Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease. It is mainly caused by structural changes such as airway narrowing or emphysema caused by smoking, which leads to obstruction of respiratory airflow, difficulty breathing or shortness of breath, and is often accompanied by discomfort such as coughing and sputum. Because COPD is a progressive disease, there are no symptoms in the early stage and it is very easy to be ignored. Once symptoms appear, the patient's lung function may lose about 50%, which is extremely harmful to the human body. Therefore, COPD is also called the "silent killer".
Causes of disease
Genetic factors: COPD has a genetic susceptibility.
Age and gender: Age is a risk factor for COPD. The older the age, the higher the prevalence of COPD. There are inconsistent reports on the difference in the prevalence of COPD between men and women, but there are literature reports that women are more sensitive to the harm of tobacco smoke.
Lung growth and development: Direct and indirect exposure to harmful factors during pregnancy, birth and adolescence can affect lung growth. Poor lung growth and development is a risk factor for COPD.
Bronchial asthma (abbreviated as asthma) and airway hyperresponsiveness: Asthma can not only coexist with COPD, but is also a risk factor for COPD. Airway hyperresponsiveness is also involved in the pathogenesis of COPD.
Low body mass index: Low body mass index is also related to the onset of COPD. The lower the body mass index, the higher the prevalence of COPD. Smoking and body mass index interact with COPD.
Predisposing factors
Smoking: Smoking is the main cause of COPD. The earlier the age of smoking, the longer the time, and the more cigarettes smoked per day, the higher the prevalence. Clinically, chronic bronchitis and emphysema are the most common diseases that cause COPD, and both diseases may be caused by smoking.
Fuel smoke: Fuels such as firewood, coal and animal manure contain a large amount of harmful components in the smoke, such as carbon oxides, nitrogen oxides, sulfur oxides, and incompletely burned hydrocarbon particles and polycyclic organic compounds.
Air pollution: Particulate matter (PM) and harmful gases (sulfur dioxide, nitrogen dioxide, ozone and carbon monoxide, etc.), such as high-dose pesticides, have irritating and cytotoxic effects on the bronchial mucosa. When the concentration of PM2.5 in the air exceeds 35 μg/m3, the risk of chronic obstructive pulmonary disease increases significantly.
Occupational dust: When the concentration of occupational dust (silicon dioxide, coal dust, cotton dust and sugarcane dust, etc.) is too high or the contact time is too long, it can lead to the occurrence of chronic obstructive pulmonary disease.
Infection and chronic bronchitis: Respiratory tract infection is an important factor in the onset and aggravation of chronic obstructive pulmonary disease. Viral and (or) bacterial infection is a common cause of acute exacerbation of chronic obstructive pulmonary disease. Recurrent lower respiratory tract infections in childhood are associated with reduced lung function and the occurrence of respiratory symptoms in adulthood.
Socioeconomic status: Socioeconomic status is also closely related to the onset of chronic obstructive pulmonary disease. People with low socioeconomic status are more likely to develop chronic obstructive pulmonary disease, which may be related to indoor air pollution, crowded living rooms and poor nutrition.
Symptoms of COPD:
Chronic cough: Usually the first symptom of COPD, which is intermittent in the early stage and becomes continuous in the later stage.
Expectoration: There may be only a small amount of sputum in the early stage, but the amount of sputum may increase as the disease progresses.
Dyspnea and shortness of breath: It manifests as rapid breathing and shortness of breath, especially after activities.
Wheezing and chest tightness: Dyspnea caused by lung disease may be accompanied by chest tightness and chest pain.
Susceptible groups:
Long-term smokers: Smoking is the main risk factor for COPD.
Long-term exposure to air pollution and occupational dust: such as coal miners, construction workers, etc.
People with family history: People with a family history of COPD are more likely to suffer from this disease.
People over middle age: With age, the risk of COPD will also increase.
Stable intervention measures:
The stable stage of COPD refers to the process of stable condition. At this time, the patient's cough, sputum, shortness of breath and other symptoms are mild, and the condition is not easy to change.
- Quitting smoking is the first step in the management of COPD. Quitting smoking can slow the progression of the disease, improve lung function, and reduce the risk of complications.
Avoid exposure to harmful gases and particulate matter, such as smoke, chemicals, dust, etc.
- Exercise
Aerobic exercise: such as brisk walking, cycling, swimming, etc., can help improve cardiopulmonary function and endurance.
Strength training: including muscle strength training using dumbbells, resistance bands, etc., to enhance muscle strength and improve daily activities.
Intervention measures during acute exacerbation:
- The acute exacerbation of COPD refers to the acute onset of COPD, which is characterized by worsening cough, increased sputum volume, or coughing up yellow sputum, worsening dyspnea, worsening respiratory symptoms, unstable condition, and easy to change.
Drug treatment requires adjustment of the medication regimen, increasing the type and dose of bronchodilators, and using antibiotics or systemic glucocorticoids, including inhaled corticosteroids, long-acting β2 receptor agonists, phosphodiesterase-4 inhibitors, etc. Provide respiratory support equipment when necessary, including oxygen therapy and mechanical ventilation.
- Breathing training
Abdominal breathing: Through abdominal breathing, you can increase the effective ventilation of the lungs and reduce the fatigue of the respiratory muscles. When practicing, put your hands on the abdomen, the abdomen bulges when inhaling, and the abdomen drops when exhaling.
Bronchodilation exercises, including exhaling, singing, etc., these exercises can help open the airway and improve breathing.
Drug treatment
Antibiotics: Acute exacerbation of chronic obstructive pulmonary disease is mostly caused by infection. Acute exacerbation of chronic obstructive pulmonary disease accompanied by purulent sputum is an indication for the use of antibiotics. Initially, antibiotics should be empirically selected based on the common pathogens in the patient's area, and the drugs should be adjusted based on the results of bacterial culture and drug sensitivity tests.
Bronchodilation: Single inhalation of short-acting β2 receptor agonists, such as salbutamol and terbutaline, or combined inhalation of short-acting β2 receptor agonists and short-acting anticholinergics (such as ipratropium bromide) are the preferred bronchodilator options for patients with acute exacerbation of chronic obstructive pulmonary disease, which can effectively relieve patients' dyspnea. In the presence of oxygen supply facilities, it is best to inhale the nebulized liquid under the condition of an oxygen flow rate of 6 to 8L/min.
Theophylline drugs: For patients with more serious conditions, when the above-mentioned bronchodilators are ineffective, intravenous administration of theophylline drugs can be considered. In addition to bronchodilating effects, theophylline drugs can also increase cardiac output. However, the therapeutic concentration and toxic concentration of this type of drug are close, and overdose will produce serious cardiovascular and neurotoxicity. Serum theophylline concentration should be monitored when necessary.
Glucocorticoids: Inpatients with acute exacerbation of chronic obstructive pulmonary disease can use short-term oral or intravenous glucocorticoids on the basis of bronchodilators to accelerate the remission of the disease and shorten the length of hospital stay. However, the use of glucocorticoids can easily cause patients to have symptoms such as poor blood sugar control, weight gain, anxiety and insomnia, and should not be used for a long time. Nebulized glucocorticoids have fewer adverse reactions and can replace or partially replace systemic glucocorticoids.
Prevention
Quit smoking
Smoking is the main risk factor for COPD. Without removing the cause, it is difficult to achieve good results with drug treatment alone. Therefore, the key measure to prevent the occurrence and progression of COPD is to quit smoking.
Reduce occupational dust and chemical inhalation. For people who are exposed to occupational dust, such as coal mines, metal mines, cotton textile industry, chemical industry and some mechanical processing, labor protection should be done well.
Reduce indoor air pollution
Avoid burning biofuels in poorly ventilated spaces, such as burning wood for cooking, lighting a fire indoors for heating, passive smoking, etc.
Prevent and treat respiratory infections
Actively prevent and treat upper respiratory tract infections. Get a flu shot in autumn and winter; avoid crowded places; keep the air in the room fresh; actively treat upper respiratory tract infections.
Strengthen exercise
Choose a suitable exercise method according to your own situation, such as walking, jogging, swimming, climbing stairs, climbing mountains, doing Tai Chi, dancing, lifting a few pounds of weight with both hands, and exhaling when lifting.
Respiratory function exercise
An important goal in the treatment of COPD patients is to maintain good lung function. Only by maintaining good lung function can patients have better mobility and a good quality of life. Therefore, respiratory function exercise is very important. Patients can exercise their lung function by doing breathing yoga, breathing exercises, deep and slow abdominal resistance breathing exercises (with the help of Fei De Kang), singing, whistling, playing flutes, etc.
Cold tolerance exercise
Reduced cold tolerance can lead to repeated upper respiratory tract infections in COPD patients, so cold tolerance is also very important for COPD patients. Patients can wash their faces with cold water from the summer; insist on outdoor activities every day, etc. to exercise their cold tolerance.
