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Abstract: A 58-year-old male patient came to our hospital with worsening symptoms of unprovoked cough, sputum and wheezing. After completing relevant examinations, the results showed that the patient had moderate obstructive pulmonary dysfunction and was diagnosed with compensatory emphysema and chronic obstructive pulmonary disease. After treatment with standard medication and respiratory function exercise, the patient’s condition was controlled and stabilized, and symptoms such as cough, sputum and wheezing were significantly reduced.
Basic information】Male, 58 years old
Disease Type】Compensatory emphysema
Hospital】Tianjin Third Central Hospital
Date of Consultation】August 2021
Treatment plan】Medication (montelukast sodium tablets, theophylline extended-release tablets, pulmonary cough capsules) + rehabilitation training (abdominal breathing, lip-reduction breathing)
【Treatment period】After 1 week of outpatient medication, the patient was rechecked again after 1 month.
Treatment effect】The condition was basically controlled, and the symptoms of coughing, coughing and wheezing were significantly reduced.
I. Initial consultation
The patient, Mr. Huang, 58 years old, has had intermittent cough, sputum and wheezing for 5 years, and his symptoms worsen every year when the seasons change. The patient complained of no cold or exertion, no patients with respiratory tract infection in the vicinity, no hemoptysis, and no improvement after taking medication on his own. The patient’s body temperature was 36.7℃, respiration was 20 times/min, heart rate was 82 times/min, oxygen saturation was 94%, the patient was clear, shortness of breath; dry rales could be heard in both lungs, complete blood routine, CRP, calcitoninogen, chest CT, pulmonary function and other examinations. The results showed that leukocytes, calcitoninogen and CRP were not increased, and chest CT showed no lamellar hyperdensity shadow, and multiple emphysema was seen; the results of pulmonary function tests were moderate obstructive pulmonary dysfunction, and compensatory emphysema and chronic obstructive pulmonary disease were considered.
II. Treatment history
The patient had a smoking history of 40 years, with an average of 30 cigarettes per day, and had previously been engaged in welding for more than 20 years. At present, he could basically be diagnosed with compensated emphysema and acute exacerbation of chronic obstructive pulmonary disease, and this time there was no evidence of infection, which was considered dominated by seasonal factors. The patient was then instructed to quit smoking and given oral montelukast sodium tablets, theophylline extended-release tablets, and pulmonary cough capsules as a comprehensive treatment, along with respiratory function exercises, doing abdominal breathing and lip contraction breathing to strengthen the respiratory muscles and increase the mobility of the diaphragm.
III. Treatment effect
The patient’s outpatient follow-up after 7 days indicated that the symptoms of cough, sputum and wheezing were significantly reduced, and the condition was basically stable without other complications. The patient continued to adhere to smoking cessation, and after 1 month, the cough and sputum were basically relieved, and the lung function results showed that the lung obstruction had improved and the lung function had basically returned to normal, and the patient was very satisfied with the treatment results.
IV. Precautions
We are glad that the patient’s condition is controlled and stable, but we still need to advise the patient to pay attention to adhere to abdominal breathing and lip retraction breathing training, which can help maintain normal ventilation. Also prohibit smoking again, avoid inhaling second-hand smoke or going to places with a lot of smoke and dust, pay attention to keeping warm, avoid getting cold, prevent colds, and do personal labor protection to help protect the respiratory system and avoid recurrence of the disease.
V. Personal insight
Compensated emphysema is mainly due to lung expansion triggered by volume reduction due to damage that has occurred in the lung tissue. The cause of the disease in this patient is directly related to the long-term habit of heavy smoking, so to treat the disease, it is crucial to quit smoking, to standardize treatment, and to adhere to pulmonary function exercises in order to help maintain a better state of lung function. It can be combined with whole-body exercise, such as brisk walking, jogging, going upstairs and pedaling, etc. are recommended.