Whenever emphysema is mentioned, the image of an elderly person bending over and coughing constantly, having to stop and rest after going upstairs or climbing a slope because of tiredness and wheezing, comes to the mind of many people. Emphysema with chronic bronchitis is the most common disease of the respiratory system, which seriously affects the health of the general public because of the large number of people affected and the high death rate. In particular, every year patients face the risk of acute attacks, and each acute attack causes a further decline in lung function, which not only makes breathing difficult, but also makes walking very difficult, seriously affecting the quality of life of patients, while requiring hospitalization because of acute attacks, increasing the economic burden on both patients and families, as well as society!
At present, doctors and patients themselves in China attach importance to the control of the disease during the exacerbation of emphysema in laryngitis, but neglect the pulmonary rehabilitation during the remission period, so it is especially important to delay and control the further deterioration of pulmonary function during the remission period, improve respiratory function, and enhance patients’ ability to work and live. Today I mainly want to talk with the audience about how to prevent acute attacks of laryngitis emphysema.
1, first of all, to prevent colds: colds can often cause aggravation of the disease, so it is very important to prevent colds on a regular basis.
(1) the prevention of colds first of all, we should stay away from the crowd of colds, especially during the epidemic of colds, do not go to places where there are many people. To maintain a distance of more than 1 meter from the patient, when the patient coughs or sneezes, the saliva with virus can splash to about 1 meter away, when you find someone to sneeze or cough, you should immediately retreat to 1 meter away or turn around, because the human eyes and nose are the most easily infected. Secondly, you should wash your hands regularly. Some viruses can survive for 3 hours in the place touched by the patient’s hands.
(2) Even if you accidentally catch the flu, you should take active anti-flu treatment to prevent the spread of inflammation to the lower respiratory tract.
(3) In the season of high prevalence of influenza, make sure to pay attention to cold and warmth, pay attention to indoor ventilation, ensure adequate nutrition, ensure sleep, do not overexert yourself, you can take oxygen appropriately, maintain appropriate room temperature (12℃ or above), humidity (40% to 70%), and open windows and ventilation frequently to keep the air fresh.
2, pay attention to the weather forecast, according to the temperature appropriate increase or decrease clothing: early spring and autumn and winter is the high incidence of respiratory disease, cold and infection is very easy to damage human health, but also the most fear of patients with chronic bronchitis emphysema and other things. Although it is now a hot summer, sudden weather changes of sudden cold and hot, as well as inappropriate use of too cold air conditioning, can also cause acute attacks and aggravation of laryngitis emphysema. Therefore, it is important to pay attention to cold prevention and warmth according to the temperature change, choose appropriate clothes, reasonably adjust the room temperature, avoid getting cold and rain, and prevent the occurrence of diseases.
Reasonable adjustment of room temperature, often open the window now many families have purchased air conditioning, but doctors reminded that the indoor temperature in winter is not easy to too high, not too low in summer, otherwise the temperature difference with the outdoors, easy to catch a cold. It has been determined that the total number of bacteria per cubic meter of air can be as many as 9,000 to 15,000, far exceeding the national health standards, indoor ventilation is not often opened. Therefore, frequent indoor ventilation is an important measure to prevent the recurrence of chronic bronchitis and emphysema.
3, stop or reduce smoking: Chinese medicine has long recognized that “tobacco, with a long time is the lung anxiety, all drugs are ineffective”, that is, long-term smoking will cause lung disease, and then the application of drug therapy is difficult to work. I often have patients in the clinic tell me: “Doctor, I have been suffering from bronchitis and emphysema for many years, and no medicine has worked. As soon as I smoke, my cough is particularly strong and my sputum is particularly high.
I said, “Isn’t it easy? Quit smoking is the best treatment! 15%-20% of smokers develop severe chronic obstructive pulmonary disease. It is absolutely important to quit smoking! Especially when airway obstruction is mild or moderate, FEV1 increases mildly in smokers for a few years after quitting, and then changes are similar to those in non-smokers. Cough and sputum decrease within a few months after quitting. Quitting smoking does not restore impaired lung function, but it can delay the onset of exertional dyspnea and reduce the risk of acute exacerbation of COPD that can result in death.
In addition to tobacco, other harmful gases, smoke and gas inhalation can also trigger acute exacerbations of COPD, so it is beneficial to avoid and reduce the inhalation of other harmful gases, including the use of range hoods to reduce the smell of grease and smoke in the room. Especially if there are irritating gases in the work environment, it is best to change the environment, which can avoid continuing to cause aggravation of the disease.
4, keep the respiratory tract open: “phlegm, cough, wheezing” three basic clinical manifestations. Many patients may have coughing and wheezing due to unfavorable coughing and phlegm. Therefore, the treatment of these diseases must emphasize active sputum excretion and effective removal of respiratory secretions to keep the respiratory tract unobstructed in order to better improve symptoms and relieve the disease. How to achieve active sputum removal? Many scholars suggest that the four words “wet”, “turn”, “pat” and “cough” should be well grasped in practice In practice, it is recommended to promote sputum dilution, facilitate coughing out, and prevent alveolar atrophy and pulmonary atelectasis. Observe the sputum coughed up, if the color is yellow or green, it indicates bacterial infection, and oral antibiotics can be taken to prevent the infection from aggravating and causing acute attack.
In addition, for bronchospasm caused by excessive respiratory secretions, nebulized inhalation with aminophylline and β-agonists can release bronchospasm and calm asthma, while applying expectorant drugs to assist sputum discharge. Otherwise, the increase in the accumulation of sputum will cause airway obstruction inducing acute exacerbation. Steam inhalation can also be used to help dilute the sputum in the lungs. Nebulized inhalation of ipratropium and tranylcypromine also help to eliminate sputum.
5.Long-term home oxygen therapy (LTOT): For patients with emphysema with obvious hypoxia, continuous low-flow oxygen can be administered for more than 16 hours a day to relieve hypoxic small pulmonary artery constriction, reduce the burden on the heart, improve physical fitness and enhance exercise endurance. It has been shown that diaphragm fatigue exists in COPD patients and can lead to respiratory failure, and that diaphragm fatigue is also responsible for impaired lung function and shortness of breath in patients. People with particularly poor lung function (who feel shortness of breath even with oxygen) can also use non-invasive artificial ventilation, which can relieve shortness of breath in COPD patients, improve lung function, and increase the strength and endurance of respiratory muscles, especially the diaphragm, by the mechanism of resting the fatigued muscles (diaphragm). Oxygen therapy at night is not only easy for patients to accept, and can solve the night hypoxemia, reduce the COPD patients with sudden death rate at night.
6, the use of immune enhancers: regular injections of influenza vaccine, pneumonia vaccine to reduce respiratory infections An annual fall vaccination against influenza, every 5 to 6 years vaccination against streptococcus pneumoniae can reduce these two respiratory infections, in addition to intramuscular injection of BCG nucleic acid extract, grass branching bacillus, thymidine, etc.. You can also take some Chinese medicine with the support of the root, but also appropriate use of interferon or immunoglobulin, in order to improve the body’s ability to resist infection and prevent acute attacks of “old slow branch”.
7, learn to do breathing exercises: breathing gymnastics on muscle endurance and strength training, mainly abdominal breathing and lip reduction breathing. Abdominal breathing: the patient takes a standing or lying position, hands are placed on the forehead and abdomen, try to inhale through the nose, while holding the abdomen, exhale through the mouth, while closing the abdomen. This deep and slow abdominal breathing reduces the oxygen consumption of respiratory muscles, increases the amplitude of diaphragm movement and increases lung capacity.
Lip contraction breathing: Breathing will be like whistling lips contracted together, so that the exhaled gas through the narrowing of the mouth slowly exhaled, generally the time used to exhale longer than inhalation. As a result of delaying the speed of exhalation, increase the airway pressure, so that the peripheral small airways can not be trapped too quickly closed, conducive to alveolar emptying, increase the tidal volume and reduce the respiratory rate, and promote the exchange of oxygen and carbon dioxide in the lungs.
8, appropriate exercise exercise: emphysema patients should be able to exercise, strive to outdoor activities, can walk
The key is to do what you can, according to the place and the time, and not to over-exert yourself beyond your ability, otherwise you will increase your burden and cause hypoxia or even respiratory difficulties. Emphysema in the elderly is appropriate to carry out slow stair climbing, tai chi and other exercises. Practice has proved that where long-term adherence to rehabilitation exercises, the deterioration of lung function will be delayed, health status improved, life expectancy significantly longer than those who do not participate in exercise.
9, nutritional diet: many patients with progressive COPD have important but slowly progressive weight loss, some patients can become significantly cachexia, due to excessive weight loss so that the respiratory muscle strength is weakened. Pay attention to the intake of high protein, high vitamin diet. Eat more vitamin A containing foods such as carrots. Vitamin A can make the tracheal mucous membrane epithelial resistance, to prevent bacterial and viral infections and toxic stimuli have a certain role.
Eat more milk, eggs, lean meat, fish, soy products and other foods with high nutritional value. In winter, you can also eat some mutton, beef, etc. to play a warm tonic role. Eating edible mushrooms regularly can regulate immune function. For example, shiitake mushrooms and mushrooms contain mushroom polysaccharide and mushroom polysaccharide, which can enhance the body’s resistance. Drink more water to help dilute the phlegm and keep the airways open. Avoid eating stimulating food and fishy and oily seafood.
10, precautions: emphysema do not eat Valium Patients with emphysema often have varying degrees of insomnia, but we must emphasize that emphysema patients are not suitable for sedative drugs such as Valium, otherwise it will cause a series of malignant consequences that are difficult to remedy, especially severe cases can cause coma, sputum obstruction, and even respiratory failure. Commonly used sleeping drugs, such as Valium, produce sedation and hypnotic effects by inhibiting the central nervous system.
It also inhibits the respiratory center, causing the patient’s breathing to become shallow and less frequent, aggravating hypoxia and carbon dioxide retention. In addition, the respiratory function is already weakened during sleep, which undoubtedly adds to the progressive failure of the respiratory center and makes breathing more difficult, which may lead to respiratory arrest in severe cases. If you do have sleep problems, you can use drugs with fast onset, short maintenance time, and relatively small inhibitory effect on the central nervous system, which are relatively safe, such as chloral hydrate, Synthroid, or Zao Ren An Shen Capsules, etc.
11, COPD treatment misconceptions – the remission period also need drug therapy! The use of medication in remission is standardized to help reduce acute exacerbations. Many people will interrupt the continuation of treatment after a phase of treatment, thinking that as long as they do not have an attack, they are fine. In fact, in many patients with significant kicking and tiredness there is also chronic non-specific inflammation that persists in the body and is the underlying cause of their recurrent acute exacerbations. Therefore, even in remission, a combination of inhaled hormones and long-acting B2 agonists needs to be used regularly on a daily basis.
For example, salmeterol fluticasone, or a combination of formoterol budesonide. These drugs contain inhaled glucocorticoids, but it is a surface hormone, and after inhalation it is distributed in the lungs and in very small amounts elsewhere in the body, with minimal side effects, sometimes causing mouth ulcers and oral fungal infections, which can be avoided if you remember to rinse your mouth promptly after inhaling. According to the results of a recent international multicenter study, patients with COPD who inhaled salmeterol fluticasone for a long time had significantly reduced kick tiredness, improved quality of life, and the frequency of acute attacks in patients could be significantly reduced. Therefore, even if COPD is not exacerbated, it is still necessary to carry out standardized treatment according to the doctor’s recommendations.
In addition to the above-mentioned points, patients with more severe COPD should go to a regular hospital for examination and treatment when their condition worsens, and should not use antibiotics or drugs of unknown composition indiscriminately by themselves. The key to prevention is to follow the treatment of doctors in regular hospitals, use reasonable medication, change bad habits, stay away from dangerous environments, eat reasonably, exercise appropriately, and treat formally and reasonably.