In order to formulate a set of non-pharmaceutical management strategies for patients with stable chronic obstructive pulmonary disease in China, the emergency department of the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine cooperated with the emergency department of Chengdu University of Traditional Chinese Medicine to translate and organize the 2021 GOLD "COPD Diagnosis , Treatment and Prevention Global Strategy, and searched a number of medical literature databases such as Medline, EmBase, evidence-based medicine databases such as UpToDate, BMJ Best Practice, etc., and at the same time with the United Kingdom National Institute of Health and Clinical Optimization (NICE) related guidelines Comprehensive comparative analysis is provided, diagnosis and treatment recommendations suitable for my country's medical practice are provided, and the dissemination efficiency and utilization efficiency of the guideline are improved, so that it can better serve the practice work of Chinese clinicians, especially primary clinicians, and optimize clinical efficacy.
Some suggestions
(1) Identify and reduce exposure to risk factors
The research team suggested that NRT or varenicline or bupropion can be prescribed 2 weeks before the patient quit smoking, combined with appropriate support programs. For more smoking cessation aids and treatment methods, please refer to the relevant information on the website of the National Centre for Smoking and Training (NCSCT)
(2) Pulmonary rehabilitation
The research team recommends that patients who meet the BTS and GOLD standards can start pulmonary rehabilitation treatment under the guidance of a doctor 1 to 2 weeks after discharge, with a course of treatment of 6 to 8 weeks and persist for life. Every patient who intends to undergo pulmonary rehabilitation needs to be assessed for respiratory function, exercise endurance, comorbidities, and cognitive language-psychosocial problems.
(3) Sports training
Endurance training
When performing endurance training, the patient needs to wear a dynamometer (arm or leg), and should continue to exercise at 60% or more of the maximum power for 20 to 30 minutes.
Resistance/strength training
When carrying out this training and endurance training, we must consider the patient's cardiopulmonary function, comorbidities, etc. The training time and intensity need to be gradual and vary from person to person.
Interval training
This research group recommends that patients with poor cardiopulmonary function, older age, and more comorbidities should adopt interval training, with a more suitable training method and intensity for the patient.
(4) Alternative sports training
Breathing retraining
The research group expects that follow-up research can support a set of effective breathing retraining methods, and patients can benefit from it if they adopt the correct training methods and methods.
Respiratory muscle training
The research group also expects that follow-up research can support a set of effective respiratory muscle training methods, and patients will be trained with the best duration, frequency and intensity, so as to maximize the benefits.
(5) Identify and manage anxiety and depression
In terms of treatment, this research group believes that patients should be given sufficient care, understanding and respect first, and through timely and correct psychological counseling, anxiety is generally easier to correct than depression. For depression patients, cognitive behavioral therapy (CBT) can be used for psychological counseling to correct their negative and incorrect cognition; for severe symptoms, it is necessary to evaluate the functional impairment and/or disability that may be related to depression Degree and duration, and ask a mental health specialist to assist in treatment.
For patients with major risks such as suicide and self-harm, refer to NICE guidelines and recommendations, they should receive specialized hospitalization, strengthen nursing care, and use high-intensity psychological interventions, antidepressants, and other comprehensive therapies. The mental health problems of COPD patients are far more common and more serious than imagined. Therefore, clinicians should attach great importance to the mental health of patients, pay more attention to their emotions, and care and love them more.
(6) Non-invasive ventilation
This research group recommends that for stable patients with severe chronic hypercapnia, a history of acute respiratory failure hospitalization, or a history of mechanical ventilation during acute exacerbations, long-term non-invasive ventilation therapy should be assisted on the basis of home oxygen therapy.
(7) Surgical treatment
Bullectomy
This research group believes that whether it is suitable to perform bullous resection requires comprehensive consideration of overall health, lung function, degree of bullous disease, surgical benefits/risks, etc.
Lung volume reduction surgery
This research group believes that the GOLD guidelines and the NICE guidelines describe the conditions required for the implementation of LVRS in more detail and have greater reference value. However, in clinical practice, doctors still need to consider the overall health of the patient and the benefits/risks of surgery.
Lung transplant
This research group believes that whether lung transplantation is performed clinically, it is necessary to refer to the lung transplantation indications recommended by the GOLD guidelines, exclude contraindications, and fully evaluate the benefits and risks of surgery.
Conclusion
Pulmonary function measurement and evaluation are the basis of non-drug management in the stable phase, and clinicians should strictly follow the operating specifications. The focus of non-pharmacological management in the stable phase of COPD is to intervene in smoking cessation for all patients, and to give supplementary drug treatment when necessary. Pulmonary rehabilitation therapy (exercise training, nutrition guidance, psychological counseling, health education, etc.) can be considered for patients with activity restriction (mMRC ≥2), or patients in groups B, C, and D.
For patients with indications, home oxygen therapy and long-term non-invasive ventilation therapy can be supplemented. At the same time, dynamic identification and monitoring of acute exacerbation high-risk populations can be taken in advance to avoid deterioration of the disease and admission to the hospital. For some serious cases, surgical treatment can be considered after a comprehensive assessment of the indications, contraindications, surgical benefits and risks, etc. The above-mentioned non-pharmaceutical management strategies in the stable phase need to be applied to different patients in the stable phase in a comprehensive and individualized manner, so as to ultimately achieve benefits such as reducing the symptoms of dyspnea, reducing the risk of acute exacerbations, and delaying disease progression.