch a stovk\u00e1ch na\u0161ich pacient\u016f, \u017ee nen\u00ed ani v 50 procentech prov\u00e1d\u011bna spr\u00e1vn\u011b, \u010dili my p\u0159i kontrol\u00e1ch pacienty kontrolujeme, jestli um\u011bj\u00ed nadechnout z toho p\u0159\u00edstroje, kter\u00fd jim d\u00e1v\u00e1 l\u00e9ky a tak d\u00e1le. Tak to je pau\u0161\u00e1ln\u00ed l\u00e9\u010dba jako druh\u00fd stupe\u0148. T\u0159et\u00ed stupe\u0148 je takzvan\u00e1 fenotypicky specifick\u00e1 l\u00e9\u010dba, to znamen\u00e1, \u017ee CHOPN m\u016f\u017ee m\u00edt ur\u010dit\u00e9 typy, a\u0165 u\u017e je to typ bronchitick\u00fd, kde p\u0159eva\u017euje z\u00e1n\u011bt pr\u016fdu\u0161ek s v\u011bt\u0161\u00edm vyka\u0161l\u00e1v\u00e1n\u00edm hlen\u016f nebo typ emfyzematick\u00fd, to je rozedma plicn\u00ed, n\u011bkde zase b\u00fdv\u00e1 sp\u00ed\u0161 su\u0161\u0161\u00ed ka\u0161el a zm\u011bny v krevn\u00edch plynech a jsou tam fenotypy \u010dast\u00fdch vzplanut\u00ed, nebo exacerbac\u00ed a dal\u0161\u00ed a dal\u0161\u00ed, m\u00e1me celkem 6 z\u00e1kladn\u00edch fenotyp\u016f a tam podle toho fenotypu ur\u010dujeme specifick\u00e9 l\u00e9ky, kter\u00e9 jsou vhodn\u00e9 p\u0159i tomto posti\u017een\u00ed. Tak to je t\u0159et\u00ed stupe\u0148. A na \u010dtvrt\u00e9m stupni, to u\u017e je p\u00e9\u010de o ty kone\u010dn\u00e9 f\u00e1ze onemocn\u011bn\u00ed, kdy pacient\u016fm krom\u011b toho, \u017ee jim trvale nebo dlouhodob\u011b pod\u00e1v\u00e1me kysl\u00edk, v\u010detn\u011b l\u00e9\u010dby doma, kdy jim zaji\u0161\u0165ujeme dostate\u010dnou v\u00fd\u017eivu, kdy se star\u00e1me o jaksi udr\u017eov\u00e1n\u00ed jejich pohyblivosti a tak d\u00e1le, tak to u\u017e, to u\u017e je opravdu ta z\u00e1v\u011bre\u010dn\u00e1 f\u00e1ze. Co se m\u00e1lo u n\u00e1s vyu\u017e\u00edv\u00e1, je rehabilitace plicn\u00ed, ta by m\u011bla za\u010d\u00edt u\u017e od toho 2. stupn\u011b a tu bych cht\u011bl zd\u016fraznit jako velmi d\u016fle\u017eitou.<\/p>\n","protected":false},"excerpt":{"rendered":"

Du\u0161nost a vlekl\u00fd ka\u0161el. To jsou z\u00e1kladn\u00ed projevy chronick\u00e9 obstruk\u010dn\u00ed plicn\u00ed nemoci, kterou u n\u00e1s trp\u00ed asi 800 tis\u00edc lid\u00ed. 2500 z nich toto onemocn\u011bn\u00ed […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":16359,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,9],"tags":[],"class_list":["post-18588","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/18588","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18588"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/18588\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/16359"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18588"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18588"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18588"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}