How to diagnose and prevent chronic obstructive pulmonary disease?

Author: Cai Peng, Community Health Service Center, Zhangyan Town, Jinshan District, Shanghai

Public welfare science popularization support: Guangdong 21st Century Education Foundation

Chronic obstructive pulmonary disease (COPD) is a chronic chronic disease with airflow obstruction features and/or emphysema, which can progress to a common chronic condition of cor pulmonale and respiratory failure. It is related to the abnormal inflammatory response of harmful gases and harmful particles, and the disability rate and case fatality rate are very high, and the global incidence rate over 40 years old has been as high as 9% to 10%.

It is a common preventable and treatable condition characterized by persistent airflow limitation, which progressively develops and is associated with an increased chronic inflammatory response of the airways and lungs to toxic particles or gases.

COPD is a common and frequent disease among respiratory diseases, with high prevalence and mortality rates. In a 1992 survey of 102,230 rural adults in northern and central continental areas, the prevalence of COPD was 3%. According to the results of the newly released epidemiological survey of COPD in mainland China in 2018, the prevalence of COPD accounts for 13.7% of people over 40 years old.

In mainland China, COPD is the most common cause of chronic respiratory failure and chronic cor pulmonale, accounting for about 80% of all cases. Due to the progressive decline of lung function, the patient's labor force and quality of life are seriously affected. COPD poses a huge social and economic burden, and according to a study published by the World Bank/World Health Organization, COPD is expected to account for the fifth largest economic burden of disease in the world by 2023.

The main cause of COPD

The exact cause of COPD is unknown, but it is thought that factors involved in the development of both chronic bronchial and obstructive pulmonary emphysema may be involved in the development of COPD. The risk factors that have been identified can be broadly divided into two categories: external (i.e., environmental factors) and internal (i.e., individual predisposing factors). External factors include smoking, dust and chemical inhalation, air pollution, respiratory infections, and people of lower socioeconomic status (which may be related to indoor and outdoor air pollution, crowded living rooms, poor nutrition, and other factors associated with lower socioeconomic status). Internal causes include genetic factors, increased airway responsiveness, and poor lung development or growth due to various causes during pregnancy, neonatal period, infancy, or childhood.

COPD is more common in the elderly, especially those with underlying diseases, such as emphysema, old and chronic artery, etc., who have been exposed to chemical smoke or dust for a long time, such as exposure to chemical smoke or dust, and such patients are also prone to the disease, and patients who have been smoking secondhand smoke for a long time are more likely to develop the disease than healthy patients.

Risk factors include smoking, occupational dust and chemicals, environmental tobacco inhalation (passive smoking), and indoor/outdoor air pollution, non-modifiable factors include lung growth and development, and genetics, and adjustable factors include nutrition, infection, and socioeconomic factors.

Symptoms of the disease

Chronic cough is often the earliest symptom of COPD, and it can not heal for life as the disease progresses, often with obvious cough in the morning and cough or expectoration at night. When the airway is severely obstructed, there is usually only dyspnea without coughing.

The sputum is generally white mucus or serous foamy sputum, occasionally blood-streaked, and there is more expectoration in the morning. During acute attacks, sputum volume is increased and purulent sputum may be present.

Shortness of breath or dyspnea, the main symptom of COPD, which begins with exertion and gradually worsens, leads to shortness of breath in daily life and even at rest. However, due to individual differences, some people can tolerate it.

Wheezing and chest tightness may occur in some patients, particularly in severe cases or in acute exacerbations.

Other fatigue, weight loss, and anxiety often occur in severe COPD but are not typical of COPD.

From the point of view of physical signs, first, the anterior and posterior diameter of the thoracic cage is enlarged, the intercostal space is widened, and the substernal angle under the xiphoid process is widened, which is called barrel chest. Second, bilateral tremor is diminished on palpation. Thirdly, percussion of the lungs is too clear, the dullness of the heart is reduced, and the lower border of the lungs and the dullness of the liver are reduced. Fourth, auscultation of both lungs with decreased breath sounds and prolonged expiratory breath may be heard, and wet and/or dry rales may be heard in some patients.

Diagnostic criteria and treatment of COPD

Patients with COPD can be tested by pulmonary function tests, chest x-rays, chest CT scans, blood gas tests, and other tests.

A diagnosis of COPD should be considered in patients with chronic cough, sputum production, progressively worsening dyspnea, and exposure to COPD risk factors (even in the absence of dyspnea). Diagnosis requires pulmonary function tests, and after bronchodilator use FEV1/FVC

Specifically, COPD pulmonary function classes include:

Grade I (mild) FEV1≥80% predicted

II.级(中度)50%≤FEV1

III.级(重度)30%≤FEV1

Grade IV (very severe) FEV1

In terms of treatment, first, stable treatment, non-pharmacological treatments can be used: smoking cessation, exercise or pulmonary rehabilitation, influenza and pneumonia vaccination.

Second, rehabilitation treatment, such as physiotherapy and hyperbaric negative ion oxygen therapy, is beneficial to the rehabilitation of pulmonary function in COPD patients.

Third, psychological adjustment: a good mood will help patients to face the disease positively, increase their compliance with treatment, and help to establish good interpersonal relationships, which will be more conducive to the recovery of the disease.

Fourth, adjust your diet, eat more fruits and vegetables, you can eat meat, fish, eggs, milk, beans, buckwheat. Talk less when eating, breathe harder, and eat more slowly. The fat should lose weight, and the thin should strengthen nutrition, eat small and frequent meals.

Fifth, long-term home oxygen therapy, if there is respiratory failure, long-term low-flow oxygen is recommended for more than 15 hours a day.

Sixth, pharmacotherapyExisting drug therapy can reduce or eliminate the patient's symptoms, improve activity tolerance, and reduce the number and severity of exacerbations to improve health. Inhalation therapy is the first choice, and educating patients on the proper use of various inhalers and explaining the purpose and effects of treatment to patients can help patients adhere to treatment.

Seventh, the treatment of acute exacerbations requires mechanical ventilation.

How to prevent it

It should not be ignored that COPD can be prevented by:

First, quit smoking: Smoking is a major risk factor for COPD, and it is difficult to achieve good results with medication alone without removing the cause. Therefore, the key measure to stop the onset and progression of COPD is to quit smoking. Reduce the inhalation of occupational dust and chemical substances, and do a good job of labor protection for people who are engaged in exposure to occupational dust, such as coal mines, metal mines, cotton textile industry, chemical industry and some mechanical processing workers.

Second, reduce indoor air pollution and avoid burning biofuels in poorly ventilated spaces, such as firewood for cooking, indoor fires for heating, and passive smoking.

Third, it is necessary to prevent and treat respiratory tract infections and to actively prevent and treat upper respiratory tract infections. Get the flu vaccine in autumn and winter, avoid crowded places, keep the air in the room fresh, and treat upper respiratory tract infections aggressively.

Fourth, strengthen exercise: choose the exercise method that suits you according to your own situation, such as walking, jogging, swimming, climbing stairs, climbing, tai chi, dancing, lifting a few pounds of things with both hands, and exhaling when lifting.

Fifth, respiratory function exercise, an important goal in the treatment of COPD patients is to maintain good lung function, and only by maintaining good lung function can patients have better mobility and good quality of life. Therefore, respiratory exercises are very important. Patients can do breathing yoga, breathing exercises, deep and slow abdominal resistance breathing exercises (with the help of lung health), singing, whistling, flute, etc.

Sixth, the reduction of cold tolerance can lead to recurrent upper respiratory tract infections in COPD patients, so cold tolerance is also important for COPD patients. Patients can exercise their ability to tolerate cold by washing their faces with cold water starting in the summer and continuing to do outdoor activities every day.

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