inflammation of the lungs



Overview

What is Pneumonia?

Definition.

Pneumonia refers to inflammation of the terminal airways, alveoli, and interstitium.

It can be caused by pathogenic microorganisms, physicochemical factors, immune injury, allergies, and medications.

Symptoms are highly variable and can be mild or severe, depending on the cause and physical status.

Classification

It is decisive for the choice of treatment.

Pneumonia caused by infectious factors: it can be categorized into bacterial pneumonia, pneumonia caused by atypical pathogens, viral pneumonia, pulmonary fungal disease, and pneumonia caused by other pathogens.

Non-infectious factors: such as radiation pneumonia, chemical pneumonia, lipoid pneumonia. Pneumonia as it is commonly referred to generally excludes this part of pneumonia.

It can assist in the diagnosis and treatment of pneumonia and has been widely used in clinical practice.

Community-acquired pneumonia: Inflammation of the infected lung parenchyma (including the alveolar walls, i.e., the interstitium in a broader sense) that occurs outside the hospital, including pneumonia that develops during the incubation period after admission to the hospital for pathogenic infections with a defined incubation period.

Hospital-acquired pneumonia: also known as hospital-acquired pneumonia, refers to new pneumonia that occurs in the hospital after ≥48 hours of admission when the patient has not received invasive mechanical ventilation during hospitalization, is not in the incubation period of a pathogenic infection, and is not in the incubation period of a pathogenic infection.

Lobar pneumonia: also known as alveolar pneumonia, in which the pathogen first causes inflammation in the alveoli and spreads to other alveoli, causing inflammation in part or all of the lung, usually without spreading to the bronchi.

Lobular pneumonia: also known as bronchopneumonia, the pathogen invades through the bronchi, causing inflammation of the fine bronchi, terminal fine bronchi and alveoli.

Interstitial pneumonia: inflammation that occurs primarily in the interstitium of the lungs and affects the bronchial walls and peribronchial tissues.

Incidence

Community-acquired pneumonia affects 5 to 11 people per 1,000 population each year. The mortality rate is low in mild cases, but is about 40% in those who require admission to an intensive care unit.

The incidence of hospital-acquired pneumonia is the most common type of hospital-acquired infection in China, with 5 to 10 per 1,000 hospitalized patients each year, causing an associated morbidity and mortality rate of 15.5% to 38.2%.

The reasons for the high morbidity and morbidity-fatality rates are related to the aging of the socio-demographic population, smoking, concomitant underlying diseases, and immunocompromise, in addition to the emergence of new pathogens and the increase in bacterial resistance due to the irrational use of antimicrobial drugs.

Questions you may be concerned about

How long does it usually take to recover from pneumonia?

Pneumonia recovery time varies widely and is related to the type of pneumonia, the severity of the disease and other conditions.

There are many causes of pneumonia, and the recovery time for different causes of pneumonia varies greatly. Streptococcus pneumonia can be cured in about 1 to 2 weeks, while some interstitial pneumonias are not even completely cured.

The severity of the pneumonia also affects the recovery time. A mild case of common infectious pneumonia can improve significantly in 5 to 7 days, while severe pneumonia often takes weeks or even longer.

How can I tell if I have pneumonia?

There is no way to tell if you have pneumonia.

The diagnosis of pneumonia requires a combination of clinical symptoms and various test results, so it is not possible to tell if you have pneumonia on your own. However, if you have symptoms such as fever, cough, sputum, chest pain, etc., you should be highly vigilant and go to the hospital in time, and cooperate with the doctor to complete all the tests in order to confirm the diagnosis as soon as possible.

Do I need to avoid eating if I have pneumonia?

No, it is not necessary.

It is recommended to pay attention to light cooking, less oil, food variety, more fresh fruits and vegetables, dairy and soy, moderate amount of fish, eggs, lean meat, etc., and choose easy-to-digest food.

People with poor appetite and insufficient food, the elderly and patients with chronic diseases can be provided with nutritionally fortified foods, special medical purpose formulas or nutrient supplements.

Is pneumonia contagious?

Pneumonia caused by different pathogens is differently contagious. Pneumonia caused by non-infectious factors is generally not contagious.

Generally speaking, pneumonia caused by viruses, mycoplasma and other pathogens are contagious, and some viral pneumonias are highly contagious, such as infectious atypical pneumonia and novel coronavirus pneumonia. Bacterial pneumonia is less contagious, and pneumonia caused by non-infectious factors is generally not contagious.

Is it necessary to get vaccinated against pneumonia?

Vaccination is an important preventive healthcare measure, and it is recommended that those who are eligible for it be immunized in a timely manner.

Pneumonia vaccines, including pneumococcal vaccines and the new coronary pneumonia vaccine, can provide effective immunization against the corresponding disease, greatly reducing the probability of illness or reducing its severity in those who are vaccinated, and the marketed vaccines have been evaluated for safety, so it is recommended that those who are eligible for the vaccine be vaccinated in a timely manner.

However, vaccination does not mean that infection can be completely avoided, and personal protection is still needed after vaccination.

Causes

Causes

Pneumonia can be caused by a variety of factors, including pathogenic microorganisms, physical and chemical factors, immune damage, allergies and medications.

Pathogenic microorganisms include bacteria, atypical pathogens, viruses, fungi, parasites and other pathogens.

Physicochemical factors such as radiologic injury, inhalation of irritants, etc.

Pneumonia occurrence depends on pathogen and host factors. Pneumonia can occur if the pathogens are numerous and virulent and/or if the host’s local and systemic immune defenses in the respiratory tract are compromised.

Predisposing factors

Old age.

Smoking.

Underlying disease (e.g., diabetes mellitus, chronic obstructive pulmonary disease, cardiac insufficiency, immune and blood disorders, chronic liver and kidney disease).

Being immunocompromised (e.g., being on glucocorticoids or other immunosuppressants, or having a condition such as acquired immunodeficiency syndrome).

Suffering from other respiratory diseases, such as viral colds.

Being bedridden for long periods of time.

Being in a crowded, poorly ventilated, dirty environment for long periods of time.

Use of a ventilator.

High pathogenicity of pathogens.

Novel pathogens, such as novel coronaviruses.

Pathogenesis

Under normal circumstances, bronchial mucus, cilia and intact intra-alveolar cellular defense, etc., constitute the respiratory immune defense mechanism, even if exposed to a small number of pathogens, or there is a slight stimulus from the outside world, inflammation is not likely to occur.

Pneumonia may occur if one is exposed to a large number of pathogenic microorganisms with high virulence, or if one is subjected to an overly strong stimulus, or if the respiratory tract or even systemic immune function is impaired.

Pathogens can enter the lungs through airborne inhalation, bloodstream dissemination, spread from neighboring sites, and aspiration of colonized bacteria by mistake, and multiply or replicate in the lungs.

This process can directly damage the cells of the lungs or cause an immune response, etc., which in turn leads to inflammation.

Symptoms

Symptoms of pneumonia depend largely on the type of pathogen, as well as the physical condition of the patient.

Main symptoms

Cough

It can be a paroxysmal, irritating dry cough. In severe cases, the cough is persistent and severe and can interfere with sleep.

Coughing up sputum

This may occur after the onset of coughing and is initially characterized by an increase in the amount of sputum, often white mucus sputum.

The nature of the sputum may then change, depending on the pathogen. For example, Streptococcus pneumoniae sputum is rust-colored, Klebsiella pneumoniae sputum is brick-red jelly-like, and anaerobic infections can have a fishy odor.

Blood sputum or even hemoptysis may also be present.

Fever

Mostly high fever, generally oral temperature of 38.1-39 ℃.

Fungal infection is often low fever.

Those who are less ill or weaker may not have obvious fever or even have no fever.

Shortness of breath

Increased respiratory rate, associated with decreased lung function, mostly occurs after coughing and fever.

In severe cases, dyspnea and nasal flaring may occur.

Cyanosis

Related to hypoxia, the skin of lips and fingers is cyanotic.

Other symptoms

Chills and chills: are common accompanying symptoms of fever.

Chest pain: can be caused by severe coughing, or the development of complications such as pleurisy, mostly associated with respiratory movements, i.e., aggravated by deep breathing and coughing.

Lack of appetite: mostly associated with fever.

Neuropsychiatric symptoms: related to fever, hypoxia, etc., which can be manifested as drowsiness, depression, irritability, lethargy or even coma. Children may have febrile convulsions.

Other extrapulmonary manifestations: some pneumonias may present extrapulmonary manifestations, such as maculopapular rash, erythema, blisters and other skin damages, diarrhea, vomiting and other digestive symptoms, weakness, oliguria and other electrolyte disorders, palpitations and other cardiac discomfort, and wet and cold extremities when combined with shock.

Complications

Pleurisy: Inflammation of the lungs may result in exudation, causing pleurisy, often with chest pain on top of existing fever and cough.

Pseudothorax: Bacterial infection produces purulent exudate that enters the chest cavity and causes a pus-filled chest, with symptoms such as high fever and difficulty breathing.

Otitis media: ear pain, hearing loss and other symptoms may occur.

Sinusitis: manifested by nasal congestion, headache, and purulent nasal discharge.

Arthritis: manifested as joint pain, swelling and so on.

Lung blisters: some pneumonias can destroy the normal structure of alveoli, and multiple alveoli rupture and fuse, forming lung blisters and losing normal function. Severe cases may have difficulty in breathing.

Consultation

Department of Medicine

Respiratory Medicine

When symptoms such as high fever, chills, cough, bloody sputum and chest pain occur, prompt medical attention is recommended.

Emergency Department

In case of emergency such as high fever, unconsciousness, agitation, wet and cold limbs, it is recommended to go to the Emergency Department immediately.

Preparation for medical treatment

Preparation for medical consultation: registration, preparation of documents, common problems

Tips for seeking medical treatment

Chest X-rays or chest CT are often needed, so avoid wearing clothing made of metal, and inform your doctor if you are pregnant or planning to become pregnant.

Avoid taking fever-reducing medicines or antibiotics by yourself before going to the doctor, so as not to influence the doctor’s judgment of the condition. For patients with high fever, physical cooling can be used first, such as applying cold compresses to the forehead and wiping hands, feet and armpits with warm water.

Preparation checklist for medical consultation

Especially need to pay attention to the time of symptom onset, special performance, etc.

Is there fever? What is the highest temperature?

Is there a cough? How long has the cough lasted?

Is there any sputum? What kind of sputum?

How long have the symptoms been present?

Do you have diabetes, COPD, etc.?

Are you taking long-term medications such as glucocorticoids, immunosuppressants, etc.?

Test results in the last six months, which can be brought to the doctor’s office.

Laboratory tests: blood test, C-reactive protein, calcitoninogen, bacterial culture + drug sensitivity test

Imaging tests: Chest X-ray, Chest CT

Medication in the last 3 months, if available, bring along the box or package

Antibiotics: penicillin, cefotaxime, vancomycin, erythromycin

Antipyretics and analgesics: ibuprofen, acetaminophen

Others: Ambroxol

Diagnosis

Diagnosis is based on

Medical history

Previous close contact with a person with confirmed or suspected pneumonia.

Long-term use of immunosuppressants, immunodeficiency diseases, or previous exposure to cold or rain.

Poor physical condition, prolonged bed rest, or inhalation of irritating substances.

Clinical manifestations

There are common symptoms such as cough, sputum and fever, which may be accompanied by other symptoms such as chills, chest pain, lack of appetite and mental depression.

Observation of respiratory rate may reveal increased respiratory rate; bruising of the lips and mouth may occur.

When the chest is auscultated with a stethoscope, bronchial breath sounds and wet rales can be heard.

Chest percussion may reveal turbid sounds, indicating the presence of pulmonary solid changes or pleural effusion.

Palpation of the chest reveals increased phonatory tremor, which is diminished in the presence of pleural effusion.

The mouth and throat can be observed with the help of a tongue depressor, and changes such as congestion can be detected in some cases.

Laboratory tests

According to the indicators such as white blood cell count and classification, it can be initially determined whether there is an infection or not, and roughly determine the type of infection.

Changes in white blood cells can also reflect changes in the condition and help assess the effectiveness of treatment.

Bacterial pneumonia may show an increased white blood cell count and an increased neutrophil ratio and count.

Blood tests require a venous blood draw and do not require fasting.

C-reactive protein (CRP) reflects inflammation in the body and helps determine the type of infection.

C-reactive protein levels are elevated in bacterial infections and can be mildly elevated in non-bacterial infections. It can also fluctuate with changes in medical conditions.

Myocardial infarction, severe trauma, burns, malignant tumors, connective tissue disease, etc., can also cause C-reactive protein levels to rise.

The test involves drawing blood from a vein and does not require fasting.

There are many indicators of blood biochemistry, such as alanine aminotransferase and glutamine aminotransferase to reflect liver function, blood urea nitrogen and creatinine to reflect kidney function, and myoglobin and troponin to reflect heart damage.

Urea nitrogen is one of the indicators to determine whether community-acquired pneumonia requires hospitalization.

Abnormalities in the relevant indicators often indicate that the function of the relevant organs is impaired and requires corresponding treatment.

Blood biochemistry tests require venous blood to be drawn on an empty stomach.

Pneumonia may affect respiratory function, and in severe cases, hypoxemia and respiratory failure may occur, the severity of which can be determined by arterial blood gas analysis.

Decreases in partial pressure of oxygen, oxygen saturation, oxygenation index, and acid-base imbalance may occur.

Arterial blood gas analysis requires taking arterial blood for examination and does not require fasting.

It is primarily a measurement of antibodies, including immunoglobulin M (IgM) and immunoglobulin G (IgG), in serum during the acute and recovery phases, and is used for the diagnosis of atypical pathogens (e.g., Legionella, Mycoplasma).

Significantly elevated antibodies (e.g., 4-fold or more) are generally required for diagnostic significance.

Not all pathogens are suitable for serologic testing and need to be selected by the physician after making an initial judgment based on the situation.

Venous blood is drawn for examination without fasting.

It mainly includes pathogen isolation and culture, pathogen antigen and nucleic acid test.

Pathogen isolation culture is the most reliable test to clarify the diagnosis. However, the culture cycle is longer, mostly used for bacterial infections. Some pathogens are difficult to culture and are mostly used for those who are difficult to make a clear diagnosis or difficult to treat.

On the basis of isolation and culture, drug sensitivity test can also be performed, which helps doctors to adjust the drug treatment program.

Antigen and nucleic acid tests for viruses can be used for early diagnosis.

The main method of viral nucleic acid testing is polymerase chain reaction, which has the best specificity and sensitivity.

Respiratory specimens need to be obtained from pharyngeal swabs, nasal swabs, nasopharyngeal or tracheal aspirates, sputum, etc. Blood specimens may also be obtained from blood draws, and pleural effusions may be obtained from puncture drainage.

Legionella and Streptococcus pneumoniae are available for urine antigen testing.

Respiratory specimens can be processed and placed under a microscope to look for pathogens, for fungal infections such as Candida.

Imaging

It can be used to find out the presence and severity of lung inflammation, specific lesions, and also to assess recovery.

It may show signs of bronchial infection such as increased lung texture, and in severe cases, infiltrative lung lesions or pleural effusion, or even fusion into patches.

The test is radioactive, and you need to cooperate with breathing as required by the doctor during the test.

Others

Samples can be obtained through fiberoptic bronchoscopy, percutaneous fine-needle aspiration, open chest surgery, etc. for histopathological examination.

It is suitable for people who have difficulty in diagnosis and treatment, and helps to rule out serious conditions such as lung cancer.

Sampling by open heart surgery involves retaining relevant samples of the lungs for histopathologic examination at the same time as the surgery.

Admission Evaluation Criteria

The CURB-65 is used to determine whether a patient with community-acquired pneumonia needs to be admitted to the hospital.

For the following criteria, 1 point is awarded for meeting 1 of the criteria.

Judge the outcome based on the score.

Diagnostic criteria

Criteria for determining severe pneumonia

If community-acquired pneumonia meets 1 of the following major criteria, or ≥3 minor criteria, it can be diagnosed as severe pneumonia, which requires close observation, active treatment, and admission to ICU for treatment when available.

Major Criteria

Secondary criteria

Differential diagnosis

Tuberculosis

Similarities: both may present with fever, malaise, cough and other symptoms.

Differences: the condition of pulmonary tuberculosis is more moderate, the fever is mostly low in the afternoon, and there may be night sweats, weight loss, insomnia, palpitation, etc.; Mycobacterium tuberculosis can be differentiated by the discovery of Mycobacterium antacidum smear, mycobacterium culture, and nucleic acid test.

Upper respiratory tract infection

Similarity: cough, sputum, fever and other symptoms.

Differences: Symptoms of upper respiratory tract infections are often more limited, e.g. acute rhinitis may present with symptoms such as runny nose. The absence of lung parenchymal infiltration on chest X-ray or CT examination can be the basis for differentiation.

Pulmonary thromboembolism

Similarities: Dyspnea and hemoptysis may occur.

Differences: People with pulmonary thromboembolism often have a history of braking, trauma, surgery, tumor, lower extremity venous thrombosis, etc. D-dimer test can reveal a tendency to thrombosis, X-ray can reveal regional reduction of pulmonary vascular texture, etc. CT pulmonary arteriography, radionuclide lung ventilation/perfusion scanning, and MRI can help to differentiate.

Lung cancer

Similarity: Both can present with a prolonged cough, fever and coughing up sputum.

Differences: Lung cancer often occurs in people who have been smoking for a long time and are older; it may also present with chest pain and hemoptysis. Imaging examination can find nodules, enlarged hilar lymph nodes and other changes; sputum exfoliative cells and histopathological examination can find malignant tumor cells, which can lead to a clear diagnosis.

Treatment

Aims and principles of treatment

Treatment purpose: control or relieve symptoms, improve lung ventilation, eliminate lung inflammation.

Principle of treatment: choose appropriate medication according to the cause of the disease and supplement with other methods according to the symptoms.

Treatment Methods

General treatment

Influenza viral pneumonia and novel coronavirus pneumonia are contagious and require isolation as required by a doctor.

Other statutory infectious diseases require isolation according to the law.

Ventilate the isolation room and maintain proper temperature and humidity.

Keep the airway open and give oxygen to those who show signs of hypoxia.

Those who have respiratory difficulties, or whose examination reveals severe or critical illnesses such as hypoxemia. According to the severity of hypoxia, conventional oxygen therapy, high-flow oxygen therapy via nasal catheter, non-invasive ventilation or invasive mechanical ventilation can be chosen, and extracorporeal membrane oxygenation can be used if necessary.

Pay attention to rest, especially in the acute stage, fever, malaise and other symptoms are more serious.

Drink plenty of water, increase nutrition, choose food with sufficient calories and easy to digest.

Mainly consume high-quality protein foods (150-200 grams per day), such as lean meat, fish, shrimp, eggs, soybeans, etc., to ensure that one egg per day, 300 grams of milk and milk products; through a variety of cooking vegetable oil to increase the intake of essential fatty acids, especially vegetable oil.

Eat more fresh vegetables and fruits. More than 500 grams of vegetables per day, 200-350 grams of fruits per day, and more dark-colored fruits and vegetables.

Medication

During drug treatment, you should adhere to the doctor’s instructions, do not change the dose of the drug or stop the drug suddenly, to ensure that the treatment plan is implemented.

People with fever can use antipyretic drugs, such as ibuprofen, acetaminophen, and loxoprofen.

People with nasal congestion can use drugs to reduce nasal mucosal congestion and antihistamines, such as pseudoephedrine hydrochloride, chlorpheniramine and so on.

Those with cough and phlegm may use cough suppressants and expectorants, such as compound licorice combination, ambroxol, and so on.

If the combination of bacterial, fungal infection, etc., follow the doctor’s instructions to use the appropriate antibiotics or antifungal drugs, such as cephalosporins.

Antibacterial drugs

Anti-infection treatment is a key part of pneumonia treatment, including empirical treatment and anti-pathogen treatment. Sensitive antimicrobial drugs should be used as prescribed by the doctor, which can be in the following categories.

Antiviral drugs

Antifungal drugs

Reasonable application after diagnosis by professional Chinese medicine practitioners.

Chinese patent medicines that may be used to relieve symptoms include Shufeng Xieyu Capsule, Tongxuan Lung Pill, Qinglong Anti-inflammatory Pill, and so on.

Glucocorticosteroids are commonly used and effective drugs for the treatment of radiation pneumonitis.

For those who inhaled gastric contents, adrenocorticotropic hormone such as methylprednisolone is given at 24 to 36 hours.

Traditional Chinese Medicine (TCM)

Pneumonia has more common symptoms in Chinese medicine. When choosing Chinese medicine treatment, professional Chinese medicine practitioners are needed to identify and treat the symptoms.

Formulas that may be used include Yin Qiao San plus or minus, Ma Xing Shi Gan Tang plus or minus Qing Jin Hua Phlegm Tang plus or minus, Bei Mu Gua Piao San plus or minus Qing Jin Hua Huo Tang plus or minus, Han Xia Hou Pu Tang plus San Zi Nourishing Relative Tang, Sen Ling Bai Zhu San plus or minus, Sheng Wei San plus or minus, and so on.

Prognosis

Cure

Pneumonia can be cured after treatment in most cases, while a few cases may develop into severe or even life-threatening diseases.

Pneumonia caused by pathogen infection can mostly be cured after using appropriate anti-infective drugs. If the pathogen is resistant to certain drugs, treatment may be relatively difficult.

Pneumonia caused by non-infectious factors can be facilitated by removing the relevant factors.

Alcoholism, smoking, advanced age, immunosuppression, and asthma can affect prognosis.

Hazards

Pneumonia can cause high fever, cough, sputum and other symptoms, depression, lack of appetite, affecting normal study, work and life.

Some pathogens are contagious, such as Mycoplasma pneumoniae and novel coronaviruses, which can spread to others.

Children under the age of 5, elderly people over 65, people with suppressed immune function, and people with chronic underlying diseases (especially lung diseases) are more likely to develop serious illnesses and even cause death.

In most cases, the lungs are not damaged and their structure and function return to normal. However, pneumonia caused by Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and fungi may lead to necrotic lesions in the lung tissue, formation of cavities, or fibrosis.

Daily

Daily management

Daily management

Some pneumonias are contagious. Avoid close contact with children, the elderly, pregnant women and immunocompromised people, wear masks, and cover the mouth and nose when coughing to prevent spreading.

Rest in bed during the fever period and reduce physical exertion. After the fever subsides, activities can be resumed gradually.

Quit smoking and avoid passive smoking to prevent aggravating lung damage.

Maintain a good work routine, ensure sufficient sleep time, and avoid exertion and late nights.

Ventilate the room, as well as pay attention to maintaining the appropriate temperature and humidity, reduce the cold air and other stimuli, and prevent cold.

People with fever treated on an outpatient basis can use warm water baths and cold compresses on towels to help lower their body temperature, and measure their body temperature regularly.

If there is coughing up sputum, pay attention to the character of the sputum, especially whether there is any blood, etc.

If you already have high blood pressure, diabetes and other diseases, you need to increase the frequency of measuring blood pressure and blood sugar on top of the existing ones.

Follow the doctor’s requirement to take medication in full dosage and on a regular basis, and follow up on time, do not stop taking medication on your own due to reduction of symptoms to avoid relapse.

Dietary management

Pay attention to balanced nutrition and eat a light diet with more protein, vegetables and fruits.

Eat less high salt and fried food.

Drink an adequate amount of water, 7 to 8 glasses (1,500 to 1,700 milliliters) per day for adults, advocate drinking plain water and tea, do not drink or drink less sugary drinks.

Prevention

Vaccination

Streptococcus pneumoniae 23-valent polysaccharide vaccine can reduce the incidence of community-acquired pneumonia and reduce the overall mortality rate, and can be given to people over 60 years of age if there is no contraindication. 13-valent Streptococcus pneumoniae conjugate vaccine is available for people over 65 years of age.

People who have received pneumococcal 23-valent polysaccharide vaccine are not recommended to receive 13-valent conjugate vaccine, but can receive pneumococcal 23-valent vaccine after receiving 13-valent pneumococcal conjugate vaccine.

Influenza vaccine can be given to prevent influenza virus pneumonia and should be given before the flu season.

The effectiveness of influenza vaccine and pneumonia vaccine can be improved by combining them.

Contraindications are during tumor chemotherapy, during the onset of acute infectious diseases, fever, critically ill patients, and allergy to vaccine components.

Adjustment of living habits

Do not come into close contact with people with pneumonia and wear a mask as much as possible.

Items used by people with pneumonia need to be sterilized. High-temperature steaming and ultraviolet irradiation are suitable for home use.

Pay attention to hand hygiene, wash hands before meals and after going to the toilet, do not touch the eyes, mouth, nose and other parts of the body with your hands, and wash your hands thoroughly after touching objects of unknown hygiene.

Keep indoor air circulating and maintain indoor relative humidity at 30% to 80%.

Avoid long stays in crowded places such as shopping malls and hospitals during the peak of the epidemic.

Strengthen outdoor physical exercise to improve the body’s ability to resist diseases.

Pay attention to adding or subtracting clothes according to the temperature during the change of seasons, and pay attention to preventing cold and keeping warm during the fall and winter seasons for the elderly and children.

Maintain balanced nutrition, avoid partiality or picky eating, and eat more fresh vegetables, fruits and other foods rich in vitamins.

Quit smoking and drinking to reduce the harm of tobacco and alcohol to the body, especially quit smoking, can improve lung function.