”World COPD Day (World COPD Day) is a global annual event supported by the World Health Organization (WHO) and celebrated on the third Wednesday of November to raise awareness and focus on COPD among patients and society worldwide. It aims to raise awareness and concern about COPD among patients and society worldwide. For several years, the theme of World COPD Day has been “Breathe Easy, Stop Helpless”, which is based on the significant progress in scientific research on COPD and can be seen as a commitment by the medical community to COPD patients. In other words, the current medical treatment methods have been able to achieve better results for patients with various types of chronic obstructive pulmonary disease. Here I would like to share my personal opinions on several issues of concern to patients. I. Overview of chronic obstructive pulmonary disease: abbreviated as “chronic obstructive pulmonary disease”
The abbreviation “COPD” is a generic term for chronic airway obstructive disease, including chronic bronchitis with airflow obstruction, obstructive emphysema and chronic asthma with inadequate long-term treatment. The central link in the pathogenesis of COPD is chronic airway inflammation caused by smoking and other harmful gases or inhalation particle stimulation. The above pathological phenomena lead to the clinical manifestations of chronic cough and sputum, severe respiratory distress and reduced mobility. Respiratory function is manifested by reduced airflow velocity during forceful exhalation, which is called “airflow obstruction” in medical terminology. This “airflow obstruction” can only be measured by pulmonary function tests, and is the “gold standard” for diagnosing chronic obstructive pulmonary disease. Many patients with chronic obstructive pulmonary disease eventually develop chronic pulmonary heart disease and chronic respiratory failure, resulting in loss of ability to work and care for themselves, and even death. Over the years, the mortality rate of chronic obstructive pulmonary disease has been increasing worldwide, and the World Health Organization (WHO) expects that the global mortality rate of this disease will rise from the sixth place now to the third place by 2020, thus becoming the focus of people’s concern. A recent epidemiological survey in China shows that the prevalence of slow-onset lung among people over 40 years of age in China is currently 8.2%, and it is estimated that there are more than 38 million people with slow-onset lung in China. In China, slow obstructive pulmonary disease has become the number one deadly disease in urban areas and the fourth deadliest in rural areas, and the number of deaths and disabilities due to slow obstructive pulmonary disease in China is more than 1 million and more than 5 million annually, which seriously endangers the health and lives of our people, and its medical costs and other losses related to the disease have become a huge social and personal economic burden. Second, how slow obstructive pulmonary occurs: people know that smoking is the main cause of slow obstructive pulmonary, paper smoke contains a variety of harmful components, such as tar, carbon monoxide, etc.. In fact, in China’s rural and some urban residents in many slow lung patients do not smoke, Zhong Nanshan academician led a survey to confirm that the onset of this part of the population and burning wood stoves and no chimney “anthracite” heating, while indoor ventilation caused by poor living room “small environmental pollution “has a lot to do with. The burning of firewood and coal produces large amounts of sulfur dioxide, nitrogen dioxide, carbon monoxide, and suspended respirable particles. Stimulate the respiratory tract to produce chronic inflammation, the long occurrence of chronic bronchitis, chronic obstructive pulmonary, emphysema. In northern cities, many residents use coal stoves for heating in winter, which also further aggravates the pollution of the urban “environment”. How to Diagnose Chronic Obstructive Lung Among all lung diseases, chronic obstructive lung is the most “silent” “killer”.
As the development of slow obstructive pulmonary disease is a chronic and progressive aggravation process, the early symptoms of chronic bronchitis are only coughing and coughing, most patients do not even realize that they have the disease, but once the symptoms worsen to the point that they feel difficulty in breathing, the condition is already very serious. Therefore, early diagnosis and prevention are very important. Chronic obstructive pulmonary disease is mainly diagnosed by pulmonary function tests. Among the pulmonary function indexes, the first second expiratory volume/exertional spirometry less than 70% is the criterion for diagnosing chronic obstructive pulmonary disease. Pulmonary function test is a non-invasive and painless test. In view of the grim reality that the prevalence rate of slow obstructive pulmonary disease among people over 40 years of age in China is already as high as 8.2%, academician Zhong Nanshan, president of the Chinese Medical Association, strongly advocates that pulmonary function tests should be a routine item in adult health checkups. 45-year-olds and above should undergo pulmonary function tests at hospitals regularly, just like blood pressure measurements, especially smokers and those with a family history of the disease should be “more The lung function test should be performed regularly at the hospital, like blood pressure, especially for smokers and those with family history of the disease. The main measures are smoking cessation and improvement of living and living environment. Smoking is the most important cause of chronic obstructive pulmonary disease, and its progress can be slowed down after quitting smoking. A very influential foreign scientific observation found that those easy patients with slow obstructive pulmonary disease, if they start smoking at the age of 25, they will become patients with slow obstructive pulmonary disease by the age of 45, and will have severe respiratory failure by the age of 60 to 65, and their life expectancy will be less than 70 years on average; however, if these people start to quit smoking at the age of 45 after they have suffered from slow obstructive pulmonary disease, they will generally not have respiratory failure before the age of 85. Life expectancy is not affected. Other researchers have found increased airway resistance in early smokers, with improvements seen six months to one year after quitting in those with relatively mild lung function impairment. The efficacy of any existing drugs is far less than that of smoking cessation, and in the foreseeable future, even the development of science and technology is unlikely to develop more effective drugs than smoking cessation for the treatment of chronic obstructive pulmonary disease. Fifth, the drug treatment of slow obstructive pulmonary For patients who have had slow obstructive pulmonary, it was thought that there is no good treatment measures, but in recent years, with the progress of science and technology, the development of new inhaled long-acting bronchodilators and inhaled pond corticosteroids, and some old drugs such as theophylline for further in-depth research, so that the clinical treatment effect of slow obstructive pulmonary has been greatly improved. At present, with different medication and oxygen therapy measures according to the severity of the disease, it has been possible to at least: significantly reduce the symptoms of dyspnea, reduce the number of acute exacerbations, increase exercise capacity, and improve the quality of life in patients with moderate to severe chronic obstructive pulmonary disease, as expressed in the theme of this year’s “World Chronic Obstructive Lung Day”. “Breathing difficulties are no longer helpless”. 1. Inhaled glucocorticoid therapy; as I mentioned earlier, the central aspect of the pathogenesis of slow obstructive pulmonary disease is the chronic airway inflammation caused by smoking and other harmful gases or inhaled particle irritation, therefore, anti-inflammatory therapy is important. It is important to emphasize that this “inflammation” is different in nature and treatment from the infectious inflammation caused by bacteria. Many domestic and international studies have reported that inhaled glucocorticoids can reduce the level of inflammatory mediators in the lungs and airways and reduce the number of acute exacerbations of chronic obstructive pulmonary disease. The Global Guidelines for the Prevention and Treatment of Chronic Obstructive Lung Disease (GOLD), developed by leading experts worldwide and coordinated by the World Health Organization (WHO), also emphasizes that “Chronic Obstructive Lung Disease (COPD) should be treated by inhaled glucocorticoids.
) also emphasizes that “the presence of inflammation in the airways of chronic obstructive pulmonary disease provides a basis for the use of inhaled hormones, and in symptomatic patients with moderate to severe disease and recurrent exacerbations, the addition of conventional inhaled hormones to bronchodilator therapy can reduce the frequency of acute exacerbations and improve health status”. There may be concerns about adverse reactions to long-term inhaled hormones. In fact, the dose of inhaled hormones is very small, only about 0.5 mg per day, compared to 5 mg for one tablet of oral prednisone. At present, it is believed that even lifelong inhalation of hormones will not cause significant adverse reactions. 2.Inhaled long-acting β2 agonists are considered to be the basic treatment for moderate to severe COPD
The basic treatment of COPD: long-term application is advocated. In addition to dilating the airway, it also has a certain anti-inflammatory effect with it, which can enhance the effect of glucocorticoids. At the same time, glucocorticoids can also increase the expression and activity of β2 receptors, the two have a synergistic effect. 3. tiotropium (trade name Silvana) is currently the only new drug developed specifically for chronic obstructive pulmonary disease: Silvana is a selective cholinergic receptor blocker. the magnitude of FEV1 increase after inhalation of tiotropium in COPD patients is dose-related, even if the conventional dose of FEV1 increases by 15% and lasts up to 15 hours. hours.
Clinical studies have shown that it can significantly improve patients’ symptoms and quality of life, reduce the number of acute exacerbations, and have additive effects with long-acting β2 agonists. 4, theophylline: China’s commonly used is aminophylline. Although theophylline is cheap, but the status in the treatment of chronic obstructive pulmonary cannot be ignored, theophylline itself has an anti-inflammatory effect, and has a synergistic effect with hormones in anti-inflammatory, and the combined application of inhaled hormones produces a 1 + 1 > 2 effect. 5, antioxidant drugs: N-acetylcysteine (NAC) has a strong antioxidant effect, long-term administration without significant adverse effects.
Long-term application of NAC can also inhibit the activation of neutrophils, the production of inflammatory mediators and the adhesion ability of vascular endothelial cells. The combined application of antioxidants, low-dose theophylline and glucocorticoids can significantly increase the anti-inflammatory effect. 6, the concept of “combination therapy”; because the pathology, pathophysiology and clinical symptoms of chronic obstructive pulmonary disease are complex and involve multiple links, the efficacy of single drug therapy is not satisfactory enough, therefore, it is currently advocated to combine several drugs that act on different aspects of the pathogenesis of chronic obstructive pulmonary disease, such as: inhaled hormone (anti-inflammatory effect) + inhaled For example: inhaled hormone (anti-inflammatory effect) + inhaled long-acting β2 agonist (dilate bronchus and improve dyspnea symptoms); inhaled hormone + theophylline can enhance the anti-inflammatory effect; inhaled long-acting β2 agonist + Siliqua can further improve lung function and symptoms. But not the more drugs combined the better, but also take into account the adverse effects of drugs and the increase in cost. In conclusion, current medical science has been able to provide better help for patients with chronic obstructive pulmonary disease, especially those with moderate to severe disease. We wish all COPD patients around the world to “breathe easy and stop being helpless”.