First, general treatment.
1, oxygen supplement: patients with severe hypoxemia can be given long-term home oxygen therapy. Generally, nasal catheter is used to inhale oxygen, so that the patient's arterial oxygen saturation rises to 90% and/or the arterial oxygen partial pressure at rest is ≥60mmHg.
2. Get rid of environmental pollution and quit smoking: Patients who have no obvious symptoms in the early stage need to avoid pathogenic factors as much as possible, including measures such as improving kitchen ventilation and quitting smoking. COPD patients diagnosed by incomplete reversible airway obstruction should be treated as COPD.
Second, emergency treatment
When the patient's treatment effect is not good, it is accompanied by serious illness and disturbance of consciousness. They need hospitalization. Acute oxygen therapy should be carried out to ensure 88%~92% oxygen saturation, and arterial blood gas analysis should be carried out after 30~60 minutes of oxygen therapy to ensure no carbon dioxide retention or acidosis. For patients who are bedridden, polycythemia or dehydrated, appropriate body fluids and electrolytes should be considered. If necessary, implement mechanical ventilation.
Third, medication.
1, bronchodilator: it can relax bronchial smooth muscle, dilate bronchi and relieve airflow restriction, which is the main treatment measure to control symptoms. Short-term on-demand application can relieve symptoms, long-term regular application can prevent and relieve symptoms and increase exercise endurance, but it can't improve the first second forced expiratory volume of all patients. Compared with oral drugs, inhalation has fewer adverse reactions, so inhalation therapy is the first choice. The main bronchodilators are β2 receptor agonists, such as salbutamol and terbutaline, anticholinergic drugs such as tiotropium bromide and theophylline such as aminophylline, which are selected according to the function of the drugs and the treatment response of patients. Short-acting bronchodilators are cheaper, but the effect is not as good as long-acting preparations. Combined application of drugs with different action mechanisms and time can enhance bronchiectasis and reduce adverse reactions.
2. Glucocorticoid drugs: Long-term regular inhalation of glucocorticoid combined with β2 receptor agonist is more effective than single use. At present, there are two commonly used combined preparations: budesonide formoterol, fluticasone or salmeterol.
3, expectorant: it is beneficial to smooth airway drainage and improve ventilation, but the overall effect is not very exact except for a few patients with phlegm. The commonly used drugs are ambroxol hydrochloride and acetylcysteine.
4. Antibiotics: For those who have no risk factors of Pseudomonas aeruginosa, antibacterial drugs can be selected. The main drugs are penicillin, amoxicillin and macrolides. For those with risk factors of Pseudomonas aeruginosa, oral or intravenous medication should be chosen according to the patient's situation. The main drug is ciprofloxacin.
Fourth, surgical treatment.
1, resection of giant pulmonary bullae: it is suitable for a small number of emphysema lesions, such as severe pulmonary bullae and particularly poor lung function, which require surgical resection.
2. Lung volume reduction surgery: The purpose of lung volume reduction surgery is to remove the diseased area with abnormal function, reduce residual gas and improve breathing.
3. Lung transplantation: When lung injury is serious and other treatment methods are ineffective, lung transplantation can be selected. Many patients may have bronchiolitis obliterans after lung transplantation, causing severe dyspnea, and often need lung transplantation again.
Verb (short for verb) Other treatments
1, respiratory muscle function exercise:
(1) Abdominal breathing method: semi-lying, standing or sitting position, knees half bent, abdominal muscles relaxed, two hands placed on the chest and upper abdomen respectively, inhaling slowly through the nose, lowering the diaphragm as much as possible, relaxing the abdominal muscles, lifting the hand placed on the abdomen upwards, and putting the hand placed on the chest in the original position; When exhaling, the abdominal muscles contract and increase the expiratory tidal volume.
(2) Breathing with contracted lips: when exhaling, the abdomen invaginates, the chest leans forward at the same time, and the lips are narrowed. Exhale as much as possible, and the expiratory time should be extended to improve the alveolar ventilation of patients, twice a day, each time 10~20 minutes.
2. Oxygen therapy: Low-flow oxygen inhalation can effectively improve hypoxia and prolong the survival time of patients.