Healthy Breathing helps you understand COPD-Health Home-Northern Network

Healthy Breathing helps you understand COPD-Health Home-Northern Network

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COPD, the full name is chronic obstructive pulmonary disease, is a common, preventable and treatable chronic respiratory disease, characterized by persistent irreversible airflow limitation. After suffering from this disease, patients may develop Symptoms such as chronic cough, sputum production, shortness of breath or difficulty breathing, wheezing and chest tightness. In other words, the lung function damage of patients diagnosed with COPD persists and is difficult to return to normal.

Why does COPD occur?

The main causes of COPD include smoking, air pollution, occupational dust exposure, and inhalation of second-hand smoke. Among them, smoking is the most important environmental pathogenic factor. Chemicals such as nicotine, tar and hydrocyanic acid in tobacco can directly or indirectly damage our airway epithelium, leading to a decrease in airway purification ability and an increase in mucus secretion, which are the most common causes of cough. , expectoration, “gas” and other manifestations are the culprit.

Factors such as long-term exposure to occupational dust and chemicals, long-term irritation from oil fume and second-hand smoke, and air pollution can also damage the airway mucosal epithelium, reduce the function of cilia in clearing mucus, accumulate airway mucus, and reduce alveolar elasticity and other lung injuries, which are caused by viruses. , mycoplasma, bacteria and other infections increase conditions.

Other physical factors such as immune disorders, autonomic nervous system dysfunction, aging, and environmental factors such as climate change are closely related to the occurrence and development of COPD. For example, the elderly are more prone to recurrent respiratory infections due to adrenal insufficiency, reduced autoimmunity, slow metabolism and other reasons. Cold air will stimulate the contraction of human airway mucosal blood vessels and pulmonary blood vessels, causing local blood circulation to be poor, which is conducive to secondary infection.

I am constantly “gasping”. Do I have chronic obstructive pulmonary disease?

If we want to know whether we have COPD, we can judge based on symptoms, signs and related examinations.

Symptoms and signs:

Patients with COPD have a slow onset and a long course of disease. They may have persistent chronic cough. They often have obvious coughing and sputum production in the morning, and usually a large amount of sputum is produced. Generally, it is white mucus sputum or a combination of yellow and white sputum, and wheezing and shortness of breath. , dyspnea is a typical symptom of COPD. Physical signs will also gradually change, with the anteroposterior diameter of the thorax increasing, the intercostal space widening, and the inferior sternal angle under the xiphoid process widening. Presenting “barrel chest”.

In addition, if you want to know whether you have COPD, you can also use the modified version of the British Medical Research Council Dyspnea Questionnaire (MMRC Questionnaire) to evaluate the degree of dyspnea, and use the COPD Assessment Text (CAT) questionnaire to conduct self-assessment. .

 Related checks:

There are many examination methods for diagnosing COPD, the most important of which is pulmonary function examination. Pulmonary function tests are the “gold standard” for diagnosing COPD. Among them, two indicators are the most important. One is FEV1, which refers to the volume of air exhaled in the first second after the maximum inhalation. For a normal non-smoking man, after the age of 30, FEV1 decreases by 30 ml per year. Dyspnea occurs when FEV1<2 liters (50% of normal value), and becomes severe when FEV1 drops to 1 liter. Another indicator is forced vital capacity (FVC). Under normal circumstances, FEV1/FVC>0.7. In patients with COPD, FEV1/FVC<0.7 indicates persistent airflow limitation.

Chest X-ray examination, also called chest DR examination, is one of the means to identify whether patients with COPD have common complications such as spontaneous pneumothorax and pulmonary infection. Chest CT examination has a higher resolution than chest DR examination and can more clearly see small airway lesions, manifestations of emphysema and complications. Clinically, it is often used to distinguish COPD from other cumulative respiratory diseases such as bronchiectasis, tuberculosis, lung cancer, pulmonary fibrosis, diffuse panbronchiolitis, etc., which all have symptoms such as cough, phlegm, and wheezing.Other examinations, such as blood gas analysis, are of great value to determine hypoxemia, hypercapnia, acid-base balance imbalance and the type of respiratory failure in patients with COPD; when COPD is complicated by bacterial infection, blood routine + C-reactive protein Examination often shows changes such as increased white blood cell count, leftward nuclear shift, and elevated C-reactive protein levels.[1].

In life, how can I protect my “lungs” and prevent COPD?

Early detection, early diagnosis, regular monitoring and long-term management of COPD patients and potential high-risk groups can alleviate patients’ respiratory symptoms and reduce the probability of acute exacerbation of the disease. This can significantly improve the quality of life of patients and effectively reduce the burden of the country and patients. Disease burden.

Enhance the awareness of “healthy breathing”, quit smoking, actively understand the pathophysiology and clinical basics of COPD, eliminate exposure to risk factors, and understand that prevention is better than cure; patients who have already experienced COPD-related clinical manifestations must understand long-term regular use The importance of medicines, insist on taking medicines and use inhaled medicines correctly; master the skills to relieve dyspnea, do not “show off”, exercise moderately, strengthen nutrition and rest, standardize training, and enhance lung function; pay attention to your own health and understand the timing of hospital treatment wait.

If I have COPD, can I stop taking hormones?

The answer is “yes”. In addition to inhaled corticosteroids (ICS), bronchodilators are also the main therapeutic drugs used in modern medicine to treat stable COPD. Compared with oral drugs, inhaled preparations have the advantages of small dosage and concentrated action (mostly on the respiratory tract and lungs), and their efficacy and safety are also more reliable. Therefore, inhaled medication is often the first choice for the treatment of COPD. And based on the role of the drug and the patient’s treatment response, combined medication is often used to better improve the patient’s lung function and health effects without increasing adverse reactions.

The current guidelines recommend the use of combination drugs as follows: low-dose theophylline + short-acting β2-receptor agonist, which has a better effect on improving lung function and dyspnea symptoms than single use; long-acting β2-receptor agonist, referred to as LABA has a longer action time and can last for more than 12 hours. It is often used for long-term maintenance treatment of patients with obvious airflow limitation, such as “old-brand” LABA such as salmeterol and formoterol, and indacaterol and odacaterol that have appeared in recent years. “Rookie” LABAs such as Terol have a faster onset and longer duration of action. Studies have found that LABA is safer in the treatment of COPD combined with cardiovascular diseases; long-acting anticholinergic drugs, such as glycopyrrolate Ammonium bromide, umeclidinium bromide, etc. are better than LABA in reducing acute exacerbations of COPD and patient hospitalization rates. Long-term use can improve patient symptoms and overall health status, and can significantly improve early asymptomatic or mildly symptomatic COPD. The lung function of lung patients is of great value to the prevention and treatment of COPD. The current clinical use of ICS is also very cautious. Usually, steroid therapy alone is not recommended for patients with stable COPD. On the basis of using one or two long-acting bronchodilators, the patient’s symptoms or lung function will not improve well. Consider adding inhaled ICS therapy.And currently on the market, common Symbicort (budesonide/formoterol), Qilchang (beclomethasone/formoterol), etc. are all forms of glucocorticoids combined with bronchodilators.[2].

Does Chinese medicine treat COPD?

From the perspective of traditional Chinese medicine, COPD falls into the category of lung distension. It is a disease syndrome in which various chronic lung diseases recur repeatedly without recovery, causing lung qi to become full and unable to be reduced. The main clinical manifestations are wheezing and shortness of breath, coughing and sputum, chest distension, chest tightness, or bluish lips and nails, palpitations and edema, and even asthma and coma. Characteristic manifestations include wheezing, coughing, phlegm, and distension.

The causes of lung distension usually include a long-term history of chronic wheezing and coughing, which leads to chronic lung deficiency and phlegm and blood stasis. The disease is often exacerbated by repeated exposure to external evils, especially cold evils, overwork, rage, and heat. This disease can be induced. The age of onset of pulmonary distension is mostly in the elderly, and is rare in young and middle-aged people.

The pathological factors of lung distension in traditional Chinese medicine include phlegm, water retention, and blood stasis, which interact with each other and are common in the same disease. In the diseased area, lung qi is stagnant, the spleen is not healthy, body fluids are not normalized, and phlegm is produced. Gradually, due to lung deficiency, fluid cannot be distributed, spleen deficiency cannot be transferred, kidney deficiency cannot be steamed, phlegm retention becomes more serious, and wheezing and coughing persist. . As time goes by, Yang is deficient and Yin is excessive, Qi does not transform into fluid, and phlegm turns from Yin into water. Drinking water compresses the lungs, restricts the heart, and traps the spleen. Coughing, palpitation, shortness of breath, decreased appetite, and nausea can be seen. Over time, it affects the movement of Qi and blood, causing blood stasis to accumulate under the ribs. The three factors of phlegm, water retention, and blood stasis can interact and transform each other, eventually forming the pathogenesis characteristics of deficiency in origin and excess in the lungs. In the acute stage of lung distension, excess in origin is the most urgent, while deficiency is the main factor in normal times. In the early stage of the disease, deficiency is the main factor. The lungs, spleen, and kidneys are mostly qi deficiency and qi-yin deficiency. In the late stage, the lungs, kidneys, and heart are the main symptoms. Qi deficiency damages yang, resulting in yang deficiency or both yin and yang deficiency. Pure yin deficiency is rare.

What Chinese medicine treatments are suitable for COPD?

Dialectical treatment with traditional Chinese medicine

According to the typical manifestations of lung distension: wheezing, coughing, phlegm, and distension, the individual differences of different lung distension patients can be treated dialectically.

If the patient has symptoms of cough, shortness of breath, chest distension, difficulty lying down, white phlegm, thin and abundant phlegm due to external cold and internal drinking, the treatment should be to warm the lungs and dispel cold, reduce phlegm and eliminate phlegm, and then take Xiaoqinglong Decoction. ; If the main symptoms are cough with excessive phlegm, loss of appetite, fatigue, expectoration with thick and white phlegm, etc., the treatment is to resolve phlegm and lower qi, strengthen the spleen and replenish qi, and take Suzi Jiangqi Decoction combined with Sanzi. Add or subtract Yangqin Decoction; if the main symptoms of phlegm-heat stagnation in the lungs are cough, shortness of breath, thick white or yellow phlegm, fullness and irritability in the chest, body heat, sweating, dry stools, or secret knots, the treatment is to clear the lungs and purge heat. , reduce phlegm and relieve asthma, take modified Sangbaipi Decoction; if the patient has worsening cough and asthma, apathetic expression, lethargy and other mental changes, it is a critical symptom. Traditional Chinese medicine treatment is to use Ditan Decoction to clear phlegm and resuscitation, combined with Angong Niuhuang Pill or Zhibao Dan to remove phlegm. Phlegm awakens the mind and rejuvenates the mind. When possible, cooperate with Western medicine first-aid measures such as phlegm elimination, oxygen inhalation, breathing and ECG monitoring. In the later stage of the disease, when the syndrome of phlegm and blood stasis blocking the lungs shows symptoms such as cough with phlegm, fullness and tightness in the chest, difficulty breathing, cyanosis of the lips and other symptoms, Tingli Dazao Xiefei Decoction combined with Guizhi Fuling Pills can be used to remove phlegm and remove blood stasis, purge the lungs and relieve asthma; if there is edema, , swelling of the lower limbs or swelling of the whole body is the main syndrome of Yang deficiency and water, the treatment is to warm Yang, drink and dilute water, and take Zhenwu Decoction. If you have shallow breathing, low cough, weakness in speech, palpitation, poor appetite, you may spontaneously The main symptoms of lung, spleen and kidney deficiency are sweating, fear of wind, abdominal distension and loose stools. The treatment is to nourish the lungs, strengthen the spleen and kidneys, lower qi and relieve asthma. The prescription is Bufei Decoction combined with Shenha Powder or Liujunzi Decoction combined with Yupingfeng Powder.

Traditional Chinese Medicine Rehabilitation Treatment

Usually suitable for the remission period of lung distension, pulmonary rehabilitation refers to the use of non-drug treatment, using traditional Chinese medicine rehabilitation programs such as acupuncture, moxibustion, Baduanjin, tuna and massage.A large number of clinical studies have shown that appropriate pulmonary rehabilitation treatment can indeed improve patients’ symptoms, quality of life and exercise tolerance. The humanistic care shown during the treatment process has a certain effect on alleviating the anxiety and depression of COPD patients.[3].

Traditional Chinese Medicine Dietary Care

For patients with lung distension, the diet structure can also be adjusted according to the corresponding physical constitution. People with physical weakness should strengthen their diet and nutrition. Those with lung qi deficiency should avoid eating cold and cold foods, and should increase the amount of food that warms and nourish lung qi, such as mutton, yams, etc.; those with spleen deficiency should avoid eating raw, cold, fat, sweet and greasy foods, and can choose jujubes. , japonica rice and other foods that replenish qi, strengthen the spleen and replenish blood; those with kidney deficiency should avoid eating hot and cold foods such as spicy, raw and cold foods, and seafood. You can choose nourishing foods such as black rice, sesame, wolfberry, and mutton.At the same time, if you can maintain an optimistic and cheerful mood and view the disease correctly and objectively, it will not only help you live a colorful life, but also help the human body improve immunity and improve the condition.[4]!

The prevention, management and treatment of COPD require the joint participation of doctors and patients. The publicity and guidance of medical staff and the attention and cooperation of relevant people on healthy breathing, actively correcting bad living habits and developing a healthy and good lifestyle are ” Get a handle on COPD and protect healthy breathing. (Guo Sijia, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Tianjin University of Chinese Medicine)

references:

  [1]Ge Junbo, Xu Yongjian, Wang Chen, Internal Medicine. Respiratory Diseases[M].9th edition. Beijing: People’s Medical Publishing House: 19-27

  [2]Guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (2021 revised edition)[J].Chinese Journal of Tuberculosis and Respiratory Medicine, 2021, 44(3): 170-205

  [3]Lai Xue, Study on the effects of early TCM pulmonary rehabilitation on exercise tolerance, anxiety and depression in patients with acute exacerbation of chronic obstructive pulmonary disease. Beijing, Wangjing Hospital, Chinese Academy of Chinese Medical Sciences, 2021-10-06.

China Association of Traditional Chinese Medicine. Guidelines for Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease by Integrated Traditional Chinese and Western Medicine (2022 Edition)[J].Chinese Journal of Evidence-Based Medicine, 2023,23(10):1117-1128

  [4]Zhang Boli, Wu Mianhua, Internal Medicine of Traditional Chinese Medicine. Pulmonary Disease Syndrome[M].Tenth Edition. Beijing: China Traditional Chinese Medicine Press, National “13th Five-Year Plan” Textbook for Higher Education in the Traditional Chinese Medicine Industry 2017.8 (Reprinted in 201911): 75-80



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