1.Keeping respiratory hygiene Keeping respiratory hygiene includes: (1) Keeping the mouth clean: Lung infections in middle-aged and elderly people are mostly caused by unclean mouth. Patients can keep their mouth clean by gargling with saline after brushing their teeth three times a day, which can effectively prevent respiratory infections and thus reduce the number of acute attacks in COPD patients. (2) Effective sputum removal methods:
① Ask the patient to sit or stand, hold the breath after deep inhalation, the body side to
Then open the mouth and cough twice in a row, contract the abdominal muscles when coughing, and keep pressing the abdomen with both hands while coughing, and after stopping coughing, contract the lips and exhale the remaining air as much as possible, and return the body to the position. Repeat the above actions 2 to 3 times after a few minutes of rest. ②Explosive coughing: first deep inspiration followed by closure of the vocal chambers, followed by a sudden contraction of the pleura and a cough that rushes out the airflow. ③Vocal cough: Ask the patient to inhale deeply and then open the mouth to keep the vocal chambers open and then cough. Encourage patients to change position frequently, assist them to pat their backs, and cooperate with ultrasonic nebulization or air compression pump nebulized inhalation of phlegm-suppressing and anti-inflammatory drugs. 2, dietary guidance COPD patients are mostly malnourished, therefore, scientific diets should be guided. In addition to easily digestible foods containing carbohydrates to ensure calories, high protein foods should be consumed and vitamin A should be supplemented, fresh green vegetables, fruits, lean meat, milk, eggs, etc. should be consumed. Encourage patients to drink water several times in small amounts, at least 1500ml per day, to dilute sputum and facilitate discharge; eat less and more meals to avoid aggravating wheezing and suffocation. According to the specific situation of the patient, encourage appropriate activities, such as tai chi, walking, doing some activities within their ability, etc.; smoking patients are advised to quit smoking and develop good living habits. If blood carbon dioxide increases, sugar intake should be appropriately limited to avoid excessive carbohydrate diet and excessive caloric intake, otherwise excessive carbon dioxide can be produced, leading to carbon dioxide retention and aggravating the condition. Because COPD patients are older, mostly elderly, attention should be paid to low-fat diet, especially for patients with hypertension, coronary heart disease and other diseases. 3, exercise guidance Long-term inactivity will lead to a decrease in exercise endurance and more pronounced respiratory dysfunction, forming a vicious circle. Moderate exercise training can improve the blood flow and oxygen utilization rate of muscles, improve the motor function and endurance of respiratory muscles, and thus improve the symptoms. For different patients, different training plans should be developed, and appropriate exercise methods and intensities should be selected in a gradual manner. According to the guidance of the American College of Sports Medicine (ACSM), during whole-body exercise, the intensity of exercise reaches 60% to 90% of the expected maximum heart rate, lasting 20 to 45 min, 3 to 5 times a week. 4.Guidance on respiratory function exercise 4.1 Abdominal breathing training Take an upright position (semi-recumbent or sitting position for the frail), and place the left and right hands on the abdomen and chest, respectively. Relax the muscles of the whole body and breathe at rest. Inhale with the nose, try to hold the abdomen, the chest does not move; exhale with the mouth, while contracting the abdomen, chest wide to maintain the minimum range of activity. Slow exhalation and deep inhalation to enhance alveolar ventilation. Breathing frequency 7-8 times / min. repeated training, 10-20 min / time. After proficiency, gradually increase the number and time, so that it becomes a conscious breathing habit. 4.2 Lip retraction breathing training Instruct the patient to inhale with gas entering through the nostrils and exhale with lips retracted like whistling, and continue to exhale slowly while contracting the abdomen. The ratio of inhalation to exhalation time is 1:2 or 1:3, 10 min each time, 3 to 4 times a day. The degree of lip contraction and exhalation flow is adjusted by the patient’s choice, so that the flame of the candle at 15-20 cm from the lips, at the same height as the lips, can be tilted and not extinguished. Long-term implementation of this method can improve the patient’s respiratory function and help the body’s CO2 discharge. 5.Oxygen therapy guidance For the very severe COPD generally advocate continuous low-flow oxygen, oxygen flow 1 ~ 2L/min, FIO2
At the same time, attention should be paid to the timely cleaning of nasal secretions to maintain effective oxygen inhalation, in order to improve the symptoms of hypoxia, increase exercise tolerance, reduce respiratory distress, relieve pulmonary hypertension, and delay the development of the disease process.