Chronic obstructive pulmonary disease (COPD) is a common and frequently occurring respiratory disease, not an independent disease. It is one of the severe outcomes of various chronic lung diseases in the late stage, with a slow onset and long course, which can lead to respiratory failure and heart failure, threatening the lives of patients.
1、 The etiology and pathogenesis of chronic obstructive pulmonary disease: (1) Etiology: It is related to factors such as age, gender, smoking, air pollution, respiratory infections, and genetics. （2） Pathogenesis: 1. Chronic inflammatory response, complex interactions between tumor necrosis factor and inflammatory cells, leading to lung diseases. 2. The imbalance between protease and antiprotease is mainly caused by an increase in protease or a decrease in its inhibitory factors, resulting in an imbalanced state where elastase breaks down elastic fibers and causes emphysema. 3. Imbalance of oxidation and antioxidation, with smoke and air pollution being the main external oxidants; The main oxidants in the body are inflammatory cells such as macrophages and neutrophils, which release oxygen free radicals. When there is an imbalance of oxidation and antioxidant in the body, it can cause lung diseases. 4. Damage to airway remodeling leads to thickening of the airway wall, narrowing of the lumen, decreased elasticity, and restricted airflow, resulting in lung diseases. 5. The pathogenesis of emphysema is related to genetic factors. The incidence rate of COPD in the offspring of COPD patients and identical twins is higher than that in the general population.
2、 Clinical manifestations and grading of chronic obstructive pulmonary disease:
1. Symptoms: shortness of breath, shortness of breath, chest tightness, aggravated after fatigue, coughing, expectoration, difficulty breathing and cyanosis, and in severe cases, respiratory failure may occur. 2. Physical signs: Barrel chest, reduced respiratory motility, decreased or absent palpation of speech tremors, percussion presenting as a voiceless sound, narrowing or difficult to palpate of the heart dullness boundary, descending of the lung or liver dullness boundary, distant auscultation of heart sounds, general weakening of respiratory sounds, prolonged exhalation, and presence of wet rales in the lungs, increased heart rate, and hyperfunction of the second note of the pulmonary valve in cases of concurrent infection. 3. Disease staging: ① Stable phase: The patient's symptoms such as cough, expectoration, and shortness of breath are stable or mild. ② Acute exacerbation phase: During the course of the disease, the condition continues to worsen and requires a change in the daily routine medication for COPD. Usually refers to the worsening of coughing, expectoration, shortness of breath, and/or wheezing in patients in the short term, with an increase in sputum volume, presenting as purulent, and may be accompanied by significantly aggravated inflammation such as fever.
3、 Complications of Chronic Obstructive Pulmonary Disease: 1. Spontaneous Pneumothorax: When patients with emphysema develop spontaneous pneumothorax, it is often due to high lung field transparency and the presence of pulmonary bullae. The signs of pneumothorax may not be typical, and chest CT is needed for a clear diagnosis. 2. Respiratory failure: Severe impairment of respiratory function can lead to respiratory failure. Some critically ill patients are in the compensatory phase, and respiratory infections, inappropriate oxygen therapy interruption of inhalation therapy, overdose of sedatives, or surgical procedures can induce acute respiratory failure, also known as acute exacerbation or decompensation of chronic respiratory failure. 3. Chronic pulmonary heart disease and right heart failure: in the compensatory phase of cardiac function, there may be no signs of right heart failure. When the disease progresses and arterial blood gas deteriorates, it can significantly increase pulmonary artery pressure and increase cardiac burden. In addition, factors such as myocardial ischemia and metabolic disorders can induce right heart failure. 4. Secondary erythrocytosis: Chronic hypoxia causes compensatory increase in red blood cells, increased whole blood volume, and blood viscosity, leading to symptoms such as headache, dizziness, tinnitus, and fatigue, and is prone to complications such as thromboembolism.
4、 The treatment of chronic obstructive pulmonary disease (COPD): Currently, a treatment plan combining traditional Chinese and Western medicine has been developed in clinical practice, which has achieved good clinical efficacy and demonstrated promising prospects for the treatment of COPD. Chronic obstructive pulmonary disease (COPD) is divided into acute phase and stable phase. Generally speaking, Western medicine is the main treatment for acute attacks, supplemented by traditional Chinese medicine; The stable period is mainly treated with traditional Chinese medicine and comprehensive rehabilitation.
（1） Western medicine treatment: 1. Drug treatment: including antibacterial treatment, expectorant treatment, placebo treatment, and hormone treatment. 2. Long term home oxygen therapy: Its indications are ① PaO2<55mmHg or SaO2<88%, with or without hypercapnia. ② PaO2, 55-60mmHg or SaO2<89%, accompanied by pulmonary hypertension, heart failure or polycythemia. 3. Nutritional support: It is necessary to increase nutrient intake and improve nutritional status. 4. Rehabilitation exercises: walking, practicing Tai Chi, doing gymnastics, pursed lip breathing, inhaling through the nose, exhaling through the mouth, blowing a whistle, and doing abdominal breathing.
（2） Traditional Chinese Medicine Treatment: Traditional Chinese Medicine believes that lung spleen deficiency is the core of the mechanism transformation of chronic obstructive pulmonary disease. The development of chronic obstructive pulmonary disease is a process from lung deficiency to spleen deficiency to kidney deficiency, often accompanied by phlegm dampness and blood stasis. Therefore, tonifying deficiency and purging excess is the principle of treating chronic obstructive pulmonary disease. The stable period mainly focuses on supplementing deficiency. The key is to invigorate the lungs and spleen, so traditional Chinese patent medicines and simple preparations often uses Sijunzi Decoction to invigorate the spleen and qi. For patients with chronic illness, if lung qi deficiency is more obvious, windproof, astragalus, five fingered peach, etc. can be used; If spleen deficiency is accompanied by qi sinking, such as severe fatigue and weight loss, one can use Bu Zhong Yi Qi Tang to promote digestion; Long term illness can lead to kidney deficiency, and can be treated with Rehmannia glutinosa, Cornus officinalis, Huangjing, or Liuwei Dihuang Pills; If there is a deficiency of yang, it can be treated with decoction of Fructus Psorale, Morinda officinalis, Epimedium, or taking Kidney Qi Pills; If lung deficiency is combined with yin deficiency, nourishing yin drugs such as Beishashen, Ophiopogon japonicus, and Dendrobium officinale can be added.