Among the 228 patients examined for CLL, chronic obstructive pulmonary disease (COPD) was diagnosed in 50 patients (21.9%). There was a significant predominance of men compared with women (44 and 6 people, respectively). The average age was 59.5 ± 3.2 years. All have a history of long-term smoking. The diagnosis of COPD in all patients was made before the first clinical and laboratory signs of CLL appeared. The duration of COPD is from 5 to 20 years. In group I, 7 patients with COPD were diagnosed, in group II, 30, in group III, 13 people.
The main clinical manifestations of COPD were dyspnea, cough, sputum production (predominantly mucopurulent or purulent), sweating, weakness, fatigue, increased body temperature , etc. . It should be noted that the last four symptoms may be a manifestation of CLL, with its progressive course (patients of groups II and III). Therefore, in all such situations, we tried to clarify whether these symptoms are a manifestation of COPD, CLL, or the associated symptoms of both diseases. Symptoms of tumor intoxication in CLL appear in the later stages of tumor progression, when there are other signs of progression of the tumor process – an increase in the size of lymph nodes, a progression of leukocytosis, an increase in anemia and thrombocytopenia, lack of effect from cytostatic therapy, etc. Choking, coughing in patients with Richter syndrome, due to compression of the lung tissue and bronchi, dense lymph nodes were rarely seen. therefore, their presence in all cases was explained by COPD. Massive leukemic infiltration of the lungs, which can be distinguished radiographically, the clinical manifestation of which may be shortness of breath, is very rarely diagnosed with CLL . Dyspnea in patients with CLL group III may be a clinical manifestation of anemic syndrome. In such patients, they tried to stop anemia as quickly as possible, if shortness of breath persisted, regarded it as a symptom of COPD. When associating COPD with CLL, auscultational picture and spirography are of great diagnostic value. In CLL, even in the case of a significant increase in bronchopulmonary lymph nodes, there were no violations of VFL detected by the method of spirography .
In patients with benign CLL, there are no symptoms of tumor intoxication and anemia, therefore, patients from group I have shortness of breath, sweating, weakness, fatigue, increased body temperature (in the absence of other comorbidities) explained by COPD.
Diagnostic bronchoscopy was performed in 40 patients with COPD. In 8 people, a double-sided diffuse endorchitis of I degree was detected, in 15 – II degree and in 17 – III degree.
Mean respiratory function recorded by spirography in patients with COPD in combination with CLL (VCD – 54.5 ± 3.8% D, FEV 1 – 50.9 ± 3.4% D, ICT – 51.7% ± 3, 5D, POS vyd – 34.8 ± 2.5% D, MOS 25 – 32.6 ± 3.0% D, MOS 50 – 31.9 ± 2.0% D, MOS 75 – 39.1 ± 3, 2% D) did not have significant differences with similar indicators in patients with COPD without concomitant hemoblastosis (3rd control group: VC 54.9 ± 3.2% D, FEV 1 – 51.5 ± 2.5% D , IVT – 52.8 ± 2.8% D, POS vyd – 35.3 ± 2.0% D, MOS 25 – 32.9 ± 2.0% D, MOS 50 – 32.7 ± 2.9% D, MOS 75 – 40.2 ± 4.0% D).
In accordance with the spirometric classification of COPD, depending on the indicators of FEV 1 and FEV 1 / FVC [262, 322], 21 (42%) patients of the II stage (moderately severe), 17 (34%) patients were diagnosed in the CLL patients group Stage III (severe) and 12 (24%) patients with Stage IV (extremely severe). In the 3rd control group, 11 patients were diagnosed II, 9 patients III and 5 patients with IV stages of COPD, which in percentage terms corresponded to patients of the main group (44, 36 and 20%, respectively).