Emphysema is a pathological condition in which the airways at the distal end of the terminal fine bronchi (respiratory fine bronchi, alveolar ducts, alveolar sacs and alveoli) are hypoelastic, hyperinflated, inflated and have increased lung volume or are accompanied by destruction of the airway walls. There are several types of emphysema according to their pathogenesis: senile emphysema, compensatory emphysema, interstitial emphysema, focal emphysema, paracentral emphysema, and obstructive emphysema.
The pathogenesis of emphysema has not yet been fully elucidated, and it is generally believed that it is formed by the synergistic effect of various factors. I. Various factors that cause chronic emphysema, such as infection, smoking, atmospheric pollution, long-term inhalation of occupational dust and harmful gases, and allergy, can cause obstructive emphysema. Second, the doctrine of imbalance of elastase and its inhibitory factors.
The main symptom of emphysema patients is shortness of breath, which occurs only during physical labor in mild cases, but gradually becomes obvious as the degree of emphysema increases, and dyspnea occurs even at rest, and chest tightness is often felt. Whenever there is a combination of respiratory tract infection, the symptoms worsen and a series of symptoms such as hypoxia and acidosis may appear.
Emphysema is a benign lesion of the lung and will not develop into lung cancer per se. However, some elderly patients often have the co-existence of lung cancer and emphysema, and the treatment of such patients, especially the pre-surgical assessment of pulmonary function, is particularly important.
Emphysema is a chronic disease, and clinically, one can only try to slow down the progression of the disease. The aim of treatment is to improve respiratory function and enhance the patient’s ability to work and live.
To this end, attention should be paid to.
1.Releasing reversible factors in airway obstruction ;
2.Control cough and sputum production;
3. eliminating and preventing airway infections;
4, control of various comorbidities, such as arterial hypoxemia and vasoconstriction, etc;
5.Avoid smoking and other airway irritants, anesthesia and sedation, non-essential surgery or all factors that may aggravate the disease;
6. Relieve patients of the mental anxiety and depression that often accompany them.
Specific measures are as follows:
1, application of bronchodilator drugs such as anticholinergics, theophyllines, β2 adrenoceptor agonists. If allergic factors are present, glucocorticoids can be used.
2.Apply effective antibiotics, such as penicillin, gentamicin, ciprofloxacin, cephalosporin, etc., according to the pathogenic bacteria or experience during the acute attack.
3.Respiratory muscle function exercise Do abdominal breathing and slow exhalation with contracted lips to strengthen the activity of respiratory muscles. Increase the mobility of diaphragm.
4.Home oxygen therapy 10–15 hours a day (1–2L/min) continuous oxygen administration can prolong life and improve the quality of life.
5.Rehabilitation therapy such as qigong, taijiquan, breathing exercises, quantitative walking or ladder climbing exercises.
6.Therapy of Chinese medicine with evidence-based treatment has a better effect of enhancing physical fitness and relieving symptoms
The treatment of emphysema requires comprehensive treatment, no one drug will be absolutely effective, and the usual maintenance is especially important.
First of all, a good living environment is necessary.
1, the room to maintain the appropriate temperature and humidity. The room temperature of the room should be relatively stable, generally 18 to 20 ℃ is appropriate. Winter should have heating facilities. When heating with a coal stove, do not make the room temperature high and low, so that patients get cold and aggravate the disease. At the same time, because of the dry air in winter and high room temperature in the room, it will cause dryness of respiratory mucosa and sore throat of patients, making sputum more sticky and not easy to cough up.
Therefore, the humidity in the room should be increased appropriately, such as using an air humidifier, or placing water in an easily heat-conducting container such as an aluminum lunch box and placing it on the heater, or heating with a coal stove, placing the kettle on the coal stove to humidify the air. The relative humidity of the room should be 50% to 60% is appropriate.
2, often open windows for ventilation. Because of the cold and flu easily induced respiratory infections, so in winter, the room is always closed, easily do not go out. In fact, open the windows to ventilate, you can let go of the dirty air in the room, into the fresh air, not only to reduce the density of pathogenic microorganisms in the air, to reduce the spread of respiratory diseases, but also to avoid the dirty air to patients bring irritability, tiredness, dizziness, loss of appetite and other adverse reactions. So it is very important to properly increase the number of times to open the windows for ventilation to keep the indoor air circulating and fresh.
3.Avoid harmful and irritating gas stimulation. Special attention should be paid to avoid harmful and irritating gases such as smoke, dust, gas and other respiratory tract stimulation. Wet sweeping and bed sweeping methods can be used, i.e. wrapping a layer of wet towel outside the broom before cleaning, or cleaning in the absence of the patient to prevent dust from flying. It is best to install exhaust fans or fume hoods in the kitchen to avoid fishy fumes from causing respiratory irritation to patients.
Develop good living habits.
1, quit smoking. Studies at home and abroad have proved that smoking is closely related to the occurrence of chronic respiratory diseases. The longer you smoke, the greater the amount of smoke, the higher the rate of disease. After quitting smoking can make the symptoms reduce or disappear. Therefore, those who have a smoking habit should quit.
2, strengthen nutrition, reasonable diet. Patients because of the long duration of the disease, gastrointestinal function is weak, eating less, long-term large amount of sputum protein consumption more, resulting in nutritional deficiencies, resistance to decline. Winter weather is cold, so patients should be given high protein, high calorie, high vitamin, light, easy to digest food, such as lean meat, fish, eggs, walnuts, soybean products, fresh vegetables and fruits, etc.. Honey, yam, white fruit, walnuts, pear and loquat have certain therapeutic effects and can be consumed appropriately. The patient’s diet should avoid cold, greasy and spicy foods and should control the intake of salt.
Asthmatic bronchitis is mostly caused by allergies. Shrimp skin, shrimp, crab, pickled vegetables, moldy food, etc., can induce bronchial asthma attacks, so they should be avoided. If the appetite is poor, give a semi-liquid or liquid diet and pay attention to the color and flavor of the food. Encourage patients to drink more water, at least 3,000ml daily, to keep the respiratory tract moist and dilute the sputum, so that it can be easily removed.
3. Dress appropriately and pay attention to keep warm. Patients with poor cold tolerance, weakness and fear of cold, when encountering cold stimulation, easy to cause colds and upper respiratory tract infections. Research shows that: about 80% of the cold can cause lung infection. Therefore, you should add and subtract clothes according to the weather changes, and wear masks and scarves when you go out in winter. It is often said that “cold starts from the feet”, so patients with slow-onset bronchitis should pay special attention to keeping their feet warm.
4, actively exercise to enhance physical fitness. According to their health condition and hobbies, the elderly can do outdoor activities to breathe fresh air, such as deep breathing, qigong, taijiquan, jogging, walking after meals, and so on. This can deepen and accelerate breathing, which is conducive to gas exchange in the lungs and increase the intake of oxygen and the discharge of metabolic waste, so as to improve lung function, enhance the immunity of the body and the ability to actively discharge phlegm.
In addition, patients should try to go to crowded places such as shopping malls, theaters and other public places as little as possible, especially during the flu epidemic. They should also maintain a positive and optimistic attitude and build up confidence to overcome the disease.
Master the correct method of sputum removal.
During the attack of the disease, patients often feel that they can’t spit and have shortness of breath because the sputum is too sticky and adheres to the bronchial wall, which makes it difficult to be expelled by coughing. Therefore, in addition to taking anti-infection and phlegm treatment according to medical prescription, mastering the correct method to promote the discharge of phlegm can reduce the patient’s symptoms and avoid tragedies caused by phlegm suffocation.
1, nebulized inhalation method: ultrasonic nebulizer inhaler can be used, also can use simple steam inhalation to make the secretions in the trachea wet, easy to cough out. Method: choose a thermos cup, half a cup of boiling water, the mouth and nose into the mouth of the cup, sucking steam, repeated several times, wait until the water is slightly cold and then change the boiling water, you can achieve the purpose of dilution of sputum, sputum smoothly. But be careful to prevent burns.
2, turn over, knock back method: long time bedridden patients can be family members or nursing staff in the milder climate at noon, try to let slightly able to walk patients in the outdoor walk; fear of cold should also be in the indoor activities. Even those who really can’t get up should be turned and tapped by family members frequently, because these activities can produce postural changes and lung vibrations, which are conducive to sputum discharge. How to tap on the back: Put all five fingers together, bend the palm, and tap the patient’s back from bottom to top and from both sides to the middle in the direction of the trachea, while encouraging the patient to cough.
Reasonable use of medication.
1. Reasonable use of antibiotics. Patients misuse antibiotics commonly, wrongly believing that antibiotics can prevent colds. In fact, the use of multiple antibiotics alternately or in the wrong combination can lead to dysbiosis and pathogenic bacteria resistance, increasing the chances of conditional pathogenic bacteria and even mycobacterial infections, increasing the difficulty of treatment. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things.
2.Rational use of cough suppressants. Patients usually cough up sputum weakly, at this time, such as the simple use of cough suppressants, sputum can not be discharged but will aggravate the condition. Therefore, it is very important to take the medication as prescribed by the doctor.
If patients are found to have obvious shortness of breath, cyanosis, or even drowsiness, the condition should be considered to be deteriorating and should be sent to hospital quickly.
Secondly, patients with emphysema should correct their breathing pattern, and it is also beneficial to do respiratory gymnastics on this basis.