I. Purpose of treatment
1.Reduce the symptoms and stop the progression of the disease.
2.Relieve or stop the decline of lung function.
3.Improve mobility and improve quality of life.
4.Reduce the death rate of the disease.
Education and management
Education and management can improve patients’ and related personnel’s understanding of COPD and their ability to deal with the disease, better cooperate with treatment and strengthen preventive measures, reduce recurrent exacerbations, maintain the stability of the disease and improve the quality of life. The main contents include.
(1) Educating and urging patients to quit smoking, the only measure that has proven effective in delaying progressive decline in lung function to date is smoking cessation.
(2) To enable patients to understand the pathophysiology and clinical basics of COPD.
(3) To master general and some specific treatments.
(4) To learn techniques for self-management of the disease, such as abdominal breathing and lip retraction breathing exercises
(5) To understand the timing of hospital visits.
(6) Regular follow-up management by community doctors.
(3) Control occupational or environmental pollution
Avoid or prevent the inhalation of dust, fumes and harmful gases.
IV. Medication
Drug therapy is used to prevent and control symptoms, reduce the frequency and severity of acute exacerbations, and improve exercise endurance and quality of life. According to the severity of the disease, gradually increase the treatment, if there is no obvious adverse drug reactions or deterioration of the disease, should be maintained at the same level of long-term regular treatment. Adjust the treatment regimen in a timely manner according to the patient’s response to treatment.
Bronchodilators: Bronchodilators can relax bronchial smooth muscle, dilate bronchi and relieve airflow restriction, and are the main therapeutic measures to control COPD symptoms. Short-term on-demand application can relieve symptoms, and long-term regular application can prevent and reduce symptoms and increase exercise tolerance, but cannot improve FEV1 in all patients. Compared with oral drugs, inhalation agents have fewer adverse effects, so inhalation therapy is mostly preferred.
1.Treatment of acute exacerbation of COPD
(1) Determine the cause of acute exacerbation of COPD
The most common cause of COPD exacerbation is tracheobronchial infection, mainly viral and bacterial infection. The cause of exacerbation is difficult to determine in some cases, and changes in environmental physicochemical factors may play a role. Pneumonia, congestive heart failure, arrhythmia, pneumothorax, pleural effusion, pulmonary thromboembolism, etc. can cause symptoms that resemble an acute COPD attack and need to be carefully identified.
(2) Diagnosis and severity evaluation of acute exacerbation of COPD
The main symptoms of COPD exacerbation are increased shortness of breath, often accompanied by wheezing, chest tightness, increased cough, increased sputum volume, change in sputum color and/or viscosity, and fever, etc. In addition, symptoms such as general malaise, insomnia, drowsiness, fatigue and depression, and mental disorders may also occur. Decreased exercise tolerance, fever and/or abnormal chest imaging may be signs of COPD exacerbation. Increased shortness of breath, increased sputum in the cough and the presence of purulent sputum often suggest bacterial infection.
Comparison with pre-exacerbation history, symptoms, signs, pulmonary function measurements, arterial blood gas tests and other laboratory tests is important to determine the severity of COPD exacerbations. Particular attention should be paid to the time of the current exacerbation or new symptoms, the severity and frequency of shortness of breath and cough, the volume and color of sputum, the degree of restriction of daily activities, whether edema has occurred and its duration, the condition of previous exacerbations and the presence of hospitalization, and the current treatment plan. Pulmonary function and arterial blood gas results during the current exacerbation compared with previous ones can provide extremely important information, and acute changes in these indicators are more important than their absolute values. In patients with severe COPD, changes in mental status are an indicator of deterioration and criticality and require prompt hospitalization if they occur. The presence of auxiliary respiratory muscles involved in respiratory movements, thoracoabdominal paradoxical breathing, cyanosis, peripheral edema, right heart failure, and hemodynamic instability are also helpful in determining the severity of COPD exacerbations.
Pulmonary function measurements: In patients with exacerbations, it is often difficult to complete pulmonary function tests satisfactorily.