How can I be guided through the stabilization phase of COPD?

Chronic obstructive pulmonary disease (COPD) is a common chronic disease characterized by chronic bronchitis and/or emphysema with airflow obstruction that can progress further to pulmonary heart disease and whistle failure. It is associated with an abnormal inflammatory response to harmful gases and harmful particles, and has a high disability and mortality rate, with a global prevalence of 9% to 10% over the age of 40. Patients with acute exacerbation of COPD enter the stabilization phase after treatment, and the management of the stabilization phase is very important for COPD patients. Good management can prevent the progressive development of COPD. But how to provide guidance for COPD stabilization and how to help patients to perform pulmonary rehabilitation accordingly? Whistle training: (1) lip contraction whistle method: quickly take a full breath, whistle like a whistle slowly “blow” out. This method can prevent premature collapse of the airway and small airways due to high intrapulmonary pressure, promote the discharge of gas in the alveoli, so as to inhale more fresh air to relieve hypoxia. (2) Cue whistling method: mainly using tactile induction of abdominal whistling. (3) slow whistling: inhalation whistling, evenly and slowly, it is best to mobilize both thoracic whistling and abdominal whistling. This method helps to reduce anatomical dead space and improve ventilation. (4) Diaphragmatic external counterpulsation method: Enhancement of diaphragmatic contraction through phrenic nerve electrical stimulation technique. This method requires the use of low-frequency electrical pulses or an extracorporeal diaphragmatic counterpulsation device. Patients with stable chronic obstructive pulmonary disease have varying degrees of inspiratory weakness, and inspiratory training is also important for the rehabilitation of stable patients. In a study by Feng et al, patients with stable COPD showed significant improvements in whistle frequency, arterial blood gas analysis, 6MWD, and dyspnea score after whistle training compared to the control group. Sputum drainage training: A combination of sputum drainage, chest percussion, cough promotion and nebulizer inhalation is often used to promote sputum drainage and airway clearance. In addition, physical factors such as ultrasound nebulization and ultrashort waves have anti-spasm and anti-inflammatory effects and are beneficial for cilia protection and coughing up sputum. Exercise training: Exercise training is the core of pulmonary rehabilitation treatment, mainly involving the mode, intensity, frequency and duration of exercise. (1) Lower extremity exercise: commonly used methods include brisk walking, jogging, rowing, cycling, climbing, etc. For better conditions, treadmill and power bike exercise trials can also be performed. dodia et al. found that patients’ 6MWD and emotional status improved significantly after aerobic exercise. (2) Upper extremity exercise: Aerobic exercise of the upper extremities helps to produce more coordinated movements of the whistling muscles, which helps to whistle, improves the efficiency of the whistling muscles and increases the effect of ventilation and symptom relief. (3) Endurance and strength training: Strasser et al. concluded that progressive strength training not only improves muscular strength of skeletal muscles, but also enhances patients’ exercise capacity, thus improving their quality of life. Exercise intensity is directly related to the efficacy of pulmonary rehabilitation therapy. Initially, patients can tolerate exercise, and then gradually increase the duration and intensity of exercise. The intensity of exercise is between 50% of maximum oxygen consumption and 60% to 80% of maximum tolerance values. Studies have shown that low-intensity exercise training can improve symptoms and quality of life in stable patients and improve the ability to perform daily activities; exercise training can also improve the quality of life of patients with better results in the long term. Nutritional support: Chronic obstructive pulmonary disease has a long and recurrent course, and patients have different degrees of malnutrition, and severe malnutrition can affect the condition and prognosis. The basic principles of nutritional support: (1) Diet should be rich in protein, low in fat and carbohydrate. (2) The caloric ratio of protein, fat and carbohydrate is 20%, 20%-30% and 50%-60%, respectively. The food intake is 1.5-2 g/(kg-d). (3) Daily multivitamin and trace elements supplementation. One study found that serum transferrin, prealbumin, albumin and body mass index were significantly increased after nutritional therapy in stable COPD patients, suggesting that nutritional support has a role in the recovery of stable COPD. In conclusion, pulmonary rehabilitation for patients with stable COPD is a comprehensive treatment based on evidence-based medicine, including treatment methods such as whistle training, exercise training, sputum excretion training, and nutritional support. Among them, whistle training is the core, and exercise training, sputum elimination training and nutritional support are important components. However, there is still a large gap in the rehabilitation of stable COPD. Most patients do not receive meaningful pulmonary rehabilitation guidance, therefore, patients in the stable phase need medical staff to develop scientific and reasonable interventions and establish a comprehensive rehabilitation intervention program to improve the quality of life of patients with COPD.