Home Oral cavity Pneumonia stage. What are the stages of pneumonia? Based on epidemiological data, pneumonia is distinguished

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Pneumonia stage. What are the stages of pneumonia? Based on epidemiological data, pneumonia is distinguished

Pneumonia is an inflammatory disease in which pathological process affects lung tissue.

Depending on the root cause (type of pathogen), pneumonia can be classified into:

viral;
viral-bacterial;
bacterial;
fungal

Except type of illness, the stages of pneumonia, as well as the severity of pneumonia, may be different, which determines the subsequent treatment tactics for the patient.

The most common form of the disease is typical acute pneumonia. As a rule, from total number of patients with this form of inflammation, more than 10% of patients are treated in a hospital.

If we talk about the “age of the disease,” then most often the disease is diagnosed in older people. The number of such patients is more than 50%. In addition, in the group increased risk there are children under 3 years old.

Classification of pulmonary inflammation

Today, doctors increasingly have to diagnose various stages pneumonia in adults and children. This prevalence of the disease is due to the fact that there are many known and unknown pathogens that lead to an inflammatory process in the lung tissues.

According to the conditions of possible infection, the classification of pneumonia is as follows:

This type of pneumonia is more common than other forms, since it is very often the cause of an untreated cold, or occurs against the background of a respiratory infection.

This type of inflammation can be determined when the patient is in hospital facility, but the reason for his hospitalization is different. In this case, the patient should be observed characteristic symptoms pneumonia no later than 48 hours after admission to the hospital department. If symptoms appear after 48 hours, pneumonia will be regarded as community-acquired.

This form occurs when the contents from the stomach or saliva (containing oral microflora) of the patient penetrates into the lungs. Very often this picture is observed with vomiting. The risk group is patients who are bedridden, as well as patients on artificial ventilation lungs and alcoholics.

Pneumonia due to immunodeficiency

This form is diagnosed in patients with low immunity. This can be caused both by a specific course of therapy for oncology, and in patients with VIL and other congenital pathologies that require treatment with potent drugs.

According to the clinical and morphological picture, pneumonia can be divided into:

parenchymal pneumonia;
interstitial.

Severity

By severity clinical picture, the severity of pneumonia is divided into 3 groups:

Mild pneumonia

With this degree of severity of pneumonia, mild symptoms are diagnosed, which is accompanied by an increase in body temperature, no more than 38 o C. In this state, the patient’s breathing rate is 25 movements, consciousness is clear, indicators blood pressure within normal limits.

Moderate pneumonia

This stage of inflammation can be observed with moderate intoxication. The patient's body temperature can exceed 38 o C, the respiratory rate increases to 30 movements, the pulse quickens to 100 beats per minute. In this condition, the patient begins to actively sweat, blood pressure decreases, and the content of leukocytes in the blood increases. general analysis blood with a shift of the formula to the left.

The severe stage of pneumonia is characterized by pronounced intoxication of the body. Temperature indicators exceed 39 o C, respiratory rate exceeds 30 movements, pulse exceeds 100 beats. This state of the patient is complemented by clouded consciousness, delirium, and a significant decrease in blood pressure. In addition, it may appear respiratory failure, leukocytosis.

As we have already noted, pneumonia has 3 stages of the disease:

pneumonia 1st degree;
pneumonia degree 2;
pneumonia stage 3.

Although each degree has its own characteristic features, today it is customary to distinguish only 2 degrees of severity of the inflammatory process, namely: severe and non-severe. To more clearly identify the severity of inflammation, a special rating scale: PSI, ATS, CURB-65, etc.

The essence of this gradation lies in the designation of an unfavorable prognosis for patients with pneumonia.

breathing rate more than 30 movements;
presence of polylobar lesion;
patient disorientation, stunning;
uremia;
leukopenia;
thrombocytopenia;
hypothermia (with rectal measurement does not exceed 36 o C);
hypotension, which requires intensive therapeutic measures.

In addition to these criteria, there are even more pronounced indicators - the need for artificial ventilation of the patient’s lungs, as well as signs of septic shock.

Despite the already existing scale for assessing the stages of pneumonia, in the territory Russian Federation a separate scale is used, which was developed by the Russian Respiratory Society. Its composition can be found in the picture.

According to this list, we can talk about a severe form of pneumonia if at least 1 symptom is present.

Pay attention to the list of factors that can worsen the patient’s condition and aggravate the course of the disease:

Even initial stage pneumonia may worsen due to exposure concomitant disease on the immune system of a sick person. In this case, the body’s support functions are significantly reduced, illnesses occur more often, and the healing process is postponed indefinitely. The risk group includes patients with pathologies of the respiratory organs, cardiovascular system, as well as those suffering from diabetes and alcoholism.
The root cause is the type of pathogen that provoked the development of the disease.
Extent of damage. Very great importance have volumes of damaged tissue, because the larger they are, the more severe the patient’s condition will be.
Timeliness. The situation can be aggravated by an untimely visit to the doctor and, accordingly, untimely treatment. The last stage of pneumonia is especially life-threatening, especially if no therapeutic measures have been taken to eliminate it.
Unfortunately, final stages pneumonia is very often diagnosed in people with low incomes or in people living on the street.

Features of the stages of pulmonary inflammation and their symptoms

The stages of pneumonia in children have some differences from the course of the disease in adults, but everything also depends on the underlying cause. Children's symptoms are similar to adults, but the severity in children, especially under 3 years of age, is more pronounced.

In order to fully understand how terrible severe pneumonia is, we will next consider the features of the course of acute typical lobar inflammation. And so, the pathology has the following stages:

Hot flash is the initial stage of development of the pathological process.

Duration takes from a couple of hours to 3 days. In such a relatively short time, the capillaries in the lungs become wider, blood flows in, and stagnation forms. This leads to a lightning-fast increase in the patient’s body temperature and a dry cough. Shortness of breath also appears; when coughing and inhaling, the patient experiences discomfort and possibly pain.

Red liver stage

Lasts for 1-3 days. This stage is characterized by the filling of the alveoli with plasma, the lung tissue becomes denser. Also at this stage, the airiness of the alveoli is lost, the lungs begin to turn red. The patient may complain of pain, a rapid rise in temperature, and rusty-colored sputum.

The stage lasts 4-8 days, during which the breakdown of red blood cells occurs. At this stage, the color of the lungs becomes brown, and leukocytes penetrating into the alveoli stain them grey colour. The productivity of the cough increases, and sputum mixed with pus or mucus begins to come out. The pain fades every day, shortness of breath disappears, and the temperature decreases.

Pneumonia in the stage of incomplete resolution

The stage of resolution of pneumonia - what this process is and what its signs are, few patients know. Many people are mistaken that this is a complete recovery, and they independently decide to stop therapy. But this is not true at all. Let's take a closer look.

Pneumonia is in the resolution stage - this means that the patient is on the road to recovery, but is not completely healthy; it is at this stage that the sputum resolves. The duration of this stage is no more than 12 days. During this time, the sputum is liquefied and the airiness of the lung is restored. Pneumonia in the resorption stage is a long process, but absolutely painless. Even in the stage of incomplete resorption, the symptoms of the disease decrease, coughing up sputum does not cause difficulty, body temperature normalizes, and the patient’s breathing is free.

Features of radiography at different stages of inflammation

Since radiography is great way for the diagnosis of pneumonia, for different stages diseases X-ray will show different results, which is very important for selecting subsequent treatment tactics.

During the reverse development stage, a darkened area will be visible in the image. This is very helpful information, which may indicate the stage of lobar pneumonia and its specific location. At the resolution stage, the image will show the darkened area decreasing in size.

It happens that even after full recovery X-rays “notice” an enhanced pulmonary pattern and fibrous areas. Therefore, some time after recovery, it is recommended to take a second photograph – a control one.

Treatment of mild pneumonia

Mild pneumonia is the stage at which it is necessary to identify diseases for quick and high-quality treatment. Pneumonia on early stage does not yet have time to expand the affected area and cause complications, which makes it possible to stop further development pathology. Of course, the first signs of pneumonia are in many ways similar to other respiratory diseases, which makes early diagnosis difficult, but it is the identification of the lesion in the initial stage that eliminates the risk of the disease progressing to a more severe form.

The essence of pathology

Pneumonia is an acute inflammation of the lungs, usually infectious nature with damage to various pulmonary structures. The disease can develop as a primary process, when inflammation occurs when a healthy organ is infected, or as a secondary reaction against the background chronic diseases respiratory organs. The disease can affect a person at any age, from birth to old age.

Infection of the lungs most often occurs through the bronchi (bronchogenic route), but can occur through the hematogenous and lymphatic route. The main pathogens: gram-positive (pneumococci, streptococci and staphylococci) and gram-negative (hemophilus and coli, Friedlander's bacillus, Proteus, Legionella, enterobacteria) microorganisms; mycoplasma; viruses various types(influenza, parainfluenza, respiratory syncytial viruses, adenovirus); pathogenic fungi. Bacterial damage by pneumococci is recorded in almost 65% of cases of the disease, but in childhood Viral infection (respiratory syncytial virus) is more common.

Pneumonia can develop in acute and chronic form. According to the coverage of the organ with inflammation, unilateral and bilateral damage is noted. The disease can occur with or without complications, with dysfunction of various internal organs and without such dysfunctions. By morphological characteristics pathology is classified into lobar, focal and interstitial pneumonia. Finally, the severity of the manifestation can be mild, moderate or severe.

Mild degree

A mild degree of pneumonia can be stated at the initial stages of the onset of the inflammatory process. This form of pathology has individual small lesions and most often develops in the alveoli, in limited areas of lung tissue, in individual lobules of the lung, i.e. belongs to the focal type of the disease. It can develop independently inflammatory reaction or become a consequence of certain infectious diseases (measles, influenza, whooping cough).

Development of the disease in mild form typical during the high tide stage. This first stage of pathology is characterized by the beginning of the pathogenic process: filling of the pulmonary vessels with blood and the formation of exudate in the alveoli. The serous composition of the exudate is replenished with erythrocytes, leukocytes, and fibrin fibers. Inflammatory tissue swelling and hyperemia arises.

At the same time, the symptoms of the disease at this stage still bear the features of implicit intoxication of the body. Body temperature does not exceed 37.7-37.9ºС, a slight cardiac arrhythmia is detected in the form of tachycardia, but within a range of no more than 90 beats per minute and with normal blood pressure. Shortness of breath and breathing problems are not yet defining, but X-ray images can reveal small foci of the inflammatory process.

Any inflammation of the lungs begins quite acutely and abruptly. Its course largely depends on the type of pathogen, but general character is saved. Incubation period usually lasts 20-70 hours, after which the first symptoms appear: runny nose, cough, fever, general weakness, difficulty breathing. When the disease progresses in a mild form, characteristic of the presence of small lesions, the first signs gradually smooth out and stabilize.

The inflammatory reaction turns into a long, sluggish process. The sputum, which initially has a mucopurulent viscous composition, acquires a liquid consistency, but sometimes small blood impurities can be observed. An important diagnostic characteristic of sputum: the presence of a significant number of leukocytes and macrophages. A blood test indicates the presence of vaguely defined neutrophilic leukocytosis and slight increasing ESR. Most obvious diagnostic factor- presence of lesions on the radiograph.

Treatment

Pneumonia in a mild form is quite easy to treat, but delay can cause an exacerbation of the disease or transition to the chronic phase, which is fraught with serious complications.

Treatment of the disease at this stage can be carried out in a hospital or at home, but with mandatory bed rest and quarantine isolation. Reinforced drinking regime(2.5-3 liters of fluid per day). It is recommended to drink tea, non-carbonated alkaline mineral water, fruit juice. The diet should be high in calories and high in vitamin C.

Mandatory treatment is based on the destruction of the infectious pathogen, eliminating intoxication, and increasing immunity. The antibiotics and anti-inflammatory drugs used are prescribed taking into account the specific pathogen, the age of the patient and the individual susceptibility of the body. Reception medicines is carried out strictly as prescribed by the doctor.

Mild pneumonia is the stage when the disease has a good prognosis - complete cure. It is important to identify the disease in a timely manner and take effective measures to eliminate it.

Description of the stages of development of pneumonia, four degrees of severity and criteria for their determination

Pneumonia is a disease associated with the development of an inflammatory process in the lung tissue, intra-alveolar exudation under the influence of infectious and, less commonly, non-infectious agents. Depending on the type of pathogen, pneumonia can be viral, viral-bacterial, bacterial or fungal.

Typical acute pneumonia is one of the common diseases. The average statistical indicator is approximately 10-13% of patients who are in therapeutic hospitals. The incidence rate of typical pneumonia is 10 men and 8 women per 1000 people. The majority of patients (about 55%) are elderly people. Also, a large number of patients are children. early age(period up to three years).

Types of pneumonia

Modern medicine is faced with various forms of pneumonia: from mild subclinical to severe and life-threatening. This variation can be explained by the variety of pathogens that can provoke pneumonia, and individual immune reaction organism to a specific infectious agent.

Taking into account criteria such as infection conditions, pneumonia is classified into:

Community-acquired - occur at home, more often after a cold, against the background of ARVI. This type pneumonia is more common than others.
Intrahospital (hospital, nosocomial) - arise and develop when the patient is in the hospital. In this case, the criterion for nosocomial pneumonia is the appearance of symptoms of the disease in a patient hospitalized for another reason within 48 hours or more from the moment of admission to the hospital. The development of the disease before the end of the second day from the moment of admission is regarded as community-acquired pneumonia.
Aspiration - develops from the entry into the lungs of stomach contents, saliva containing microflora oral cavity. As a rule, this occurs with vomiting. At risk for aspiration pneumonia are bedridden patients, patients on mechanical ventilation, and patients with chronic alcoholism.
Pneumonia in people with immunodeficiency – oncology (against the background specific treatment), HIV, immunodeficiencies associated with taking medicines, and congenital conditions.

Based on clinical and morphological features, pneumonia is divided into parenchymal and interstitial. The first type, in turn, is divided into lobar (polysegmental), focal and segmental pneumonia.

Severity of the disease

According to expression clinical manifestations determine three degrees of severity of pneumonia:

Mild severity is characterized by mild signs of intoxication with a body temperature of up to 38 degrees, a respiratory rate (RR) of up to 25 movements, clear consciousness and normal blood pressure, and leukocytosis.
The average degree is classified as moderate intoxication with a body temperature above 38 degrees, respiratory rate - 25-30, heart rate up to 100 beats per minute, sweating, a slight decrease in blood pressure, an increase in the number of leukocytes in the CBC with a shift of the formula to the left.
A severe degree is considered to be indicators of pronounced intoxication with a body temperature above 39 degrees, a respiratory rate of more than 30, a heart rate of more than 100 beats, clouding of consciousness with delirium, a strong decrease in blood pressure, respiratory failure, severe leukocytosis, morphological changes neutrophils (granularity), a decrease in the number of leukocytes is possible.

Currently, only two degrees of severity of the disease are most often distinguished: mild and severe. To identify a severe degree, scales for assessing the severity of the disease are used: PSI, ATS, CURB-65, etc.

The principle of these scales is to identify groups at risk of poor prognosis among patients with pneumonia. The figure below shows the ATS scale for identifying severe disease.

On the territory of the Russian Federation, taking into account the shortcomings of American and European scales, as well as taking into account Russian specifics, criteria of the Russian Respiratory Society have been developed for assessing the patient’s condition (figure below).

Pneumonia is considered severe if at least one criterion is present

It is worth mentioning separately a number of factors in which pneumonia is more severe

Pneumonia develops against the background of concomitant diseases. At the same time, the immune system is weakened, the disease occurs more often (on average compared to other categories), and recovery occurs later. This is especially true for patients with chronic diseases respiratory organs, of cardio-vascular system, alcoholism and diabetes.
Pathogen type. If affected by gram-negative flora, the likelihood fatal outcome much higher.
The greater the volume of lung tissue exposed to the inflammatory process, the more severe the patient’s condition.
Contributes to the development of severe disease untimely appeal and diagnostics.
Severe pneumonia often occurs in people who are homeless or living in poor conditions, who are unemployed or have low incomes.
Severe pneumonia is more common in people over 60 years of age and newborns.

Characteristics of stages and their clinical symptoms

During acute typical lobar pneumonia stages are also distinguished:

The flushing stage is the first stage of development of this disease. Lasts from several hours to three days. At this time, the pulmonary capillaries expand, and the blood in the lung tissue rushes in and begins to stagnate. The patient's body temperature rises sharply, a dry cough appears, shortness of breath is observed, and the patient feels pain when inhaling and coughing.
The second stage is the red liver stage. Lasts from one to three days, the alveoli are filled with sweating plasma and become denser lung tissue. At this time, the alveoli lose their airiness, and the lungs become red. The pain gets worse, the body temperature is steadily elevated, and “rusty” sputum appears.
The third stage of gray hepatization lasts from four to eight days. During the flow in the alveoli, red blood cells disintegrate and the hemoglobin contained in them becomes hemosiderin. During this process, the color of the lung turns brown. And the leukocytes entering the alveoli also make it gray. The cough becomes productive, the patient coughs up purulent or mucous sputum. The pain dulls, shortness of breath decreases. Body temperature decreases.
The fourth stage of resolution is accompanied by the process of recovery and resorption of sputum. Its duration is from 10 to 12 days. At this time, gradual dissolution and liquefaction of sputum occurs and the airiness of the lungs is restored. The resorption process is long, but painless. Symptoms subside, sputum is coughed up easily, pain is practically absent or mild, breathing process and body temperature are normalized.

The results of radiography allow us to determine the stage of development of the disease. At the height of the disease, a darkening of varying extent and size (focal, segmental, lobar) is observed on the radiograph. At the resolution stage, the darkening decreases in size, infiltration disappears, as residual effects Increased pulmonary pattern may persist for up to a month. Sometimes after recovery, areas of fibrosis and sclerosis may remain. In this regard, it is recommended to keep the last photographs in hand after the disease has resolved.

Is phlegm coming out poorly?

For Get well soon It is important that the sputum is expectorated and removed from the body, as pulmonologist E.V. Tolbuzina tells how to do this.

In atypical pneumonia associated with a lack of immunity, the above stages are not inherent. It is characterized by smoother symptoms and changing periods of the disease. In addition, with atypical pneumonia, only interstitial changes without clear infiltration are often observed.

Correct and timely determination by the attending physician of the degree and stages of pneumonia allows one to avoid many complications in the further course of the disease. Therefore, it is very important to identify the source of infection and begin treatment on time.

Additional studies and patient management tactics

Patients with suspected pneumonia will be prescribed:

UAC, OAM;
X-ray of the chest organs in two projections (if necessary, the number of projections increases, this is decided by the radiologist);
Blood chemistry;
Sputum tests: general, for BK, for microflora and its resistance-sensitivity spectrum;

Types of pneumonia

Modern medicine is faced with various forms of pneumonia: from mild subclinical to severe and life-threatening. This variation can be explained by the variety of pathogens that can provoke pneumonia, and the individual immune response of the body to a specific infectious agent.

Taking into account criteria such as infection conditions, pneumonia is classified into:

Community-acquired - occur at home, more often after a cold, against the background of ARVI. This type of pneumonia is more common than others.
Intrahospital (hospital, nosocomial) - arise and develop when the patient is in the hospital. In this case, the criterion for nosocomial pneumonia is the appearance of symptoms of the disease in a patient hospitalized for another reason within 48 hours or more from the moment of admission to the hospital. The development of the disease before the end of the second day from the moment of admission is regarded as community-acquired pneumonia.
Aspiration - develops from the ingress of stomach contents and saliva containing oral microflora into the lungs. As a rule, this occurs with vomiting. At risk for aspiration pneumonia are bedridden patients, patients on mechanical ventilation, and patients with chronic alcoholism.
Pneumonia in people with immunodeficiency – oncology (against the background of specific treatment), HIV, drug-related immunodeficiencies, and congenital conditions.

Based on clinical and morphological features, pneumonia is divided into parenchymal and interstitial. The first type, in turn, is divided into lobar (polysegmental), focal and segmental pneumonia.

According to the severity of clinical manifestations, three degrees of severity of pneumonia are determined:

Mild severity is characterized by mild signs of intoxication with a body temperature of up to 38 degrees, a respiratory rate (RR) of up to 25 movements, clear consciousness and normal blood pressure, and leukocytosis.
The average degree is classified as moderate intoxication with a body temperature above 38 degrees, respiratory rate - 25-30, heart rate up to 100 beats per minute, sweating, a slight decrease in blood pressure, an increase in the number of leukocytes in the CBC with a shift of the formula to the left.
A severe degree is considered to be indicators of pronounced intoxication with a body temperature above 39 degrees, a respiratory rate of more than 30, a heart rate of more than 100 beats, clouding of consciousness with delirium, a strong decrease in blood pressure, respiratory failure, severe leukocytosis, morphological changes in neutrophils (granularity), and a possible decrease in the number of leukocytes.

The principle of these scales is to identify groups at risk of poor prognosis among patients with pneumonia. The figure below shows the ATS scale for identifying severe disease.

Pneumonia is considered severe if at least one criterion is present

It is worth mentioning separately a number of factors in which pneumonia is more severe

Pneumonia develops against the background of concomitant diseases. At the same time, the immune system is weakened, the disease occurs more often (on average compared to other categories), and recovery occurs later. This is especially true for patients with chronic diseases of the respiratory system, cardiovascular system, alcoholism and diabetes.
Pathogen type. When affected by gram-negative flora, the likelihood of death is much higher.
The greater the volume of lung tissue exposed to the inflammatory process, the more severe the patient’s condition.
Late treatment and diagnosis contributes to the development of severe disease.
Severe pneumonia often occurs in people who are homeless or living in poor conditions, who are unemployed or have low incomes.
Severe pneumonia is more common in people over 60 years of age and newborns.

During acute typical lobar pneumonia there are also stages:

The flushing stage is the first stage of development of this disease. Lasts from several hours to three days. At this time, the pulmonary capillaries expand, and the blood in the lung tissue rushes in and begins to stagnate. The patient's body temperature rises sharply, a dry cough appears, shortness of breath is observed, and the patient feels pain when inhaling and coughing.
The second stage is the red liver stage. Lasts from one to three days, the alveoli are filled with sweating plasma, and the lung tissue thickens. At this time, the alveoli lose their airiness, and the lungs become red. The pain gets worse, the body temperature is steadily elevated, and “rusty” sputum appears.
The third stage of gray hepatization lasts from four to eight days. During the flow in the alveoli, red blood cells disintegrate and the hemoglobin contained in them becomes hemosiderin. During this process, the color of the lung turns brown. And the leukocytes entering the alveoli also make it gray. The cough becomes productive, the patient coughs up purulent or mucous sputum. The pain dulls, shortness of breath decreases. Body temperature decreases.
The fourth stage of resolution is accompanied by the process of recovery and resorption of sputum. Its duration is from 10 to 12 days. At this time, gradual dissolution and liquefaction of sputum occurs and the airiness of the lungs is restored. The resorption process is long, but painless. Symptoms subside, sputum is coughed up easily, pain is practically absent or mild, breathing process and body temperature are normalized.

The results of radiography allow us to determine the stage of development of the disease. At the height of the disease, a darkening of varying extent and size (focal, segmental, lobar) is observed on the radiograph. At the resolution stage, the darkening decreases in size, infiltration disappears, and an increase in the pulmonary pattern may persist as residual effects for up to a month. Sometimes after recovery, areas of fibrosis and sclerosis may remain. In this regard, it is recommended to keep the last photographs in hand after the disease has resolved.

Additional studies and patient management tactics

Patients with suspected pneumonia will be prescribed:

UAC, OAM;
X-ray of the chest organs in two projections (if necessary, the number of projections increases, this is decided by the radiologist);
Blood chemistry;
Sputum tests: general, for BK, for microflora and its resistance-sensitivity spectrum;
Computed tomography and bronchoscopy can be performed additionally according to special indications. This is done, as a rule, to exclude/clarify localization cancerous tumors in the lungs, abscesses, encysted pleurisy, decay cavities, bronchiectasis and so on.

Based on all the collected data, after determining the degrees and stages of development of pneumonia, the doctor can determine the optimal tactics for managing the patient and where it is best to treat him. Also, based on data reflecting the severity of the disease, make a forecast. This is all important for further patient management.

Pneumonia is an inflammatory disease in which the pathological process affects the lung tissue.

Depending on the root cause (type of pathogen), pneumonia can be classified into:

viral;
viral-bacterial;
bacterial;
fungal

In addition to the type of illness , the stages of pneumonia, as well as the severity of pneumonia, may be different, which determines the subsequent treatment tactics for the patient.

The most common form of the disease is typical. As a rule, of the total number of patients with this form of inflammation, more than 10% of patients are treated in a hospital.

If we talk about the “age of the disease,” then most often the disease is diagnosed in older people. The number of such patients is more than 50%. In addition, children under 3 years of age are at increased risk.

Today, doctors are increasingly having to diagnose various stages of pneumonia in adults and children. This prevalence of the disease is due to the fact that there are many known and unknown pathogens that lead to an inflammatory process in the lung tissues.

According to the conditions of possible infection, the classification of pneumonia is as follows:

Community-acquired pneumonia

This type of pneumonia is more common than other forms, since it is very often the cause of an untreated cold, or occurs against the background of a respiratory infection.

In-hospital

This type of inflammation can be determined when the patient is in a hospital facility, but the reason for his hospitalization is different. In this case, the patient must experience characteristic symptoms of pneumonia no later than 48 hours after admission to the hospital department. If symptoms appear after 48 hours, pneumonia will be regarded as.

Aspiration

This form occurs when the contents from the stomach or saliva (containing oral microflora) of the patient penetrates the lungs. Very often this picture is observed with vomiting. The risk group is bedridden patients, as well as patients on mechanical ventilation and alcoholics.

Pneumonia due to immunodeficiency

According to the clinical and morphological picture, pneumonia can be divided into:

parenchymal pneumonia;
interstitial.

Severity

According to the severity of the clinical picture and severity of pneumonia, they are divided into 3 groups:

Mild pneumonia

With this degree of severity of pneumonia, mild symptoms are diagnosed, which is accompanied by an increase in body temperature, no more than 38 o C. In this state, the patient’s respiratory rate is 25 movements, consciousness is clear, blood pressure is within normal limits.

Moderate pneumonia

This stage of inflammation can be observed with moderate intoxication. The patient's body temperature can exceed 38 o C, the respiratory rate increases to 30 movements, the pulse quickens to 100 beats per minute. In this state, the patient begins to actively sweat, blood pressure decreases, and the content of leukocytes in the general blood test increases with a shift in the formula to the left.

Severe degree

The severe stage of pneumonia is characterized by pronounced intoxication of the body. The temperature exceeds 39 o C, the respiratory rate exceeds 30 movements, and the pulse exceeds 100 beats. This state of the patient is complemented by clouded consciousness, delirium, and a significant decrease in blood pressure. In addition, respiratory failure and leukocytosis may occur.

As we have already noted, pneumonia has 3 stages of the disease:

pneumonia 1st degree;
pneumonia degree 2;
pneumonia stage 3.

Despite the fact that each degree has its own characteristic signs, today it is customary to distinguish only 2 degrees of severity of the inflammatory process, namely: severe and non-severe. To more clearly identify the severity of inflammation, a special rating scale has been developed: PSI, ATS, CURB-65, etc.

The essence of this gradation lies in the designation of an unfavorable prognosis for patients with pneumonia.

breathing rate more than 30 movements;
presence of polylobar lesion;
patient disorientation, stunning;
uremia;
leukopenia;
thrombocytopenia;
hypothermia (with rectal measurement does not exceed 36 o C);
hypotension, which requires intensive therapeutic measures.

In addition to these criteria, there are even more pronounced indicators - the need for artificial ventilation of the patient’s lungs, as well as signs of septic shock.

Despite the already existing scale for assessing the stages of pneumonia, a separate scale is used in the Russian Federation, which was developed by the Russian Respiratory Society. Its composition can be found in the picture.

According to this list, we can talk about a severe form of pneumonia if at least 1 symptom is present.

Pay attention to the list of factors that can worsen the patient’s condition and aggravate the course of the disease:

Even the initial stage of pneumonia can worsen due to the impact of the concomitant disease on the immune system of the sick person. In this case, the body’s support functions are significantly reduced, illnesses occur more often, and the healing process is postponed indefinitely. The risk group includes patients with pathologies of the respiratory system, cardiovascular system, as well as those suffering from diabetes and alcoholism.
The root cause is the type of pathogen that provoked the development of the disease.
Extent of damage. The volume of damaged tissue is very important, because the larger it is, the more severe the patient’s condition will be.
Timeliness. The situation can be aggravated by an untimely visit to the doctor and, accordingly, untimely treatment. The last stage of pneumonia is especially life-threatening, especially if no therapeutic measures have been taken to eliminate it.
Unfortunately, the last stages of pneumonia are very often diagnosed in people with low incomes or in people living on the street.

Features of the stages of pulmonary inflammation and their symptoms

In order to fully understand how terrible severe pneumonia is, we will next consider the features of the course of acute typical pneumonia. And so, the pathology has the following stages:

Hot flash is the initial stage of development of the pathological process.

Red liver stage

Gray Heat

The stage lasts 4-8 days, during which the breakdown of red blood cells occurs. At this stage, the color of the lungs becomes brown, and leukocytes penetrating into the alveoli color them gray. The productivity of the cough increases, and sputum mixed with pus or mucus begins to come out. The pain fades every day, shortness of breath disappears, and the temperature decreases.

Pneumonia in the stage of incomplete resolution

Features of radiography at different stages of inflammation

Since radiography is an excellent way to diagnose pneumonia, at different stages of the disease an x-ray will show different results, which is very important for selecting subsequent treatment tactics.

During the reverse development stage, a darkened area will be visible in the image. This is very useful information that may indicate the stage of lobar pneumonia and its specific location. At the resolution stage, the image will show the darkened area decreasing in size.

It happens that even after complete recovery, x-rays “notice” an enhanced pulmonary pattern and fibrous areas. Therefore, some time after recovery, it is recommended to take a second photograph – a control one.

Pneumonia is considered one of the most dangerous diseases modernity. It ranks 4th in terms of deaths. An accurate classification and diagnosis of the degree and stage of pulmonary inflammation in the affected area is required. The causative agents of the disease are bacteria, viruses, and fungi. There are 3 degrees of severity and 4 stages of the pathological condition.

The most common form of pneumonia is classic; atypical pneumonia is less commonly diagnosed. The main sets of signs of damage include fever, disturbances in the functioning of organs respiratory system and intoxication.

Thanks to the development of medicine in the field of treatment and diagnosis of the disease, the risk of death from pneumonia is constantly decreasing. Most often, the worst prognosis occurs in patients with critical condition or those suffering from immunodeficiency.

In accordance with the circumstances of infection, pneumonia is classified into the following types:

Nosocomial - which develops within 2 days after admission to the hospital or 72 hours after discharge.
Community-acquired – infection and progression of the disease does not correlate with hospital-acquired strains of pathogens.
Aspiration – develops due to the penetration of various liquids or other substances into the lower respiratory organs.
Diseases in patients with immunodeficiency.

Pathogens that provoke inflammation in the lungs can be:

Viruses – usually measles, influenza or enteroviruses.
Bacteria – pneumococci, chlamydia, mycoplasma, hemophilus influenzae, etc.
Fungi - candida.
Mixed forms are the most severe.

By volume of tissue damage lung pneumonia classified into the following forms:

Focal: one or more parts are affected - segmental or polysegmental, maybe involved in pathology bronchial tree– bronchopneumonia.
Lobar or lobar: inflammatory process covers a whole share.
Interstitial – inflammation of tissues near the bronchi.

Depending on the part of the lung in which inflammation occurs, upper, middle or lower lobe pneumonia is distinguished.

When did pneumonia occur in healthy person, then it is considered primary, and if as a complication of another disease, then it is considered secondary.

In addition, the abortive course of pneumonia is classified. Thus, regression of symptoms occurs in a short time, the disease ends in the first stages of the lesion. This occurs due to timely treatment measures and the correct selection of antibiotics, as well as due to the proper functioning of the immune system.

If the course of pneumonia is protracted, then therapy takes 4 weeks or longer. During treatment, mild residual symptoms persist, such as asthenia and cough. On the X-ray image, the lesion does not appear, but an enhanced pulmonary pattern is noted.

Classification of the disease by severity

According to the strength of severity, taking into account the severity criteria of pneumonia, its clinical signs, it is classified into three degrees of damage:

In a mild form of pneumonia, the temperature does not rise above 38 degrees, the respiratory rate is 25 movements, consciousness remains clear, and blood pressure is normal.

Inflammation of moderate severity is detected with moderate manifestations of intoxication of the body. The patient's temperature is no more than 38 degrees, the respiratory rate reaches 30 movements, and the pulse increases. The patient begins to sweat heavily, the blood pressure level decreases, the concentration of leukocytes in the bloodstream increases with a shift in the formula to the left.

Severe pneumonia is characterized by severe intoxication, the temperature can exceed 39 degrees, the respiratory rate is more than 30 movements, and the pulse is greatly increased. The disease is accompanied by clouding of reason, delirium, and a strong drop in blood pressure. At the same time, respiratory failure and leukocytosis may develop.

A type of division of stages of the disease

When pneumonia develops, the stages of its development are characterized by general pattern. The duration of each stage depends on many influences, the main ones include:

age group;
concomitant pathologies;
state of immunity;
pathogen type;
duration of defeat;
time of diagnosis;
primary or secondary lung damage.

In accordance with the severity of the pathology, pneumonia goes through 4 stages.

First stage

The first stage of the disease, or hot flash, is often poorly expressed, so it is easily confused with a cold. Its duration is short, because pneumonia continues to progress, injuring new parts of the lung tissue.

The tide period is approximately 3 days. At this stage, the capillaries in the lung expand, blood rushes to the tissues of the organ, and stagnation occurs. The patient may complain of weakness nonproductive cough, shortness of breath with physical activity, pain when inhaling and exhaling, fever.

The patient's condition is moderate in severity, and occasionally severe. With rapid forms, already at the stage of high tide, delusional states, hallucinations, and clouding of consciousness occur.

During diagnosis, the doctor may see cyanosis of the lips and tip of the nose with simultaneous redness of the cheeks. The movement of the chest during breathing is asynchronous, because the affected half is prevented from working normally by swelling.

Second stage

The second stage is red hepatization. It lasts 1 – 3 days. In this case, the alveoli are filled with sweating blood plasma, which causes the organ tissue to become denser. The alveoli cease to be airy, the lungs turn red.

Clinical characteristics of the second stage are:

The pain becomes much stronger.
The temperature remains steadily elevated.
There may be sputum of a “rusty” hue.

Third stage

The third stage of pneumonia is called gray hepatitis and lasts 4–8 days. The breakdown of red blood cells in the alveoli occurs, and the same thing happens with the hemoglobin in them. The lung takes on a gray tint. The cough becomes productive, mucous or purulent sputum is coughed up. The pain subsides, shortness of breath decreases, and the temperature gradually normalizes.

Resolution stage

In the resolution stage, a full recovery occurs, sputum comes out, pathological symptoms decrease, and well-being is restored. The permit lasts about 12 days.

Pneumonia at the resolution stage is a long process, but it does not cause pain. Even with incomplete resorption, the symptoms appear less, coughing is not difficult, and the temperature is normal.

Additional Research

If pneumonia is suspected, the doctor must prescribe the following types of examinations to the person:

general analysis of urine and blood;
radiography for the respiratory system in chest with an increase in the number of projections according to the doctor’s indications;
blood biochemistry;
sputum tests, including to determine the sensitivity of microbes to antibiotics;
CT and bronchoscopy for special indications, usually to identify the location of oncology, abscess, decay cavity, etc.

The most common and informative diagnostic method for pneumonia is radiography. At different stages of the disease, the results in the images also change. This is important for the doctor, as it helps to monitor the success of treatment and, if necessary, change tactics. Sometimes, even after recovery, an enhanced pulmonary pattern remains. In such a situation, the specialist prescribes x-rays again after some time.

After analyzing all the data collected as a result of diagnosis, identifying the stage and extent of pneumonia, the doctor develops an appropriate treatment strategy. In addition, a forecast is made based on the research results. All of these components are extremely important for successful recovery.

Pneumonia in adults (pneumonia) - inflammation of the lower respiratory tract of various etiologies, occurring with intra-alveolar exudation and accompanied by characteristic clinical and radiological signs. The main cause of the development of the disease is a pulmonary infection that affects all structures of the lungs. There are many types of pneumonia, varying in severity from mild to severe, or even those that can be fatal.

What is pneumonia?

Pneumonia is predominantly acute pathological condition caused by infectious and inflammatory lesions of the pulmonary parenchyma. With this disease, the lower respiratory tract (bronchi, bronchioles, alveoli) is involved in the process.

This is a fairly common disease, diagnosed in approximately 12–14 adults out of 1000, and in older people whose age has exceeded 50–55 years, the ratio is 17:1000. By frequency deaths pneumonia comes first among all infectious diseases place.

ICD-10 code: J12, J13, J14, J15, J16, J17, J18, P23

The duration of the disease depends on the effectiveness of the prescribed treatment and the reactivity of the body. Before the advent of antibiotics heat decreased on days 7-9.

The degree of contagiousness directly depends on the form and type of pneumonia. But one thing is for sure - yes, almost all types of pneumonia are contagious. Most often, the disease is transmitted by airborne droplets. Thus, being in poorly ventilated areas with a carrier of the pneumonia virus (collective), a person is easily susceptible to infection.

Causes

Treatment of pneumonia

How to treat pneumonia in adults? Treatment of uncomplicated forms of pneumonia can be carried out by general practitioners: internists, pediatricians, family doctors and general practitioners.

For non-severe pneumonia in adults, hospital treatment is provided. It consists of a set of the following measures:

taking medications that dilate the bronchi to expel mucus;
taking antibiotics, antiviral drugs to combat the causative agent of pneumonia;
undergoing a course of physiotherapy;
performing physical therapy;
diet, drinking plenty of fluids.

Moderate and severe course requires hospitalization in a therapeutic or pulmonology department. Uncomplicated mild pneumonia degrees can be treated on an outpatient basis under the supervision of a local therapist or a pulmonologist visiting the patient at home.

It is preferable to carry out treatment in a hospital in the following situations:

patient over 60 years old;
presence of chronic lung diseases, diabetes, malignant tumors, severe heart disease or renal failure, low body weight, alcoholism or drug addiction;
failure of initial antibiotic therapy;
pregnancy;
the desire of the patient or his relatives.

Antibiotics

For pneumonia in adults, it is advisable to use antibiotics after the disease has been confirmed by at least one diagnostic method.

In mild cases, preference is given to protected penicillins, macrolides, and cephalosporins.
Severe forms require a combination of several antibiotics: macrolides, fluoroquinolones, cephalosporins.
Efficiency is assessed after 2-3 days. If the condition does not improve, this is direct reading change the group of drugs.

Other drugs

Besides antibacterial therapy Antipyretic therapy is also prescribed. Antipyretics are prescribed when the temperature rises from 38.5 degrees:

Ibuprofen;
Paracetamol;
Ibuklin;
Aspirin.

Mucolytics are used to thin sputum:

Ambrohexal;
Lazolvan;
Ambrobene;
Fluimucil;
Fluditek.

Physiotherapeutic treatment of pneumonia in adults

There are a number of procedures that are used in the treatment of pathology, the most effective are:

ultrasonic aerosol inhalation using mucolytics and antibiotics;
electrophoresis with the use of antibiotics and expectorants;
decimeter wave treatment of the lungs;
UHF therapy;
magnetophoresis;
UV radiation;
chest massage.

Therapeutic measures are carried out until the patient recovers, which is confirmed by objective methods - auscultation, normalization of laboratory and X-ray tests.

The prognosis for pneumonia in an adult directly depends on the degree of virulence and pathogenicity of the pathogen, the presence of a background disease, as well as the normal functioning of the human immune system. In most situations, pneumonia proceeds favorably and ends with complete clinical and laboratory recovery of the patient.

Compliance with the regime

Throughout the entire period of illness, the patient must remain in bed.
Necessary good nutrition, rich in vitamins. If there are no signs of heart failure, drinking plenty of fluids up to 3 liters per day is beneficial.
The room should have fresh air, light, and a temperature of +18C. When cleaning a room, you should avoid products containing chlorine, and do not use heaters with an open spiral, as they greatly dry the air.

During the period of resorption of the inflammatory focus, physiotherapy is prescribed:

inductothermy;
microwave therapy;
electrophoresis of lidase, heparin, calcium chloride;
thermal procedures (paraffin compresses).

Diet and nutrition

Diet for pneumonia during exacerbation:

lean meat, chicken, meat and chicken broths;
lean fish;
milk and fermented milk products;
vegetables (cabbage, carrots, potatoes, herbs, onions, garlic);
fresh fruits (apples, pears, citrus fruits, grapes, watermelon), dried fruits (raisins, dried apricots);
fruit, berry and vegetable juices, fruit drinks;
cereals and pasta;
tea, rosehip decoction;
honey, jam.

Exclude products such as: alcohol, smoked products, fried, spicy and fatty foods, sausages, marinades, canned food, store-bought sweets, products with carcinogens.

Recovery and rehabilitation

After pneumonia, very important point is rehabilitation, which is aimed at bringing all functions and systems of the body to a normal state. Rehabilitation after pneumonia also has a beneficial effect on general state health in the future, which minimizes the risk of development and recurrence of not only pneumonia, but also other diseases.

Recovery implies reception medications, physiotherapy, diet, hardening procedures. This stage can last up to 3-6 months, depending on the severity of the disease

Prevention

The most best prevention This is leading a rational lifestyle:

Proper nutrition (fruits, vegetables, juices), walks fresh air, avoiding stress.
In winter and spring, to avoid a decrease in immunity, you can take a multivitamin complex, for example, Vitrum.
To give up smoking.
Treatment of chronic diseases, moderate consumption alcohol.

Pneumonia is dangerous and unpleasant disease respiratory tract, which is accompanied by manifestations specific signs. These symptoms should be paid attention to in order to maintain wellness and maintaining the health of the body.

This is all about pneumonia in adults: the medical history, symptoms and first signs, treatment features. Be healthy!

Classification of pulmonary inflammation

Severity

Features of the stages of pulmonary inflammation and their symptoms

Features of radiography at different stages of inflammation

Treatment of mild pneumonia

The essence of pathology

Mild degree

Treatment

Description of the stages of development of pneumonia, four degrees of severity and criteria for their determination

Types of pneumonia

Severity of the disease

Characteristics of stages and their clinical symptoms

Additional studies and patient management tactics

Types of pneumonia

Additional studies and patient management tactics

Severity

Features of the stages of pulmonary inflammation and their symptoms

Features of radiography at different stages of inflammation

Classification of the disease by severity

A type of division of stages of the disease

First stage

Second stage

Third stage

Resolution stage

Additional Research

What is pneumonia?

Causes

Treatment of pneumonia

Antibiotics

Other drugs

Physiotherapeutic treatment of pneumonia in adults

Compliance with the regime

Diet and nutrition

Recovery and rehabilitation

Prevention

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