Frequent coughing and chest tightness? Beware of this "fatal suffocation"

In early winter, Chengdu was hit by a sudden drop in temperature, making people shiver. The corridor of the respiratory medicine clinic gradually became crowded. For patients with poor lung function, the cold winter is like a "tribulation".

Fish Leong's song tells us: "Missing is a pain that can breathe, it lives in every corner of my body~". Do you know what is the pain that can't breathe?

The answer is: COPD!

Some people may feel that they have never heard of the disease "COPD", but when it comes to chronic bronchitis and emphysema, everyone is more familiar with them.

COPD - the silent killer of respiratory diseases

COPD, the full name of which is “chronic obstructive pulmonary disease”, is a common, preventable and treatable chronic airway disease.

Slow: refers to chronic diseases (slow onset, prolonged course, and persistent existence);

Obstruction: airflow obstruction (airway obstruction, exhalation obstruction);

Lung: refers to various diseases that affect the lungs. COPD specifically refers to diseases that affect the airways and alveoli.

COPD is characterized by persistent airflow limitation and corresponding respiratory symptoms (dyspnea, cough, sputum, etc.).

Simply put, it means that the air cannot flow in and out of the lungs smoothly, and there is a "traffic jam". When the airway is inflammatory, long-term inflammatory stimulation will cause a series of pathological changes in the airway, including airway epithelial hyperplasia, thickening and narrowing of the tube wall, and then lead to airway obstruction. This is just like the traffic situation. The more vehicles on both sides of the road, the more likely it is to be congested. When the airway is blocked, the airflow cannot flow smoothly, which naturally makes people feel breathless.

In addition, in the lung tissue of COPD patients, proteases and anti-proteases are in an unbalanced state. The relative increase in proteases destroys the elastin in the lung connective tissue and reduces the elastic recoil of the alveoli, so that the gas cannot be completely discharged. Some thinner bronchi and alveoli become enlarged, causing emphysema and further developing into COPD.

The onset of COPD is related to significant exposure to harmful particles or gases such as cigarette smoke. Host factors can also cause individuals to develop COPD, including genetic abnormalities, abnormal lung development, and accelerated aging.

The disease usually occurs in middle age and is more common in the cold seasons of autumn and winter.

In summary, COPD is a long-standing lung disease that causes airflow limitation and mainly affects respiratory function.

COPD, atypical early symptoms

The main symptoms of COPD are chronic cough, sputum and dyspnea. In the early stage of COPD, patients may not have obvious symptoms. As the disease progresses, cough and sputum appear. Therefore, in reality, many COPD patients wait until they have obvious symptoms before going to the hospital for treatment, and then they miss the opportunity for early treatment. In the later stage of the disease, dyspnea is the main symptom.

Symptom characteristics and evolution:

①Chronic cough: It is a common symptom of COPD. The cough symptom appears slowly and lasts for many years, mainly in the morning and at night.

② Coughing and sputum: It is often accompanied by coughing, and the sputum is often white muco-serous. It often occurs in severe coughing paroxysms when getting up in the morning. The symptoms will be relieved after coughing up more muco-serous sputum. During acute exacerbations, the sputum may become mucopurulent and difficult to cough up.

③ Shortness of breath or difficulty breathing: In the early stage, it only occurs during exertion, and then gradually worsens, so that difficulty breathing is felt during daily activities or even resting; difficulty breathing after activity is the "signature symptom" of COPD.

④ Chest tightness and wheezing: Some patients have obvious chest tightness and wheezing, which are not specific symptoms of COPD and are common in patients with severe or acute exacerbations.

⑤ Fatigue: Due to difficulty breathing and insufficient oxygen supply, patients often feel tired.

⑥Recurrent respiratory tract infections: COPD patients are more likely to suffer from respiratory tract infections such as pneumonia and bronchitis.

High risk factors for COPD

1. Smoking: Smoking is the main environmental risk factor for COPD. Smokers are 2-8 times more likely to develop COPD than non-smokers. The longer you smoke and the more you smoke, the higher your chance of developing COPD.

2. Air pollution: When the concentration of PM2.5 in the air increases by 10 μg per cubic meter, the hospitalization rate for COPD increases by 3.1% and the mortality rate increases by 2.5%. In haze weather, try to reduce going out. If you must go out, wear a special mask.

3. Occupational exposure: Long-term exposure to dust and harmful gases will also increase the risk of COPD. Protective equipment should be used correctly at work to reduce the harm of dust and harmful gases to the human body.

4. Genetic factors: In families with severe COPD and smoking, airflow obstruction has a significant familial risk. In addition, α-1 antitrypsin deficiency is a known genetic risk factor.

5. Age and gender: Age is a risk factor for COPD. The older you are, the higher the prevalence of COPD. Reports on the difference in COPD prevalence between men and women are inconsistent, but some literature reports that women are more sensitive to the harm of tobacco smoke.

6. Bronchial asthma, airway hyperresponsiveness, and chronic respiratory tract infections: Asthma can not only coexist with COPD, but is also a risk factor for COPD. Airway hyperresponsiveness is also involved in the pathogenesis of COPD; repeated respiratory tract infections may increase the risk of COPD, especially in childhood.

How to treat COPD?

Pulmonary function tests are considered the "gold standard" for the diagnosis of COPD. They are a safe, simple, non-invasive, non-radioactive, and rapid diagnostic test.

This test uses a spirometer to measure the forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). If the FEV1/FVC ratio is less than 70% after inhalation of bronchodilators, it is considered to be the presence of persistent airflow limitation, which is the lung function standard for diagnosing COPD.

Treatments for chronic obstructive pulmonary disease (COPD) mainly include the following:

1. Medication

① Bronchodilators: such as short-acting and long-acting β2 agonists and anticholinergic drugs, which can relieve shortness of breath and rapid breathing by dilating the airways.

② Inhaled steroids: used to relieve airway inflammation and reduce airway mucus secretion, usually used in combination with bronchodilators.

③Phosphodiesterase-4 inhibitors: can be used to reduce the risk of acute exacerbations.

④ Targeted therapy with biological agents such as dupilumab.

2. Oxygen therapy: Because COPD patients have impaired lung function, the oxygen content in the blood may be reduced. Oxygen therapy helps to increase blood oxygen levels and relieve shortness of breath and other symptoms by giving additional oxygen.

3. Pulmonary rehabilitation: including exercise training, nutritional guidance and disease management education, through the planning of individualized exercise plans to improve lung function, enhance muscle strength, thereby reducing dyspnea and improving quality of life.

4. Quit smoking: For smokers, quitting smoking is the most important intervention measure that can slow down the progression of the disease.

5. Surgical treatment: In some cases, lung volume reduction surgery or lung transplantation may be considered, especially for severe patients.

6. Management of acute exacerbations: including the use of antibiotics, oral steroids, etc. to treat the symptoms of acute exacerbations.

Doctors emphasize that treatment plans are usually individualized according to the patient's specific situation and the severity of the disease. Here are some practical self-management suggestions for COPD patients, which will help you gradually improve your health and life:

01Quit smoking and avoid smoke

Smoking is the most important environmental risk factor for COPD, so quitting smoking is the most important step for all COPD patients. Try to avoid secondhand smoke and indoor air pollution, such as fuel fumes and chemical vapors.

02Exercise regularly

Regular physical activity can strengthen your breathing muscles and improve your heart and lung function. It may be difficult at first, but you can start with light activities such as walking or water fitness and gradually increase the intensity of your activities. Please develop an exercise plan that suits you under the guidance of your doctor.

03Balanced diet

A healthy diet is essential for COPD patients. It is recommended to eat small and frequent meals, 3-5 meals a day, low-salt, high-protein, high-fiber, low-carbohydrate foods, eat more fresh vegetables and fruits, supplement vitamins and trace elements, etc.; drink enough water, 8-10 cups a day. Maintain a proper weight, being overweight or underweight may aggravate breathing difficulties.

04Manage your breathing

Learn breathing control techniques, such as slow, deep breathing and pursed-lip abdominal breathing, which can help you better control your breathing and improve breathing difficulties. It is also important to use the correct breathing method when doing physical activities, such as inhaling when squatting, standing up, raising your head, clenching your fists, climbing stairs, lifting your legs, and expanding your chest and arms, and exhaling when lowering your legs and contracting your arms when climbing stairs, twice a day, 30 minutes each time.

05 Comply with medication regulations

Use your medications, including inhalers and other medicines, on time. Correct use of medications can help relieve symptoms, improve breathing function, and prevent worsening of the condition.

06Regular checkups and vaccinations

Go to the hospital for regular checkups to monitor changes in the condition. Patients with grade 1-3 COPD should be checked at least once a year, and patients with grade 4 COPD should be checked at least twice a year. Especially COPD patients aged > 65 should be vaccinated with influenza and pneumococcal vaccines in autumn and winter, which can reduce the risk of respiratory infections.

07 Pay attention to your mental health

You may feel anxious or depressed when facing a chronic illness. Talk to your family, friends or professionals about your feelings and seek psychological counseling if necessary.

08Environmental Management

Keep the air in your living environment fresh. Avoid extremely cold or hot environments, as extreme air quality may cause breathing difficulties.

Through these self-management methods, COPD patients can better control their symptoms and reduce the interference of the disease on their lives. Remember to maintain close communication with your doctor and adjust the management method according to your specific situation. Let us work together for better breathing and a better life!

(Authors: Cheng Xiaoliang and Huang Yuanyue, Department of Pneumoconiosis/Department of Respiratory and Critical Care Medicine, West China Fourth Hospital; Instructor: Peng Lijun, a first-level expert in the Department of Pneumoconiosis/Department of Respiratory and Critical Care Medicine, West China Fourth Hospital)