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 been fully elucidated so far, and it is generally believed that it is formed by the synergistic effect of various factors.
1, various factors that cause chronic emphysema such as infection, smoking, atmospheric pollution, long-term inhalation of occupational dust and harmful gases, allergy, etc., can cause obstructive emphysema.
2.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 work 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 lung cancer and emphysema co-existing, so the treatment of such patients, especially the preoperative lung function assessment before surgery, is especially important!
Emphysema is a chronic disease, and clinically, we 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. release reversible factors in airway obstruction.
2.Control cough and sputum production.
3.Eliminating and preventing airway infections.
4.Control various comorbidities, such as arterial hypoxemia and vasoconstriction.
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 often associated with the disease.
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 has a better effect of enhancing physical fitness and relieving symptoms
The treatment of emphysema requires comprehensive treatment, and no one drug will be absolutely effective. The usual maintenance is especially important.
First of all, it is necessary to have a good living environment
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 the patients, making the sputum more sticky and not easy to be coughing. 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 hoods in the kitchen to avoid fishy and spicy 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 habit of smoking 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 sputum is not smooth and the chest is stuffy, which is because the sputum is too sticky and adheres to the bronchial wall, so it is 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 asphyxiation.
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 the back: Put all five fingers together, bend the palm, and tap the patient’s back from the bottom to the top and from the sides to the middle in the direction of the trachea, while encouraging the patient to cough.
Reasonable use of medicine
1. Rational use of antibiotics. Patients abuse 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 infection, 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.
Specific methods.
(1) Firstly, learn calm abdominal breathing, which can be induced by breathing method. Sit in a comfortable position, focus on the mind, relax the tense breathing muscles, and press the upper abdomen with one hand. Breathing begins with exhalation, and the abdomen sinks during exhalation. Then use the hand to gently press the upper abdomen to increase abdominal pressure and help the diaphragm to lift up, and during inhalation, the upper abdomen rises slowly against the pressure exerted by the hand.
(2) This abdominal augmentation and subsidence is referred to as inhalation and deflation. In order to enable the gas to be exhaled smoothly, the flute-like exhalation method through the mouth should be adopted, that is, when exhaling, the lips are contracted into a flute-like shape, so that the gas is slowly blown out through the narrowed mouth shape, which raises the pressure in the airway by about 5 cm of water column and avoids premature occlusion of the fine bronchi.
(3) Inhalation is then passed through the nasal cavity so that the air is moistened, warmed, filtered and adsorbed by the nasal cavity to reduce the irritation of the trachea. Inhalation time should be 1 to 2 times longer than exhalation, but do not hold your breath. Holding the breath can increase the pressure in the lungs, which is not good for lung gas.
(4) On the basis of practicing good abdominal breathing, you can do breathing gymnastics.
The first section, pressure abdominal breathing: natural standing, both hands crossed waist, thumb in the back, four fingers in front.
(1) exhale, active abdominal, two hands four fingers pressed in the abdomen, while the two elbow joints leaned forward to restrain the chest.
(2) When inhaling, expand the chest with both shoulders backward to increase the range of rib movement. Repeat for two eight beats.
Section 2, leg press plank.
(1) Step out with the left leg to the left front into a left lunge with the center of gravity in the middle and both hands holding the left knee.
(2) The weight falls forward on the left foot and presses the leg downward.
(3) Rhythmically shift the center of gravity forward and backward, repeat eight times; switch to the right leg, same method as above, also repeat eight times.
(4) then the two legs together slightly bent knee, for the knee around the ring movement, left and right direction around, each repeated eight times.
Note: Older people often have lower limb weakness symptoms, for this section is to increase the strength of the lower limbs. The depth of the leg press and the amplitude of the knee loop should be gradually increased according to the specific situation of the patient.
Section 3, single lift breathing: stand naturally with both hands bent flat in front of the abdomen, palms up and fingers facing each other.
(1) Inhale, one arm is lifted up through the abdomen and chest, turning the palm into a palm rest, with the arm close to the side of the head, as far up as possible. The other arm palm turned down, while sticking to the side of the body down, press down hard.
(2) restore on exhalation. Change the other arm up, the same practice as above. Repeat for four eight beats.
Note: breathing should be abdominal, exhale as much as possible to close the abdomen, both arms should be straight. This section of the activity observed under X-rays, diaphragmatic activity can be increased by 1 cm.
Section IV, holding the ball: two legs stand apart and shoulder width, half squat into a horse riding style.
(1) Both hands make a ball hold on the right side, the body turns to the right, while the center of gravity shifts right, the right hand is on top.
(2) body to the left, to the left and then change the left hand on the top, the right hand in the bottom, while the center of gravity left shift. Make four eight beats. The whole body should be relaxed, the upper body rotation to the waist as the axis, arm, leg and waist movements should be coordinated, slow, natural breathing.
Fifth section, the day of breathing: natural standing, two hands in front of the abdomen flat flexion.
(1) both hands straight upward, palms upward, as in the shape of the sky. Take the waist as the axis, rotate the waist to the left. Do a total of eight times.
(2) Rotate the waist to the right, and do it eight times.
Note: This section is to prevent and control age-related low back pain through lumbar activities. Rotation speed should be slow and the amplitude gradually increases. Do not rotate your head to prevent dizziness. Be sure to rotate the waist, so there is a lumbar jutting forward and convex backward movement, avoiding hip-based activities.
Section 6, squat breathing: free standing, both feet together.
(1) exhale when squatting, the heel does not leave the ground, while holding the knee joint with both hands, the elbow joint outside.
(2) Inhale when standing up, while holding both hands sideways and flat. Do a total of two eight beats.
Note: the squatting depth depends on the patient’s possibilities, for those who can not squat, can be forward bending body movements.
Section 7, flinging: relax, natural standing.
(1) the upper body to the waist as the axis, while the waist to move the shoulders and then drive the two arms relaxed swing, when the waist to the left moment, drive the left forearm and hand flip hit the waist back (near the point of life), the right forearm and hand flip hit the abdomen.
(2) When the waist turns to the right, drive the left forearm and hand to fling the abdomen, and the right forearm and hand to fling the waist and back.
Note: In the flinging two arms should be relaxed like a whip, with the waist turn and flinging with arms and hands, not with hands to beat. The whole body muscles must be relaxed, with the flap, the two lower limbs slightly for a volley of action, to have a rhythm, light important appropriate. It is both a whole-body activity, but also to increase the muscle tone of the low back and abdominal muscles, but also to improve the blood circulation of the abdominal back. Repeatedly do each eight times.
Section eight, press the abdominal breathing: natural standing.
Finally, for limited emphysema or pulmonary blister, appropriate surgical treatment can be chosen, or lung decompression surgery can be performed. Lung transplantation is the last treatment and may be considered if necessary.