The mention of "old slow branch" must be well-known, it is a high incidence of respiratory diseases in our daily life, with the characteristics of prolonged course and easy recurrence. Seasonal changes are an important trigger for chronic bronchitis in the elderly, and spring is the high incidence season of the old slow branches.
Case review
Case 1
Xu Moumou, male, 81 years old, because of "asthma for more than 30 years, aggravated by 1 day" on March 30, he urgently called 120 to our department for treatment. The patient has been smoking for more than 30 years and has been slow for more than 30 years.
At presentation, the patient was confused and uncooperative on physical examination, and T 36.0 °C, P 112 times/min, R 22 times/min, BP 132/54mmHg, SpO265% were measured.
Patients were given immediately noninvasive ventilators to assist breathing, established intravenous channels, monitored by ECG, and blood gas analysis, but the patient's symptoms of hypoxia did not improve. The patient is immediately given a tracheal intubation and ventilator to assist breathing, and after 1 minute, SpO2 rises to more than 90%.
After 5 minutes, the patient's heart stopped, and CPR was immediately given for rescue, and the patient died of ineffective rescue.
Case 2
Wu Moumou, male, 82 years old, came to the emergency department of our hospital on April 5 due to "repeated cough, sputum cough, asthma for more than 10 years, aggravated for 3 days". The patient has been smoking for more than 20 years and has been slow for more than 20 years. The patient's vital signs were T 36.2 °C, P 110 times/min, R 20 times/min, BP 168/82mmHg, SpO270%.
Immediately establish an intravenous channel, mask oxygen (oxygen flow 4 to 6 L/ min), ECG monitoring, blood gas analysis, after a few minutes, the patient's asthma symptoms did not improve, immediately switch to non-invasive ventilator to assist breathing.
After 1 minute, the patient's oxygen saturation increased from 70% to more than 95%, and then contacted the respiratory medicine department for consultation and assistance in hospitalization procedures.
From the above, it can be seen that the old slow branch is not like some elderly people think - just the old problem, as long as you pay more attention to keep warm, take some cough medicine can be. Patients with chronic branches of the elderly who have been onset for more than 5 years have a higher risk factor of concurrent emphysema, and those lasting 10 years may cause cor pulmonale. These diseases are fatal, so we must pay attention to them. Next, let's take a look.
Knowledge Links
Chronic bronchitis, referred to as chronic bronchitis, is a chronic, nonspecific inflammation of the trachea, bronchial mucosa, and surrounding tissues. Clinically, cough, sputum production as the main symptoms, or wheezing, the onset lasts for 3 months or more each year, and the continuous ≥ 2 years.
Usually, the cause of the disease is related to smoking, persistent recurrent infections of viruses and bacteria, air pollution, and chronic irritation from smoke and dust.
1. Clinical manifestations
(1) Cough
The cough is heavier in the morning, lighter during the day, and more pronounced at night in the late stages, and there are often coughing attacks before going to bed, and there is a cough of sputum.
(2) Cough up sputum
Early morning sputum is more excreted, generally white mucus or serous foam sputum, occasionally with blood.
(3) Shortness of breath and wheezing
As the course of the disease progresses with obstructive emphysema, shortness of breath of varying severity gradually occurs, with activity being the most severe.
Chronic bronchitis with asthma may have bronchospasm, which can cause wheezing, usually with wheezing.
2. Clinical classification
(1) Simple type
Lesions are mainly in the airways. Patients present with cough, sputum production, no dyspnea, wheezing, hypoxemia, and carbon dioxide retention, with little lung function impairment, and are more common in adult men.
(2) Wheezing type
On the basis of chronic cough and sputum production, accompanied by episodic bronchospasm, bronchial wall edema, and increased mucus secretion. This type is more common in older smokers.
(3) Blocking type
The narrow parts are mostly in the small airways, and the pathological changes such as chronic inflammation, fibrosis, goblet cell hyperplasia, and smooth muscle hypertrophy are prominent, and the lung function is progressively impaired, often accompanied by hypoxemia and hypercapnia, which are easy to be complicated by emphysema and pulmonary heart disease, which are rare but serious.
3. First aid and care when the patient has asthma and causes extremely low oxygen saturation
(1) Keep the respiratory tract unobstructed
Prompt removal of sputum. Encourage awake patients to cough up sputum vigorously, for patients with viscous sputum, strengthen atomization and dilution of sputum, and regularly assist people with weak cough to turn over and pat their backs to promote sputum discharge. Mechanical suction is possible in comatose patients to keep the airway open.
(2) Improve ventilation
Oxygen therapy: according to the patient's blood gas analysis, patients with type I respiratory failure can intermittently receive high concentration (50%) high-flow (4-6 L/min) oxygen for a short period of time; patients with type II respiratory failure should be given low-concentration (25% to 29%) low-flow (1-2 L/min) nasal cannula for continuous oxygenation, so as not to cause respiratory center depression caused by rapid correction of hypoxia.
Mechanical ventilation: noninvasive or invasive ventilator-assisted ventilation therapy is given depending on the patient's condition. Do a good job in the care of airways and pipelines, and timely review blood gas analysis to observe the treatment effect.
In order to alleviate the symptoms of chronic bronchitis and avoid the continuous progression and deterioration of the disease, it is crucial to do a good job of home care for patients, and patients and family members need to pay special attention to the following aspects:
Home care
1. Quit smoking
Smoking can lead to severe damage to the bronchial epithelium and cilia shedding in the human body, and lead to a decrease in lung function, especially in patients with old chronic branches acute attacks.
2. Adhere to scientific exercise
During the change of seasons, the old and slow branches are prone to high incidence, and patients need to adhere to scientific exercise. There are mainly jogging, tai chi, brisk walking or breathing exercises.
3. Abdominal breathing exercises
It is a more scientific auxiliary sputum coughing method, which is simple and easy to learn. Patients practice two to three times a day, each time about ten minutes, can help maintain good respiratory tract patency and improve lung capacity, can reduce the onset of chronic bronchitis disease.
4. Long-term oxygen therapy
For patients with older slow branches with hypoxemia, oxygen intake for 15 hours or more per day can help alleviate the degree of the disease and inhibit the persistent deterioration of lung function.
5. Improve the living environment
Avoid soot pollution indoors, and regularly open windows for ventilation to maintain indoor air freshness. The indoor temperature and humidity are reasonably adjusted, the temperature can be controlled at about 16 ~ 22 ° C, and the relative humidity can be controlled at 45%.
6. Strengthen nutritional supplementation
In the daily diet of patients with old and slow branches, they can eat more lean meat, fish, milk and eggs to supplement high-quality protein, eat more fresh vegetables and fruits, and eat soft and tender foods as much as possible.
7. Self-psychological regulation
Due to the long course of the old slow branch disease, patients are prone to negative emotions. Therefore, on the one hand, it is encouraged for patients with old slow support to do a good job of self-psychological adjustment, on the other hand, it is recommended that patients' families pay more attention to patients, and inform them to seek medical help in time for old slow branch patients with severe depression.
bibliography:
Fan Yuhong, Wang Jingyi, Liu Dandan, et al. The role of observation system health education in the care of chronic bronchitis[J]. Diet and Health Care,2020,7(4):241-242.
[2] Punam Pahwa, Masud Rana, Khalid Amin, etal. Incidence and Longitudinal Changes in Prevalence of Chronic Bronchitis in Farm and Non-Farm Rural Residents of Saskatchewan[J]. Journal of Occupational and Environmental Medicine, 2019, 61(4): 1-1.
About the Author
Article author: Yang Xingzhi
Author Affilications:Liaocheng Second People's Hospital
The final interpretation of this article belongs to the author