Chronic obstructive pulmonary disease (copd) is a common, preventable and treatable chronic respiratory disease. Statistics show that the total number of adult copd patients over the age of 20 is close to 100 million. But at the copd clinicalMedical careIn practice, problems such as low rates of early diagnosis and inadequate or irregular treatment persist. To that end, we have issued a series of basic and rational medicines for chronic obstructive pulmonary diseaseGuideGuidelines for the treatment of chronic obstructive pulmonary disease (2021 revision), the implementation guidelines for the clinical treatment of chronic obstructive pulmonary disease and the consensus of experts on the integration of western and central medical care for chronic constraint pulmonary diseases (2023 edition), among others, are designed to promote the copd standardized treatment and improve the quality of disease management for people with chronic obstructive pulmonary disease。
From this point of view, e we invite prof. Zhao xing, second hospital, ningbo city; prof. Ii jun, fourth central hospital, tianjin city; prof. Li xin, general hospital, hua yun wu gang; prof. Sha jung, toji hospital, university of chinese science and technology and prof. Jung liwen, general hospital, tianjin medical university, to combine the guidelines and personal clinical experienceSlow lungsThe topic of early identification and normative treatment was discussed to provide guidance and support to further improve clinical copd treatment and management。
The current situation and difficulties of the copd
Q1: our copd population is large, but in clinical practice there are still problems of low recognition and inadequate treatment. What reasons do you think hinder early identification and standardisation of the copd
Professor dong zhao xing: currently, the problem of inadequate and misdiagnosed copd is common across the globe, both within and outside the country. The low level of awareness of the copd among doctors at the grass-roots level, the limited public awareness of the symptoms of the copd and the low prevalence and detection of lung function are the main reasons for the lack of diagnosis and misdiagnosis at the copd level。
Prof. Shi joongang: research shows that the rate of error in the first check-ups in the country's community hospitals is as high as 22. 9 per cent and the rate of absenteeism is as high as 22. 1 per cent. The national copd epidemiological survey shows that only 12. 0 per cent of our copd patients have undergone lung function tests。
Professor li xin: in a study on the incidence of disease in the copd, which included 30,874 participants from 27 countries, only 26. 4 per cent of patients had undergone a lung function check-up and only 5. 0 per cent had been diagnosed with the copd and up to 81. 4 per cent had not been diagnosed。
Professor zheng liwen: the reasons for the lack of diagnosis and error of the copd also include its own risk of being misdiagnosed as other respiratory diseases. These causes have led to a large number of copd patients being chronically undiagnosed and without intervention, and many early copd patients at a reversible stage have missed the best time for treatment, thereby increasing the incidence of disability, mortality and socio-economic burden of the copd。
Prof. Ii juno: for the reasons given by the professors, on the one hand, it is necessary to strengthen the teaching of the ill and to make the general public aware of copd diseases, like hypertension and diabetes; on the other hand, it is necessary to raise the level of awareness of the copd among doctors at the grass-roots level and to devote more financial resources at the national level to the copd consultations and to promote more fully the early identification and normative treatment of the copd。
Copd early identification and diagnosis of high-risk populations
Q2: the consensus of experts on the integration of western and central medicines for chronic constraint pulmonary diseases (2023 edition) states that screening and clear diagnosis should be carried out as early as possible for populations at high risk of chronic obstructive pulmonary disease. How can clinical services identify and diagnose people at high risk of disease at an early stage
Professor tung zhao xing: the risk factors for copd include age 40, moderate and severe smoking, history of long-term dust exposure, premature birth, low birth quality, repeated infections of the lower respiratory tract during childhood, and clinical symptoms such as chronic coughing, coughing and breathing difficulties。
Prof. Ii juno: in addition to risk factors, attention to respiratory symptoms facilitates early identification of patients with copd, who are typical of cough, cough and respiratory difficulties. The examination of the lung function is the gold standard for the diagnosis of the copd, and all patients with the copd risk factors and typical symptoms should undergo the examination of the lung function for a clear diagnosis。
Professor li xin: in addition to the points made by professor dong, studies have also shown that chronic bronchitis among adults under 50 years of age is an early indicator of the vulnerability of the copd. Pneumonic stress volume (fev1)/pneumonic activity (fvc) for 1st second after bronchial suffocation
Professor she joongang: based on different risk factors, the global initiative on chronic interdiction pulmonary diseases (gold) 2024 refers to copd, biofuels and air pollution-related copd, in addition to previously known smoking-related copds, including genetic factors-related copds, abnormal lung development-related copds, and infection-related copds。
Professor zheng liwen: in addition to the points made by the professor, the new copd profile also includes environmental factors, copd asthma overlap and unknown causes. Gold 2024 highlighted the need for clinical scrutiny of possible risk factors for patients, attention to non-smoking related copd, early identification, early intervention。
Copd integrated assessment
Q3: the global initiative on chronic obstructive pulmonary diseases (gold) 2024 is clear for the definition of copd and acute severity, case assessment, initial treatment and follow-up management. What are the clinical concerns in conducting the copd assessment in the context of our updated guidelines
Professor li xin: the purpose of the comprehensive copd assessment is to determine the extent of air flow constraints, the impact of disease on patients ' health status and the risk of future adverse events such as an acute increase in the copd, hospitalization or death, to guide individualized treatment。
Prof. Ii juno: gold 2024 noted that copd's assessment of the condition should include lung function, i. E., assessment of air flow limit and dynamic change, acute stress risk assessment, symptoms assessment and combination assessment。
Professor tung zhao xing: slow lung resistance is a heterosexual disease that requires comprehensive management and a targeted, individualized treatment strategy following a comprehensive and integrated assessment. Pulmonary functional examination is a mandatory copd diagnostic project, and patients diagnosed should undergo at least one lung functional examination per year。
Professor zheng liwen: symptoms are assessed using the chronic obstructive pulmonary disease assessment test (cat) or an improved version of the british medical research council's breathing difficulty table (mmrc), with copd patients receiving at least one cat assessment every three months. Moreover, how to diagnose and assess acute increases is at the heart of the copd assessment。
Professor she joongang: gold 2024 emphasizes the integrated assessment of which the most important predictor of future acute increases in risk is the previous year's history of acute increases. In the case of thorium two moderate acute increases or thorium one history of acute aggravated hospitalization in the previous year, it is assessed as a high risk group (group e)。
Initial treatment programme for copd
Q4: the copd is a heterosexual disease that requires individualized treatment strategies. What are the domestic and international guidelines recommended for initial treatment at copd
Prof. Ii juno: the main objective of the copd stabilization period is to mitigate symptoms and reduce the risk of future acute increases, and individualized initial treatment should be given based on the patient's symptoms and levels of acute aggravating risk. It is important to emphasize that both doctors and patients at the grass-roots level should recognize copd as a disease requiring sustained long-term treatment, like hypertension, diabetes and coronary heart disease。
Professor dong zhao xing: gold 2024, for different groups, is recommended for initial treatment strategies (figure 1), of which bronchial expansion agents are the main therapeutic drugs for the copd stabilization period。
Figure 1 gold 2024 initial drug treatment strategy
Professor li xin: for group a, gold 2024 refers to the possibility of improving respiratory difficulties with a short- or long-acting bronchic extension, giving priority to long-active bronchic extremizers where drugs are accessible and affordable。
Prof. Shae joong: for group b, gold 2024 recommends treatment of long-activated beta2 receptor agonists (laba)+ long-activated anticholines (lama) as the initial drug, where available and affordable; if laba + lama is not applicable, for example, the patient has prostate disease, glaucoma eyes, etc., the choice of a single bronchic expansion agent (lama or laba) may be based on the patient's symptoms reduction。
Professor zheng liwen: for group e, laba + lama is recommended for treatment as an initial drug, with no reference to laba + ics; if there is an inhaled sugar cortex (ics) application indicator, lba + lama + ics is recommended for preference over laba + ics. In addition to drug treatment, the management of the copd stabilization period should also focus on non-pharmaceutical measures such as vaccination, smoking cessation, lung rehabilitation, traditional chinese sports, acupuncture and dressing。
Cotrimoxazole is an advantage in the use of copd therapy
Q5: the common symptoms of copd include chronic cough, cough and respiratory difficulties. In addition to bronchial extremizers and ics, the guide to reasonable grassroots use of chronic obstructive pulmonary diseases similarly recommends coughing as a therapeutic drug. Cotrimoxazole is effective in mitigating the cough, sip and asthma symptoms of the copd patients. What do you think is its advantage in treating the copd
Prof. Hei jungang, professor. The polymoxin capsule is a compound formulation consisting of four components, imitation, imitation, imitation, imitation and imitation, which have a high frequency of clinical use。
Professor zhou xing: a study that included 72 cases of copd patients, 1:1 random grouping for cotrimoxazine treatment or routine anti-infection and disease treatment for six months found a significant reduction in acute increases in treatment group patients (p < 0. 05) and a significantly lower rate of referral than the control group (p < 0. 05), indicating that co-promoxazole treatment for copd patients during stable periods could reduce the number of acute increases and reduce the referral rate。
Prof. Lee shin, prof. Jung liwen: another study included 140 cases of copd patients with severe acute stress, 1:1 random group treatment with a combination of salmetoxone and oxoxoxin capsules or single drug treatment with salmetoxone for 14 days. The results show significant improvements in fev1 (2. 20 ± 0. 88 l vs. 1. 72 ± 0. 49 l, p < 0. 05) and fvc (3. 31 ± 0. 43 l vs. 2. 77 ± 0. 59 l, p < 0. 05) of the joint treatment group, and no apparent adverse medical effects occurred during the treatment of group 2 patients. The results show that co-methooxone capsules, combined with salmetone gaseous aerosols, significantly improve the lung function of patients during the acute stress period of the copd and are safe。
Summary
Our country, the copd, has a large population and a heavy burden of disease, and its early identification and regularization are important. With the development of medicine, the national and international guidelines are constantly being updated and disseminated, and clinical doctors should keep up with the times, master the core content of the guidelines and improve the normative and treatment capacity of the copd in order to promote the integrated management of the copd in our country。
Introduction by experts
Professor dong zhao xing
Director of respiratory and critical diseases, hospital ii, ningbo
Director of the clinical medical research centre for respiratory diseases, ningbo city
Member of the inter-respiratory pulmonary disease unit of the chinese medical association
Member of the working committee on inter-bulk pulmonary diseases of the chinese society of medical doctors
Member of the fifth specialized committee on aerobics and respiration of the chinese society of pathological physiology
Member of the academic committee on inter-breathing pulmonary diseases of the chinese society of gerontology
Member, internal science branch, zhejiang medical council
Member, deputy director, respiratory branch, ningbo medical society
He's been studying in the general hospital of massachusetts, martinos centre, mahilun university, thailand, and the general hospital of the chinese people's liberation army for almost 20 years
Specialized in the treatment of respiratory disorders and acute diseases such as mesotheliosis, lung infections, chronic gastropathic diseases, lung cancer, etc
Chaired 4 nwf, 4 provincial projects, published more than 50 papers, sci presented 16 papers. Editor, deputy editor 4
Post-doctoral training
Zhejiang province health innovator, ningbo city military leader, zhejiang pilot project
(top down viewing)
Professor
Doctor, deputy director, 4th central hospital, tianjin city
Member, respiratory section, association of medical doctors of tianjin city
Member of the society of medical doctors of tianjin
Specialized in chronic obstructive pulmonary diseases, lung infectious diseases, bronchial asthma and inter-pulmonary diseases
Professor li xin
Director, director of respiratory and critical diseases, medical director, master of arts division
Standing committee of the respiratory physicians section of the wuhan medical association
Standing member of the committee of experts on interventions in respiratory pathology, hubei provincial society for clinical oncology
Member of the respiratory division of hubei medical council, wuhan medical council
Member of the scientific committee for the prevention and control of respiratory diseases of the hubei medical institute
Member of the inter-breathal pulmonary disease branch of the society of pathological physiology of hubei province
Member of the respiratory professional committee of the hubei pathology society
Member of the chronic lung alliance
(top down viewing)
Thank you, professor
Deputy director, professor, director doctor, doctoral director of respiratory and critical medicine, toji hospital, university of technology, china division
Member of the copd section of the chinese medical association
China copd permanent committee of the league
Member of the working committee of the chinese association of medical doctors on acute and acute illness
Member of the deputy director, respiratory section, wuhan medical association
Permanent member of the respiratory section of the hubei medical council
Director of the copd alliance, hubei province
Member and secretary, deputy director, respiratory work committee, hubei pathology society
Communications board, china tuberculosis and respiratory journal, international respiratory journal
Member of the board of editors of the journal of emergency internal studies
Ongoing basic and clinical research on respiratory diseases, including copd and bronchial asthma
To undertake 6 projects under the national fund for nature (nwf) and participate as research backbone in 2 projects
Publication of more than 60 papers in chinese and english in national and international magazines and participation in the first prize of the ministry of education for the advancement of science and technology awards
Professor jung liwen
Doctor, deputy director, general hospital, tianjin medical university
Graduated from tianjin medical university
More than 10 years in respiratory clinical work, specializing in chronic aromatic diseases, mestizo pulmonary diseases and lung cancer
Proficiency in mechanical ventilation technology. The topic " slow and severe lung retardation and acute respiratory failure in the absence of mechanized ventilation to treat cognitive disorders " fills the technological gap in tianjin city
Several distinguished professors at the institution level, several articles in core periodicals, participation in and completion of topics at all levels
Approval number: cn-21
This information comes from the doctor's personal point of view and is available only to professionals such as health care
Content planning: yanz
Review of contents: liang
