了解COPD：医生问答
Chronic obstructive pulmonary疾病（COPD）通常指慢性支气管炎和肺气肿。慢性阻塞性肺病是一种复杂的、危及生命的疾病，随着时间的推移，肺部会恶化。虽然COPD无法治愈，但人们可以通过改变生活方式来改善症状和预期寿命。我们请教了匹兹堡大学医学院副教授Frank Sciurba和医学院主任。气肿/COPD Research Center at UPMC, to explain what COPD patients and their families need to know.
Dr. Frank Sciurba of UPMC
What causes COPD?
COPD is a disease that, in this country, is primarily caused by cigarette smoking. What it involves is obstruction to expiration, so when you try to blow out air forcefully there is an obstruction and it takes longer. The consequence is that air stays trapped in the lungs so you can’t empty them and you’re breathing at a higher, less efficient, more uncomfortable lung volume.
So the two processes[慢性支气管炎和肺气肿]caused by tobacco smoking include inflammation in the airway tubes with scarring and excessive mucous secretion, often associated with more cough and sputum production. The second process is the little air sacs at the end of the airways that transfer oxygen and carbon dioxide in and out of the blood system, the walls of those get destroyed. The consequence of that are several fold. One is that it can worsen the obstruction because those little air sacs also act like ropes to tether open the airways, so when those air sacs get destroyed the airways tend to collapse and increase the obstruction—and that is called emphysema. The other consequence is that as it gets worse and worse, the oxygen can’t transfer as efficiently.
有哪些常见症状？
这两个过程都会导致呼吸急促。起初，呼吸急促发生在活动中。事实上，早期，患者甚至可能甚至没有意识地撤出他们的活动，甚至可能没有注意到他们呼吸缺乏症，特别是如果他们仍然吸烟。这是诊断COPD的问题之一。人们甚至不认识到他们有症状，因为他们停止了他们的活动。所以，他们并不呼吸迅速，甚至不会告诉他们的医生。活动限制通常是COPD的第一步。由于大多数人都有这两种过程，通常具有COPD的患者将具有支气管炎的症状和疾病的疾病的进展。
How does one get tested for COPD?
Lung function testing and spirometry. The key test isspirometry这衡量了两个重要的数字：你从深呼吸中呼出的空气量，以及你在第一秒钟呼出的空气量。如果第一秒钟排出的空气量比你能排出的空气量少70%，那么你就有阻塞。医生会使用支气管扩张剂和吸入器，如果这个数字没有完全逆转，那就是COPD。慢性阻塞性肺病的严重程度取决于与你的年龄、身高和性别的其他人相比，在第一秒钟排出的空气量。
COPD的进展是否在每个人身上都是一样的？
慢性阻塞性肺病有许多方面可以独立进展。例如，一些肺功能异常非常严重的患者的氧气水平可能不会下降，或者他们可能不会有那么多的病情恶化。而轻度肺功能异常的人可能会出现更多的发作和较低的氧气水平。因此，这种疾病可以在不同的个体中进行独特的进展。但随着时间的推移，你吸烟的时间越长，你的年龄就越大，如果你有遗传倾向或家族史，你可能更容易出现更严重的肺功能异常和症状。
What are some common treatments?
Once someone is diagnosed, number one isquit smoking. It’s critical to get a flu shot every year. To get a pneumococcal vaccination every five years can decrease the risk of pneumonias. Exercise,任何阶段的肺部康复都很重要打破做得少而呼吸急促的循环。锻炼很重要。第一次使用时，尤其是患有中度或重度疾病的患者，应在监督下进行，因为心脏病通常与COPD同时发生，我们希望确保对他们安全。
就药物治疗而言，当患者患有中重度疾病时，我们希望从长效维护吸入器开始，而不仅仅是短效吸入器，它可以持续4到6个小时来缓解症状。除了更持久地缓解症状外，维持性吸入器还可以防止肺功能持续下降的风险，防止发作，最终可能延长寿命。这些维护性吸入器包括各种支气管扩张剂（含或不含吸入性类固醇），每12至24小时给药一次。病情更严重的患者通常会同时服用这两种药物[long-acting and short-acting inhalers]以获得最佳症状缓解。新推出的药物从12小时到每24小时一次，我们相信这将提高对治疗的依从性，并可能随着时间的推移总体上提高其风险。降低氧气水平的患者确实需要补充氧气治疗。
运动如何帮助与互联网有人？
So exercise—while it doesn’t necessarily improve lung function right away—by improving the muscle strength and cardiovascular conditioning, it could allow you to do more activity with fewer symptoms. When your body is more efficient and in better condition you don’t have to breathe as much. We’ve also noticed that patients who participate in pulmonary rehab programs are less inclined to get chest flare-ups and less inclined to be admitted to the hospital. Breaking this inactivity cycle and getting folks back to better activity levels is really an important component in the treatment of COPD.
你能多谈谈肺康复吗?
So, unfortunately, there aren’t as many programs out there as there needs to be to help patients. But if you look in most areas, you will find a program. A good program deals with multiple factors. First of all, they educate and make sure people are using their inhalers, using their oxygen right if they need to. They can connect people with smoking cessation programs. They can refer people for nutritional counseling if they’re obese or are malnourished.
但肺康复最重要的组成部分与力量和耐力训练有关。我们经常会做上下肢柔韧性和力量训练。我们经常做跑步机或自行车耐力训练。一般来说，在康复项目中，我们每周工作三到四次，每次20到40分钟。总的来说，我们喜欢对人们进行培训，使他们在离开康复计划后，能够在自己的家或环境中舒适地继续进行维护计划。因此，一个好的康复计划将始终考虑到他们在自己的环境中可以使用什么类型的设备或步行表面，因为六周是不够的。这必须是一个终生的改变，在做活动和保持活跃，以保持他们的功能水平，并尽量减少他们的症状。
从医生的角度来看，治疗COPD最大的担忧是什么？
其中一个重要问题是当我们规定药物患者必须接受教育以了解药物的影响。大多数患者在检查时，不要完全符合药物。或者当他们正在获得处方时，有时它们不会正确使用吸入器。因此，我认为在使患者中的教育了解有时吸入器不会让您感觉更好，但它们可以防止肺功能和可能的肺功能下降，因此定期使用它们是重要的。当患者在办公室到办公室时，一名医生应该在间歇性地，实际上看他们患者使用吸入器并确保他们适当地使用它们. Because it’s common to not have good technique. When your technique is not ideal, you’re not going to get the drug delivery and you’re not going to get the benefits from the inhaler medications.
What triggers a COPD flare-up?
大约三分之一的案例我们没有良好的解释。病毒和其他细菌非常常见。但总的来说，当有人有一个爆发它是因为肺部的细菌决定得到更活跃或暴露于可以起飞的新细菌的菌株。我们用抗生素对待它们。在某些情况下，环境刺激物可能是一个因素。
你有什么建议吗？
一般来说，尝试eat healthier. If you’re overweight, get your weight back in line because being overweight just adds to the burden of exercise and activity. If you’re underweight, then nutritional supplementation may be appropriate. In general avoid irritants, especially if you have overlapping allergies. Stay away from people who have colds. Stopping smoking is really critical and avoiding particularly pollutant days. Most importantly, I think, is that patients need to actually live life. They need to exercise; they need to go out there and not be afraid. Unless you have overlapping heart disease or other conditions, activity and going out there and living life will not result in further harm. It will improve your overall well-being and probably prolong life.
人们能做些什么来帮助他们的医生尽其所能地治疗他们？
对你的医生说实话。告诉他们你是否吸烟，你是否愿意戒烟，你是否遵守药物治疗，因为他们需要了解这一点，以便全面指导药物治疗是否成功。最终，医生可以为你指明一个方向，但这取决于患者。积极参与肺康复并遵守药物治疗的患者表现良好。这对患者来说是一项艰巨的工作，他们必须与医生合作，尽自己的责任。
