Respiratory support in people with chronic obstructive pulmonary disease

The article was written by Dr. Tran Thi Diem Trang - Respiratory Internal Medicine Doctor - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital

Chronic Obstructive Pulmonary Disease (COPD) is a condition in which the airways become progressively blocked, slowly and for a long time. This condition causes worsening of lung function manifested by increasing shortness of breath. This is a dangerous disease because the disease progresses in the human body for decades but the patient does not detect the disease. The evolution of COPD in only one direction is the gradual progression over time.

Chronic obstructive pulmonary disease (COPD) is a social burden. COPD is a chronic disease with increasing morbidity and mortality rates. The fourth leading cause of death after cardiovascular disease, cancer and cerebrovascular accident. It is expected that by 2020 it will be the third leading cause of death. It is estimated that in the United States there are 16 million people with COPD and 100,000 people die from it each year.

Yes, people with COPD can partly decide their future. The patient's future will be better, the rate of decline in respiratory function will slow down if the patient adheres well to the treatment measures that the doctor has instructed: using the right medicine and re-examined on time during the period. stable; Timely examination and treatment if there are signs of suspicion in the acute exacerbation. In addition to drug treatment, there are non-pharmacological interventions:
+ Quit smoking or avoid exposure to risk factors
+ Physical therapy
+ Get a flu shot

In people with COPD, the airways are no longer open, but narrow because there is a lot of sticky mucus or swelling due to prolonged inflammation. The alveoli are also "calliated", losing elasticity and making it difficult for gas trapped in the lungs to escape.
The consequences of both conditions are that the lungs do not get enough oxygen needed for the body's needs and the patient often has difficulty breathing. At that time, it is necessary to have additional measures to support the patient's breathing.

Measures for physical exercise and rehabilitation for people with COPD include: measures to increase body endurance such as walking, running on a rolling mat, swimming, cycling... Measures to increase the strength of the body Muscle: weightlifting, resistance training..., in which important measures for people with COPD are to increase endurance because the nature of the exercises is usually gentle, suitable for patients because the patients are mainly tall people. year old.
Lower extremity exercise improves exercise capacity, upper extremity exercise improves muscle strength and reduces the need for ventilation. During exercise, when the feeling of shortness of breath begins to appear, the patient can stop and perform breathing exercises.

A.In the stable stage of the disease
4.1 Pinch-lip breathing Pinch-lip breathing is a method to prevent the airways from collapsing when exhaling, so air can escape more easily.

Comfortable sitting position. Relax your neck and shoulders. Inhale slowly through the nose.
Close your lips as if you are whistling, exhale through your mouth slowly so that the exhalation time is twice as long as the inhalation time.
Should repeat the movement of pursed lips several times until the shortness of breath stops. Practice over and over again until it becomes fluent and becomes a habit.
Should use pursed-lip breathing technique whenever you feel short of breath, such as taking the stairs, showering, exercising...
4.2 Diaphragmatic breathing Practicing diaphragmatic breathing will help enhance the effectiveness of the breathing movement. steam and save energy.
Diaphragm breathing technique
Sit in a comfortable position. Relax your neck and shoulders.
Place one hand on your stomach and the other hand on your chest.
Inhale slowly through the nose so that the hand on the abdomen feels the abdomen rising. The chest does not move.
Draw in your stomach and exhale slowly through your mouth with the exhalation twice as long as the inhale and the hand on the abdomen feels the abdomen sink.
Should practice diaphragmatic breathing several times a day until it becomes a habit.
After you have mastered the technique of diaphragmatic breathing in a lying or sitting position, you should practice diaphragmatic breathing while standing, walking and even doing housework.
B. As the disease progresses
The disease will progress more and more if the patient is not diagnosed early or does not strictly adhere to treatment. The patient enters the stage of respiratory failure, often low oxygen in the blood, increased shortness of breath.
+ At that time, the patient may have many acute episodes requiring emergency hospitalization or sometimes life-threatening. At this time, the patient is assigned to breathe oxygen intermittently to ensure SpO2 > 92%.
+ Must be assisted ventilation (non-invasive (oxygen mask) or invasive (ventilator). Experience shows that people with severe COPD, once ventilated, are very difficult to wean off the machine and have a very poor prognosis
+ Having to give long-term oxygen at home is very inconvenient and expensive

Indications: COPD in the stage of severe chronic respiratory failure, ie:
+ PaO2 < 55 mmHg
+ PaO2 from 55-60 mmHg with: Pulmonary hypertension; Leg edema / right heart failure; Polycythemia vera
These parameters are confirmed in the stable phase of the disease and are measured twice ≥ 3 weeks apart. The doctor will assign the patient an appropriate dose of oxygen depending on the patient.
>>> PaO2, PaCO2, FiO2 indicators in arterial blood gas test results
How to use long-term oxygen at home: Oxygen source

Compressed oxygen cylinders are the oldest and most common form of oxygen supply today, in which oxygen is compressed by pressure into metal containers of various sizes. There should be a small bottle with a rack or a trolley that can be moved and moved easily to help the patient be active and not dependent on others.
Compressed oxygen tank has 2 parts:
Regulator includes pressure gauge, safety valve, air flow regulator (number of liters of oxygen in 1 minute) Oxygen humidifier

An oxygen purifier from the air is an electric-powered device that separates oxygen from the air to provide oxygen in its pure form, so the cost of use will be cheaper than using a compressed oxygen tank. Because the machine operates on electricity, it is necessary to have a backup oxygen tank at home in case of a power outage or sudden machine failure.
Oxygen dose:
Minimum oxygen flow so that PaO2 reaches 60-65 mmHg or SpO2 reaches 88-94%. Usually about 1-2 liters/minute. Increase by 1 liter over basal dose during exercise and sleep. Time to breathe oxygen: Time to breathe oxygen must be at least 15 hours per day. Note: Oxygen is also a drug, underdosing or overdose is life-threatening. The person should follow the doctor's instructions strictly. Never arbitrarily adjust the dose of oxygen, but always with a doctor's order.
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