General Knowledge Chronic obstructive pulmonary disease (COPD for short) is what we usually call chronic bronchitis and emphysema. It is a common, frequent, high disability and high death rate chronic respiratory disease, the prevalence rate in China over 40 years old is up to 8.2%, smokers up to 13.2%, there are 40 million in China, and 1 million deaths every year. It has become the fourth largest killer of death in China’s urban population, and is also known as the silent killer because it is not taken seriously and not diagnosed by patients for a long time. It is a chronic inflammatory airway disease that can be prevented and treated, and the disease progression is accompanied by incomplete reversible airflow limitation. The pathology of airflow limitation is based on an abnormal inflammatory response of the airways to different noxious particles and gas stimuli. The systemic effects on the whole body cannot be ignored. Smoking is the most important risk factor for COPD, exposure to occupational dust and chemicals, indoor air pollution, outdoor air pollution, passive smoking, and respiratory tract in early childhood are important risk factors for the development of COPD. The diagnosis of COPD should be considered in anyone with a history of exposure to the following characteristic diseases and disease risk factors: chronic cough, coughing or with dyspnea, or with the following risk factors: smoking, occupational dusts and chemicals, history of exposure to fumes from household cooking and heating fuels, air pollution, etc. People with a family history of COPD, a history of allergies, airway hyperreactivity or asthma, a history of prematurity and recurrent airway lung infections in early childhood, a low standard of living, smoking, and a history of occupational exposure to harmful substances are all susceptible or at high risk for COPD. Pulmonary function tests are needed to clarify the diagnosis and to grade the severity of the disease. COPD manifestations Patients may have symptoms such as cough, sputum and shortness of breath during activity. The disease usually starts in middle age and progresses slowly. Diseases that need to be differentiated include bronchial asthma, bronchiectasis, tuberculosis, occlusive bronchitis, panbronchitis and congestive heart failure. Once you develop some of the symptoms of COPD or have a history of smoking or other risk factors, you should seek the help of your doctor and have a pulmonary function test to determine if you have COPD. Smoking is the most important risk factor for COPD. Smoking cessation is the single most effective and best-economized intervention. Patients of any age or smoking age can effectively slow the rate of FEV1 decline and disease progression after quitting, both by reducing the risk of developing COPD and, for patients already diagnosed with COPD, by slowing the progression of the disease. Smokers should actively give up smoking or quit with the help of a physician, and the success rate of quitting smoking under the guidance of a physician is significantly higher. Stable phase treatment: Comprehensive prevention and treatment measures should be taken, including smoking cessation nucleus to avoid pathogenic factors, medication, rehabilitation exercises, nutritional support, home oxygen therapy, psychotherapy, and surgical treatment of the lung. Bronchodilators are the main measures to relieve COPD symptoms, including β2 agonists and cholinergic receptor blockers, theophylline analogs, and inhalation therapy is preferred. Mild COPD can be treated with bronchodilators on demand, while moderate and severe COPD require the regular application of a bronchodilator, such as anticholinergics, long-acting β2 agonists or theophyllines, or a combination of the above-mentioned bronchodilators. Long-term inhaled glucocorticosteroids are indicated for patients with symptomatic COPD who have improved pulmonary function or increased airway responsiveness after experimental inhalation therapy. In symptomatic COPD patients with FEV1 < 50% of predicted values and recurrent exacerbations, adding conventional inhaled hormones to treatment with bronchodilators may reduce the frequency of exacerbations and improve the patient's health status. Acute exacerbation of COPD is defined as an acute worsening of dyspnea, cough and sputum symptoms at baseline level in COPD patients. Most acute exacerbations are due to respiratory infections or aggravation of air pollution. Treatment includes the application of bronchodilators, glucocorticoids (short-term systemic use), antibiotics, and oxygen therapy (or) mechanical ventilation therapy. Self-care Quit smoking and try to eliminate or reduce the exposure to various risk factors in the workplace or in the living environment. Adhere to appropriate sports, such as brisk walking, tai chi, breathing exercises, etc. The time, method and place of exercise will vary from person to person. Diet should be diversified, three meals a day with carbohydrates, lipids, high quality protein, fresh vegetables and fruits are essential. Special medical advice Influenza vaccine should be given once (in autumn) or twice a year (autumn and winter), which can reduce severe morbidity and mortality of COPD patients by 50%. Some immunomodulators such as thymidine or BCG polysaccharide nucleic acid, oral polyvalent bacterial vaccine can improve the immunity of the body and reduce the number of acute COPD attacks and hospitalization rates. Long-term oxygen therapy (>15 hours/day) can increase mobility, mental status and survival time in patients with chronic respiratory failure. Low-flow (1-2 l/min) oxygenation is required. Precautions Adhere to regular medical appointments and adopt an aggressive treatment attitude. There are two undesirable attitudes toward disease treatment. One of them is that COPD is a chronic disease, so they do not pay attention to it and only seek medical treatment when there is an acute exacerbation; the other is that they are eager to find a panacea that can “cure” the disease by all means. The treatment of COPD needs to be planned and comprehensive long-term treatment to reduce symptoms, prevent deterioration, reduce acute exacerbations and improve the quality of life. Master the proper inhaler administration technique. Avoid long-term use of systemic (oral or injectable) glucocorticoids to prevent their serious side effects, such as: osteoporosis, hypertension, diabetes, obesity, ulcer disease, osteonecrosis and hypokalemia. Brief use during acute exacerbations is beneficial for disease recovery. Monitor for changes in symptoms and pulmonary function. In patients with moderate to severe COPD, in addition to lung function measurement, bronchodilator test, chest X-ray and arterial blood gas analysis should be checked to select different treatment plans according to different conditions. Respiratory rehabilitation therapy (including exercise training, nutritional guidance, and education) can reduce symptoms, improve quality of life, and increase the ability to participate in daily activities. For some patients with severe COPD, pneumonectomy and lung transplantation may be effective.