What is COPD? Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by airflow limitation. It is associated with an abnormal inflammatory response of the lungs to harmful particles or gases, and COPD may also affect changes in various systems throughout the body, so it has systemic effects. Patients with what is commonly referred to as “chronic lung disease” and “emphysema” who have restricted expiratory airflow are all COPD patients. Is there a high incidence and mortality rate of COPD? The incidence of COPD is very high, with a global incidence of 4-10% and an incidence of 8.2% for people over 40 years of age in China, with about 43 million COPD patients in China. About 3 million patients die from COPD each year worldwide, accounting for 5% of all deaths worldwide, a figure greater than the sum of deaths from lung cancer and breast cancer. Therefore, COPD is not only a common disease, but also a serious threat to human health. Who is at risk for COPD? The causes of COPD are complex and are mainly related to environmental factors (harmful smoke and dust, etc.) and, of course, to genetics. The most common cause of COPD is smoking, and all patients diagnosed with COPD have a history of smoking, some may have occupational exposure to harmful fumes and dust, cold and air pollution are also common causes of COPD, and the onset of COPD in women is related to exposure to biofuels and oil fumes. What are the symptoms of COPD? COPD symptoms mainly include chronic cough and sputum with chest tightness or shortness of breath. Many smokers have a cough or sputum, which they often consider to be “normal”, but in fact, it is recommended that they seek medical attention for pulmonary function and a high-resolution CT scan of the chest once they have these symptoms, as they are likely to have COPD. Many patients do not pay attention to their symptoms in the early stage, and when shortness of breath or chest tightness appear, they have already reached severe COPD. Epidemiological surveys have found that COPD is severely under-diagnosed, mainly due to patients’ own lack of general knowledge of the disease and late consultation. Should COPD be treated with oral or intravenous medications or do I need inhaled medications? COPD is divided into a stable phase and an acute exacerbation phase. Generally speaking, inhaled medications are recommended for patients in the stable stage because, on the one hand, the medication reaches the lung directly and the efficacy is more direct; on the other hand, the dose of medication applied by inhalation is smaller and the side effects of the medication are less. For acute exacerbations, intravenous or oral use of bronchodilators, antibiotics and glucocorticoids are often required. What kinds of inhaled medications are available for COPD stabilization treatment? Stable phase treatment inhaled medications include bronchodilators and inhaled anti-inflammatory medications. Bronchodilators include anticholinergics and beta2 agonists, both of which are available in short-acting and long-acting formulations. Short-acting anticholinergic drug ipratropium bromide, 2-4 sprays/dose, 3-4 times/day; short-acting β2 agonists, such as salbutamol, are used as needed; in addition, a combination of short-acting β2 agonists and short-acting anticholinergic drugs (salbutamol combined with ipratropium bromide), 2 sprays/dose, 4 times/day is recommended. The long-acting anticholinergic drug tiotropium, 1 spray/dose, 1 time/day. Long-acting β2 agonists include salmeterol and formoterol, 1 spray/dose, 2 times/day. Inhaled anti-inflammatory drugs are mainly inhaled glucocorticoids. For COPD patients, inhaled glucocorticosteroids alone are not advocated. The combination of long-acting bronchodilators and hormones is generally recommended, which can prevent acute exacerbation of COPD, delay disease progression and reduce mortality in COPD. The combination salmeterol/fluticasone or formoterol/budesonide is widely used in clinical practice. Different inhalation medications are chosen according to the severity of the patient’s disease, so patients are advised to visit a COPD-specific clinic where a specialist will develop a treatment plan based on your condition. Can COPD patients stop inhaled medications at will? COPD is a progressive, chronic inflammatory disease that causes lung function to deteriorate over the years. Once COPD is diagnosed, it is important to take medication for life, just like hypertension or diabetes, to improve quality of life, prevent exacerbations, delay lung function decline, and prolong survival. What are the goals of COPD treatment? (1) to relieve symptoms; (2) to stop disease progression; (3) to improve activity tolerance; (4) to improve health status; (5) to prevent and treat complications; (6) to prevent and treat acute exacerbations; and (7) to reduce death. What is an acute exacerbation of COPD? COPD patients with a short period of time suddenly appear cough, cough shortness of breath and/or wheezing aggravated and beyond the daily changes, sputum volume increased, purulent or mucopurulent? The acute exacerbation of COPD is called acute exacerbation of COPD when it is accompanied by fever and other symptoms and requires a change in the conventional medication for COPD. acute exacerbation of COPD patients can lead to complications of various systems, such as impaired consciousness, respiratory failure, cardiac failure, gastrointestinal bleeding, pulmonary embolism, etc., which can be life-threatening in severe cases. Do COPD patients need long-term antibiotics? Long-term antibiotics are not required for patients with stable COPD. Patients with acute exacerbations of COPD are classified as type III according to the Anthonisen typology. Antibiotics are recommended for type I (those with three symptoms: increased sputum, purulent sputum and worsening dyspnea) and type II patients (those with two symptoms, including purulent sputum), but not for those with only one symptom. Long-term use of antibiotics can induce the development of drug-resistant bacteria and can have side effects on the organism; therefore, patients with COPD should use antibiotics selectively under the guidance of a physician.