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Abstract: Interstitial emphysema is a chronic obstructive pulmonary disease. The patient presented with shortness of breath and wheezing symptoms for more than 10 years, which worsened in the past 1 month, sometimes with coughing sputum or fever, etc. His activity tolerance has been deteriorating in the past 4 years, and the effect of self-medication was poor, so he came to the clinic. He was diagnosed with interstitial lung fibrosis combined with interstitial emphysema, pneumonia and chronic obstructive pulmonary disease by physical examination and chest CT. Through medication + assisted ventilation + rehabilitation, the disease has been controlled and all indicators are improving.
Basic information】Male, 62 years old
Disease Type】Interstitial fibrosis combined with interstitial emphysema, pneumonia, chronic obstructive pulmonary disease
Hospital】Tianjin Third Central Hospital
Consultation Time】October 2014
Treatment plan】Medication (piperacillin tazobactam for injection, doxorubicin for injection, ambroxol hydrochloride injection, montelukast sodium tablets, salmeterol ticapone inhaler, theophylline extended-release tablets, eucalyptus citrus grandis soft capsules) + non-invasive assisted ventilation + rehabilitation therapy (abdominal breathing, lip reduction breathing)
Treatment period】Inpatient treatment for 14 days, outpatient follow-up after 14 days
Treatment effect】The condition has been controlled and the lung function has gradually recovered
I. Initial interview
The patient had intermittent cough, sputum and wheezing for more than 10 years, and in the past 4 years, he felt that his activity tolerance was significantly weaker than before. This time, 1 month ago, he felt that the above symptoms were aggravated after getting cold without any obvious cause, mainly with wheezing after activity, accompanied by cough and sputum, mainly white mucous sputum, with high volume in the morning, accompanied by intermittent fever, no hemoptysis, no other symptoms, taking moxifloxacin hydrochloride tablets, compound methonamine capsule, salmeterol fluticasone powder inhaler and montelukast sodium tablets on his own, but no significant improvement was seen. Examination: T: 36.7℃, R: 25 times/min, HR: 100 times/min, SpO2 : 89%; the patient was clear, shortness of breath, dry rales could be heard in both lungs, complete blood routine, CRP, calcitoninogen, chest CT, pulmonary function and other examinations. Chest CT: as described in the figure, leukocytes, calcitoninogen and CRP were all elevated, and pulmonary function was severe mixed ventilation dysfunction.
II. Treatment history
Combining the patient’s medical history and examination findings, one disease in particular requires attention, namely “interstitial fibrosis combined with interstitial emphysema and pneumoconiosis combined with pulmonary infection”. Therefore, we should focus on asking the patient whether he smokes, whether he has a history of occupational dust exposure, past medical history: more than 20 years of occupational dust exposure, diagnosis of pneumoconiosis stage II, disability level 2, 40 years of smoking, 20 cigarettes per day, hypertension, coronary atherosclerotic heart disease, type 2 diabetes, I told the patient that the diagnosis of interstitial fibrosis combined with emphysema, pneumoconiosis combined with lung infection, chronic acute exacerbation of obstructive pulmonary disease”, this time there was evidence of pulmonary infection, and the patient was at risk of bacterial resistance with repeated antibiotic applications. The patient was given piperacillin tazobactam for injection, intravenous glucocorticoids for anti-inflammation and asthma, intravenous doxorubicin to relieve bronchospasm, intravenous amiloride injection to reduce sputum, and non-invasive assisted ventilation to improve oxygenation. After 3 days of treatment, the symptoms were relieved and the blood count, CRP and PCT were rechecked, and the inflammatory indexes improved significantly. Respiratory function exercise as abdominal breathing, lip contraction deep and slow exhalation to strengthen the activity of respiratory muscles and increase the mobility of diaphragm.
III. Treatment effect
Interstitial fibrosis combined with interstitial emphysema is caused by a combination of smoking, history of occupational disease exposure, environmental and genetic factors, so the first step is to remove the factors that induce aggravation and strengthen the functional exercise of the lungs, lung function can be enhanced as well as muscle exercise. The patient’s oxygenation decreases significantly with non-invasive assisted ventilation; medication is also necessary to relieve bronchospasm in the acute stage, strengthen phlegm and anti-inflammatory treatment, the patient’s wheezing symptoms improve significantly during the treatment period. 14 days later, the outpatient follow-up, wheezing is significantly reduced, it is necessary to maintain the treatment for a period of time, the outpatient follow-up adjusts the treatment, the lung function is rechecked after the symptoms are completely relieved, and the lung function is partially recovered.
IV. Notes
We are glad that the patient’s symptoms were relieved after treatment. Interstitial fibrosis combined with interstitial emphysema, a condition with both obstructive and restrictive lesions, is focused on improving obstructive ventilation dysfunction. To try to avoid acute exacerbation, it is necessary to enhance autoimmune function and perform pulmonary function rehabilitation, and patients can perform abdominal breathing and lip retraction exercises on their own after discharge from the hospital. Secondly, to keep the airway unobstructed, inhibit microsputum formation, and take long-term oral phlegmolytic drugs to release airway spasm and inhibit airway inflammation again. In addition, daily need to quit smoking, pay attention to warmth, avoid cold, prevent cold; improve environmental hygiene, do a good job of personal labor protection, eliminate and avoid the influence of smoke, dust and irritating gas on the respiratory tract.
V. Personal insight
1, education and management of patients with interstitial emphysema is very important. Health education mainly includes advising all patients to avoid exposure to risk factors, recognizing and managing acute attacks, and understanding the timing of hospital visits.
2. recommending increased exercise for pulmonary function, enhanced nutritional support, increased autoimmunity, appropriate exercise, such as respiratory training, such as deep and slow lip retraction abdominal breathing, etc., with a recommended exercise intensity of 60% – 80% of extreme exercise, duration of 5 – 40 minutes, 1-3 times a day, more than 3 times a week.
3, keep the respiratory tract open, long-term oral phlegm medication, can also be nebulized inhalation to wet the airway, physical means can also help patients with chronic obstructive pulmonary clearance of airway secretions.