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 rate of death.
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 so far proved effective in delaying progressive decline in lung function is smoking cessation.
2.To enable patients to understand the pathophysiology and clinical basics of COPD.
3. mastering general and some specific treatment methods
4. to learn techniques for self-control of the disease, such as abdominal breathing and lip retraction breathing exercises
5. to understand the timing of visits to hospitals
6. Regular follow-up management by community doctors.
3. Control occupational or environmental pollution
Avoid or prevent dust, smoke and harmful gas inhalation.
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 plan in a timely manner according to the patient’s response to treatment.
1.Bronchodilators: Compared with oral drugs, inhalation agents have fewer adverse reactions, so inhalation therapy is mostly preferred.
The main bronchodilators are β2 agonists, anticholinergics and methylxanthines.
(1) β2 agonists: mainly salbutamol, terbutaline, formoterol, etc.
(2) Anticholinergics: ipratropium bromide, tiotropium bromide .
(3) theophylline drugs, smoking, drinking alcohol, taking anticonvulsants, rifampin, etc. can cause liver enzyme impairment and shorten theophylline half-life; the elderly, persistent fever, heart failure and obvious liver dysfunction, simultaneous application of cimetidine, macrolides (erythromycin, etc.), fluoroquinolones (ciprofloxacin, etc.) and oral contraceptives may increase theophylline blood concentration.
2, glucocorticoids: long-term application of glucocorticoid inhalation therapy in the stable phase of COPD does not stop the trend of its FEV1 reduction. Long-term regular inhaled glucocorticosteroid is more suitable for FEV115 h/d. The purpose of long-term oxygen therapy is to make patients at sea level, at rest, achieve PaO2≥60 mm Hg and/or make SaO2 rise to 90%, so as to maintain the function of vital organs and ensure the oxygen supply of surrounding tissues.
V. Rehabilitation therapy
Rehabilitation therapy can improve the mobility and quality of life of patients with progressive airflow limitation, severe respiratory distress and little activity, and is an important treatment measure for COPD patients. It includes respiratory physiological treatment, muscle training, nutritional support, spiritual treatment and education. Respiratory physiological treatment includes helping patients to cough and exhale forcefully to promote secretion removal, relaxing patients, lip retracting breathing and avoiding rapid shallow breathing to help overcome acute respiratory distress. In terms of muscle training, there are whole-body exercises and respiratory muscle exercises, the former including walking, stair climbing and bicycling, and the latter including abdominal breathing exercises. In terms of nutritional support, an ideal body weight should be required; at the same time, excessive carbohydrate diet and excessive caloric intake should be avoided to avoid excessive carbon dioxide production.
Sixth, surgical treatment
1.Pulmonary herniotomy: In patients with indications, the degree of dyspnea can be reduced and the lung function can be improved after surgery. Preoperative chest CT examination, arterial blood gas analysis and comprehensive evaluation of respiratory function are very important to decide whether to operate.
2.Lung decompression surgery: It is performed by removing part of the lung tissue to reduce lung overinflation, improve respiratory muscle work, and improve exercise capacity and health status, but it cannot prolong the life of the patient. It is mainly applied to a part of patients with obvious non-homogeneous emphysema in the upper lobe, whose exercise capacity is still low after rehabilitation, but its cost is high and it is a kind of surgery of experimental palliative surgery. It is not recommended to be widely used.
3, lung transplantation: for patients with advanced COPD who choose the right one, lung transplantation can improve the quality of life and lung function, but it is technically demanding and costly, so it is difficult to promote its application.