Popular Science Article丨COPD should not be “taken lightly”, how should daily rehabilitation management be done?

COPD is one of the most common chronic diseases in the world, with nearly 100 million patients in my country. The mortality rate of a single disease ranks third. It will be included in the national chronic disease management in 2024.

"Coughing, sputum production, and difficulty breathing" are typical symptoms of chronic obstructive pulmonary disease (COPD), a heterogeneous lung disease caused by bronchitis, bronchiolitis, or emphysema that leads to persistent airflow obstruction.

High-risk factors for COPD include:

Environmental factors : smoking, biomass exposure (wood burning), occupational exposure (dust chemicals)

Genetic factors : Gene mutations leading to alpha-1 antitrypsin deficiency

Developmental and aging factors : Premature birth leads to pulmonary hypoplasia

Infection and disease factors: asthma and airway hyperresponsiveness, chronic bronchitis, infection

Many patients have no symptoms or very mild symptoms in the early stage, but once obvious symptoms (cough, sputum, wheezing) appear, their lung function is often at least 30% lower than that of normal people, and they lose the most precious treatment opportunity. So far, there is no cure for COPD, but the quality of life of patients can be significantly improved through early screening, early diagnosis, and early intervention.

Pulmonary function screening is the gold standard for diagnosing COPD. It is the most direct means of understanding lung function. It is also a non-invasive, repeatable, cheap and easily accessible examination method. It is a lung function blowing test conducted under the guidance of medical staff. The National Health Commission calls for adults over 40 years old to have their lung function checked every year.

Usually, to diagnose COPD, it is necessary to complete the same test again after inhaling a bronchodilator after regular exhalation to ensure that there is fixed airflow obstruction. Currently, the international general guidelines use FEV1/FVC < 70% as the standard for whether COPD is diagnosed :

If the lung function report shows that FEV1/FVC is less than 70%, then COPD is diagnosed. There is currently no treatment that can reverse lung function, but the trend of continued deterioration of lung function can be slowed down through a variety of means. For example, quitting smoking is the most critical intervention measure for all smoking COPD patients; and standardized inhalation therapy can allow drugs (LABA, etc.) to act directly on the small airways, with good efficacy and low side effects, and can control the progression of the disease for a long time. It is currently considered to be the most effective way to treat COPD; it is recommended that COPD patients receive regular influenza and pneumonia vaccines , which can effectively reduce lung infections; a reasonable diet, increase the intake of high-quality protein, such as fish, shrimp, eggs, milk, etc., reduce the intake of salt and sugar in food, and supplement more vegetables rich in vitamins and dietary fiber, which can alleviate the negative nitrogen balance of the human body caused by COPD consumption.

In addition, daily rehabilitation management of COPD is simple and effective , but rehabilitation management is not achieved overnight. It usually takes more than 8 weeks of exercise to see significant changes. Training methods include:

1. Breathing training

Learn abdominal breathing, pursed lip breathing and other training methods under the guidance of a rehabilitation therapist.

2. Physical training

Follow the exercise prescription designed by the rehabilitation therapist to exercise regularly. The exercise prescription includes:

Exercise frequency: 5 to 7 aerobic training sessions per week or 3 to 5 strength training sessions per week;

Exercise forms: aerobic training such as jogging, swimming, cycling, etc., strength training such as lifting dumbbells, pulling elastic bands, etc.;

Exercise intensity: target heart rate = (220-age) * (60%-80%);

Exercise time: 30 to 40 minutes each time, 5 minutes of warm-up and 5 minutes of relaxation.

COPD is divided into a stable phase and an acute exacerbation phase. The acute exacerbation phase refers to the onset of dyspnea, worsening cough and sputum production, accompanied by shortness of breath or tachycardia within 14 days. Once the above symptoms are found, you need to go to the respiratory department immediately and be included in the rehabilitation medicine department for early management.

END

Author: Xu Yihao (Rehabilitation Therapist at Jiangwan Hospital, Hongkou District, Shanghai)

Reviewer: Luo Zhendong (Honorary Director of the Rehabilitation Medicine Department of Jiangwan Hospital, Hongkou District, Shanghai, and Standing Committee Member of the Medical and Health Integration Working Committee of the Chinese Rehabilitation Medicine Association)

Editor: Jia Jing (Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine)