<原著>慢性閉塞性肺疾患の予後・労働能力の低下に関与する 2・3 の因子について

Abstract

Prior to this study, the authors published the clinical study concerning with the progress and excervation of chronic obstructive lung disease (COLD), in which COLD was classified into 4 groups from the view point of the onset, the clinical findings and courses of the diseases. In this paper, the authers attempted to evaluate the prognosis of COLD and grade of disability of the patients on the basis of their previous study. COLD takes a turn for the worse by repeating acute excervation with infection, the observation of 41 cases with pulmonary function test in the midst, before and after the acute excervation was studied. These 41 cases were classified into 4 groups as follows; Type a; Group originated in bronchial asthma remaining obstructive ventilation insufficiency on ease and suffering from infection sometimes. This insufficiency is markedly reversible. Type b; Group with repeating bronchitis with wheezing on excervation and taking a turn for the worse gradually. Irreversible. Besides obstructive ventilation insufficiency, restrictive ventiration insufficiency is acommpanied. Hypoxemia and Hypercapnia grow to right ventricular hypertrophy. Subjective complaints are marked. Many patients belonging this group are disabled. Type c; Group of diffuse bronchiectasis with the symptomes of chronic bronchitis since very young age. This type of COLD has the clinical and roentgenological features of pulmonary fibrosis. Most patients with this type can work except on the excervation. They have restructive and obctructive ventiration insufficiency. When such insufficiency reaches to some limit, the general state of the patient turns to worse suddenly. The prognosis is poor. Type d; Group of restrictive ventiration insufficiency due to restrictive movement of thorax. This group is alike the severe cases of Type c. The prognosis is poor. From these observations, it could be concluded that the diagnosis of the type of GOLD and cognition of restrictive ventilation insufficiency besides obstructive are immportant for the evaluation of the prognosis of COLD and disability of the patients with COLD.