(Health Times reporter Wang Zhenya Chen Linhui) Since the beginning of winter, COPD patients have ushered in a "difficult winter". According to the Chinese Academy of Engineering academician Wang Chen and others published in the Lancet "China's ** Lung Health Research", the number of COPD patients in China is 99.9 million, and there is 1 COPD patient in every 4 people over 60 years old, with an average of about 2 per minuteFive people died from COPD. With high prevalence, high mortality and high disease burden, it is difficult for patients to persist in the prevention and treatment of COPD.
99.9 million COPD patients, "pain from not being able to breathe".
Zhang Ming (pseudonym) from Xingtai City, Hebei Province, every year after a cold, the cough is not easy to get better, this year the flu is better, the cough is not better, a check only to know that it is COPD.
COPD is known as the "silent killer", dyspnea, chronic cough, and sputum production are the most common symptoms of COPD, and may also be accompanied by symptoms such as chest tightness and wheezing, and patients with severe COPD often have symptoms such as fatigue, weight loss, and loss of appetite.
Long Fa, director of the Department of Respiratory and Critical Care Medicine at Shenzhen Hospital of the University of Chinese Academy of Sciences, said that many patients have no obvious symptoms in the early stage, and when they come to the hospital after dyspnea or shortness of breath, they are often in the middle and late stages after pulmonary function tests. Since it is not yet clear, COPD is currently unable to do so, and it is mainly focused on controlling and alleviating the symptoms and delaying the development of the disease.
Although COPD is "slow", prevention and ** cannot be "slow".
Yang Ting, deputy director of the Respiratory Center of the China-Japan Friendship Hospital, told reporters that the prevalence of COPD in people over 40 years old in China is 137%。
COPD is all about slowly tormenting you, pumping out oxygen little by little, so that you can't breathe. As a patient with severe COPD, Zhang Bing (pseudonym) has been rescued three times in a month, he said, "Usually, my chest is like pressing against a stone, and it is difficult to breathe in air with my mouth wide open." As soon as it was serious, the feeling of suffocation hit, and it hurt my head and made it even more uncomfortable. ”
In winter, the ventilator is turned on earlier than the heater.
Oximeters, portable oxygen concentrators, home ventilators, air purifiers, ......This is a medical device that an elderly COPD patient needs on a daily basis.
As soon as the weather cooled down in winter, Zhang Bing started using the ventilator at home early, he said, "Every winter, the ventilator is turned on earlier than the heating. ”
Many patients with COPD will have an acute exacerbation in autumn and winter, because the climate change is more obvious during this time, and they are prone to acute exacerbations caused by colds, colds, or airway sensitivities. Long Fa said.
For COPD patients, there are three main stimuli in winter, including cold stimulation, pathogen infection, and environmental pollution, which may lead to aggravation of the disease.
In winter, the temperature is low, and the cold air can stimulate the glands on the airway mucosa, resulting in increased mucus secretion of the glands and weakened ciliary movement, and the blood vessels of the airway mucosa are in a state of contraction under the stimulation of cold, which makes the local blood circulation of the airway mucosa impaired, and the airway mucosa cannot get sufficient blood** and malfunctions, resulting in the aggravation of chronic obstructive pulmonary disease.
At the same time, winter is the active period of various pathogens, especially viruses, patients with chronic obstructive pulmonary disease are prone to upper respiratory tract infections, such as influenza virus, rhinovirus, adenovirus, respiratory syncytial virus, etc., which are easy to invade the airway mucosa, resulting in airway tube mucosal damage, and the above-mentioned pathogens proliferate in the airway mucosa and produce infection, which can stimulate airway mucosal congestion, edema, airway lumen narrowing, poor ventilation of patients, and aggravation of chronic obstructive pulmonary disease.
Infection is the leading cause of acute exacerbations in patients with COPD, with 78% of patients with exacerbations having a viral or bacterial infection. In addition to paying attention to cold and warmth, wearing masks reasonably, maintaining social distancing, and avoiding crowded places, the most effective means are to get influenza and pneumonia vaccines. Liu Dan, director of the Department of Respiratory and Critical Care Medicine at West China Hospital of Sichuan University, said that COPD patients can complete the influenza vaccine every year before the local influenza season, and the pneumonia vaccine can be vaccinated every five years.
COPD is most likely to be acutely attacked. According to Longfa, the "2022 Global Strategy for the Diagnosis, ** and Prevention of Chronic Obstructive Pulmonary Disease (COPD)" divides COPD into four grades: A, B, C, and D according to the severity of the disease. Clinically, many patients are already above grade C when they seek medical diagnosis, and their condition is relatively serious. Patients with COPD above grade C may have a decline in lung function if they have more than 2 acute attacks per year. With each acute attack, the lung function is ** a step, and it is difficult to return to the original level.
There are ways to prevent COPD, but the most difficult thing is to stick to it.
The most typical symptom of COPD patients in the advanced stage is that they cannot breathe, even if they sit or lie down. "They can't breathe in, they can't breathe out, they have oxygen tubes in their noses, and their mouths are wide open. Long Fa told the Health Times reporter that whenever he saw a terminal patient who was even breathing painfully, his heart was pinched.
But in fact, in winter, it is not difficult to prevent acute exacerbations of COPD. A number of doctors told the Health Times reporter that COPD prevention is difficult to adhere to.
Liu Dan believes that smoking is an important genogen of COPD, which can not only promote the occurrence of COPD, but also lead to aggravation of the disease. It is very important for people with COPD to quit smoking.
Patients with COPD are prone to respiratory infections due to their poor lung resistance.
In addition to measures such as quitting smoking and getting a flu vaccine, people with COPD need to improve their quality of life through active training.
Liu Dan introduced that ** training is mainly divided into breathing training and physical training.
Breathing exercises include pursed lip breathing and abdominal breathing exercises.
Pursed lip breathing is to inhale through the nose and exhale slowly with a pursed lip like whistling, so that the candle flame at a distance of 30 cm from the lips and the same height point as the lips is tilted with the air flow and does not go out, 3 times a day, for 30 minutes each time.
Abdominal breathing exercises, the patient takes a standing position, can also sit or lie on his back, relax and take deep breaths, try his best to support the abdomen when inhaling, invert the abdomen when exhaling, try to exhale the breath, generally inhale for 2 seconds, exhale for 4 6 seconds, keep the breathing rate at 7 8 times per minute, start 2 times a day, 10 15 minutes each time, and increase after proficiency.
Physical exercise includes a variety of gymnastic activities including chest expansion, bending, squatting and limb exercises, as well as aerobic physical exercises such as walking, climbing slopes, climbing stairs and jogging. However, be careful to do what you can when doing these exercises, and gradually increase the amount of exercise, depending on how well your body can tolerate it.
For people aged 40 and older, it is best to have their lung function checked every year.
The situation of COPD prevention and control is severe, and in addition to the characteristics of "three highs", there are also characteristics of "three lows".
Yang Ting told the Health Times reporter, "First, the public awareness rate is low, and the awareness rate of COPD is less than 10%;Second, the rate of pulmonary function tests is low, and epidemiological surveys have found that only 5% of those who have done pulmonary function tests have done it beforeThird, the standard rate is low, especially at the grassroots level. For example, the first choice of drugs for COPD is inhaled drugs, but the most commonly used drugs at the grassroots level are antibiotics, expectorants, and even oral hormones. ”
Yang Ting introduced that to prevent the occurrence or aggravation of COPD, patients must pay attention and do not stop taking the drug as soon as the symptoms are controlled. COPD is a chronic disease like hypertension and diabetes. Medications can improve symptoms, improve lung activity tolerance, and slow the decline in lung function, but lifelong medication is required.
Some patients find the device cumbersome to use and are reluctant to use inhaled drugs. Inhaled drugs can be brought directly into the airway through breathing, work at the site of the lesion, and have a rapid onset of action, and inhaled drugs are recommended for patients with COPD**. Moreover, the medication for COPD is inhaled hormones, which are used in small amounts and are mainly deposited into the lungs through inhalation devices, which are very low.
On November 21, the patient waited outside the respiratory clinic of the Third Affiliated Hospital of Beijing University of Chinese Medicine. Photo by Chen Linhui.
Yang Ting reminded that patients with COPD who have been diagnosed must quit smoking.
The "Happy Breathing" China COPD Standardized and Graded Diagnosis and Treatment Promotion Project, the "National Debt Project" Grassroots Respiratory Disease Early Screening and Intervention Ability Improvement Project, and the National COPD High-risk Groups Early Screening and Comprehensive Intervention Project have been organized and undertaken by the National Center for Respiratory Medicine, and the practice and exploration of the COPD early prevention and early treatment management system have been carried out across the country. These projects have reached nearly 300 million people. A total of more than 2.8 million people have been screened for COPD, more than 210,000 COPD patients and high-risk groups have been standardized, 1,830 training sessions for medical personnel at all levels and grassroots respiratory chronic disease prevention and treatment personnel have been carried out, and more than 1,200 sessions of chronic obstructive pulmonary disease health education have been carried out for residents20,000 people.
Many experts reminded that high-risk groups and patients who have been diagnosed with COPD should check their lung function regularly like monitoring their blood pressure, and it is best to check lung function every year for people aged 40 and above, so as to detect and treat early.
This year's flu vaccine has been given. Li Hua (pseudonym), a patient with COPD, told the Health Times reporter that every year the community will notify the community that the vaccination is very timely. At 10 a.m. on November 21, after a 20-minute consultation, the doctor prescribed Li Hua some traditional Chinese medicine for conditioning, and at the same time told her the breathing training method, "The breathing method is very simple, and I will start practicing when I go home." ”
With regular check-ups, medication and training, I hope that in the next winter, COPD patients such as Li Hua, Zhang Bing, and Zhang Ming will no longer suffer from "breathing pain".