Editor's note:

Chronic obstructive pulmonary disease (COPD), chronic obstructive pulmonary disease, is characterized by incompletely reversible airflow limitation. The disease has a high prevalence among the elderly and is the third most common chronic disease in China after hypertension and diabetes. This invisible killer of lung disease cannot be ignored during the new crown pneumonia epidemic.

Ran Xinxin , director of the State Key Laboratory of Respiratory Diseases and secretary of the Party Committee of Guangzhou Medical University , said , "There are more than 100 million people with COPD in the country. Preliminary observations have shown that COPD patients are more susceptible to infection, more likely to transition to severe disease, and have a better prognosis Poor, the course of disease is related to the underlying diseases of the body and the damage to the immune system. Clinicians should pay close attention to this part of the population. "

What problems should COPD patients pay attention to during the epidemic? How can patients prevent acute exacerbations? What can I do to relieve my symptoms before going to the hospital for an acute exacerbation?

Experts in this issue of "epidemic prevention science":

Deng Tiying (Deputy Chief Pharmacist, Wuhan First Hospital)

Cui Min (Deputy Chief Pharmacist, Renji Hospital, Shanghai Jiaotong University School of Medicine)

Wang Xiaohua (Chief Pharmacist, First Affiliated Hospital of Anhui Medical University)

Q: Patients with COPD have finished their medicine. Can they be temporarily discontinued?

Answer: First of all, medicine cannot stop! During the epidemic, it is recommended that you prepare in advance, check your remaining inhalation in time, go out to buy medicines in advance or purchase online through professional and regular Internet hospitals or online platforms, and reserve enough time to wait for the arrival. (Deng Tiying)

Q: My inhaler is used up immediately. Can I buy another inhaler?

Answer: If it is the same generic name, the inhalants can be replaced by each other, such as tiotropium bromide inhaler (Silihua) and tiotropium bromide powder (Sule), tiotropium bromide inhaler (Nanchang) Hongyi), tiotropium bromide inhalation powder (Pidovir), tiotropium bromide spray (Noble) can be substituted for each other. The medicines shown below can be used interchangeably.

Patients who cannot buy Symbioco can choose Shulidie (the reverse is also true). It should be noted that the specifications of the two drugs are different in size. For details, you can consult a pharmacist or an online free clinic expert. Both Symbiotic Dubo and Shulidie need to be used twice a day, inhaled at 12-hour intervals, and both need to be rinsed.

It should be noted that short-acting albuterol aerosol and ipratropium bromide aerosol cannot replace the above long-acting inhalants. The duration of action is short, and frequent use is prone to tolerance. (Deng Tiying)

Q: I can't buy any inhaler. Can I take oral medicine to control COPD?

A: We recommend buying inhalers as much as possible to control the condition, but if you can't get the medicine, it is recommended to consult a doctor or pharmacist remotely. Under the remote guidance of professional medical personnel, oral aminophylline or doxofylline sustained-release tablets can be temporarily replaced. It should be noted that oral administration of theophylline drugs may cause rapid heartbeat and adverse reactions of mental excitement, which requires self-monitoring. For patients with concurrent irritating dry cough, it can be replaced by compound methenamin capsules, which contain aminophylline and cough medicine. However, it must be noted that the replacement time of oral drugs should not be too long, and you still need to actively purchase your inhalants to avoid the side effects related to oral drugs. (Deng Tiying)

Question: At present, new-type coronary pneumonia is raging. How can patients with COPD prevent acute exacerbation?

A: While at home, patients with COPD must not relax their vigilance, but also need to exercise strict self-management.

1. Strict smoking cessation: Quitting smoking is a key measure for the management of COPD patients. Never use tobacco again because of boredom at home.

2. Moderate ventilation: Coronavirus ravages require daily ventilation, but patients with COPD need to keep warm, and must not over-ventilate and make room temperature too low, which will cause acute exacerbation.

3. Balanced diet: During the home period, do not overeating or eat less. You need to pay attention to a balanced diet and increase nutrition to ensure the daily intake of meat, eggs, vegetables and fruits.

4. Moderate exercise: If you stay at home for a long time, it will lead to physical decline. COPD patients should pay attention to exercise, exercise 4-5 times a day, and guarantee 10 minutes each time.

5. Breathing exercise: Breathing exercise should not be ignored during the home stay of COPD patients. Common exercise methods include abdominal breathing and constricted breathing. Abdominal breathing method is to increase the ventilation of the lungs by diaphragmatic movement. COPD patients place their hands on the upper abdomen, and the abdomen sags during exhalation, a little pressure is applied. The upper abdomen resists this pressure when inhaling, and the abdomen rises slowly every day. 5 times, 3 minutes each. Lip-reducing breathing is when the patient closes his mouth and inhales through the nose, and the mouth-pumping and whistle-like breathing slowly exhales for 4 to 6 seconds. Lip-reducing breathing can be applied together with abdominal breathing.

6. Home oxygen therapy: Long-term oxygen therapy can increase the partial pressure of arterial blood oxygen in patients with COPD, improve the function of hypoxic tissue, and reduce the load on the heart. For patients with severe hypoxemia in a resting state, continuous low-flow oxygen is recommended, 1-2 liters / minute, preferably more than 15 hours per day. The target value of blood oxygen concentration is 88-92%.

7. Regular medication: Regular medication according to the doctor's advice is the key to reducing the acute exacerbation of COPD. During home, you cannot return to the clinic on time, but regular medication must be guaranteed. (Cui Min)

Q: What measures can be taken to alleviate the symptoms of patients with chronic obstructive pulmonary disease before they go to the hospital for an acute exacerbation?

A: Patients with chronic obstructive pulmonary disease should go to the hospital as soon as possible when their symptoms are exacerbated. The current situation of new coronary pneumonia is severe, and they can also go to the formal Internet hospital for timely assessment and treatment. Before going to the hospital, patients can take appropriate measures to temporarily relieve symptoms.

(1) Oxygen inhalation: When chest tightness, dyspnea worse, and lips cyanosis, oxygen should be taken at a low flow rate (1 to 3 liters / minute) immediately. High-oxygen inhalation can cause carbon dioxide retention, and even pulmonary encephalopathy and Coma, so high flow oxygen should be avoided.

(2) Appropriate use of phlegm-reducing drugs: COPD is often accompanied by infections when acute exacerbation of COPD occurs, and sputum thickens and coughs are difficult to cough, bronchial tubes are blocked, and symptoms of dyspnea may be aggravated. Therefore, appropriate application of phlegm-reducing drugs, such as ambroxol, bromhexine, acetylcysteine, carboxymethanine, etc., and appropriate drinking water to dilute the sputum and easy to cough. Family members can help pat back to promote sputum excretion.

(3) Rapid-acting bronchodilator drugs: salbutamol aerosol (Ventolin) can be used to relieve the symptoms of asthma urgently, but it should be used according to the usage and dosage directed by the physician or pharmacist. The maximum daily dose is 4 揿, 2 times each time, not overdose or repeated use within a short period of time, otherwise it may lead to serious adverse reactions such as arrhythmia. (Wang Xiaohua)

(Finishing / Guangming.com reporter Zhan Zhao Acknowledgement: Pharmacy Committee of China Association of Science and Technology, Chinese Hospital Association, Pharmacological Specialty Committee of Chinese Pharmacological Society)