Mastering COPD: Your Guide to 6 Staged Medication Plans & Long-Term Lung Health

COPD (abbreviation“ COPD ”) is a chronic respiratory disease characterized by continuous airflow restriction and progressive aggravation. The core symptoms are long-term cough and sputum (mainly white mucus sputum) Shortness of breath (aggravated after activity), acute exacerbation is often accompanied by purulent sputum and fever. Treatment needs to revolve around “ symptom relief, reduction of acute exacerbations, delay Lung function Decline”, the following 6 classic medication regimens cover long-term management in the stable stage and symptomatic treatment in the acute exacerbation stage. They are commonly used clinical and have clear efficacy. They need to be selected based on the patient’s lung function grade (GOLD level 1-4) and the stage of the disease.

1. 6 classic medication plans and applicable scenarios, staged + graded medication is the core

COPD treatment must follow the principle “long-acting drugs are used to maintain the stable phase, and short-acting drugs + anti-infective treatment are added in the acute exacerbation phase”. Different lung function grades and stage plans have different focuses:

– Scheme 1: Stable phase (GOLD level 1, mild airflow restriction) —— Long-acting single drug Bronchodilation

Typical manifestations: no significant shortness of breath in daily activities, only mild after strenuous exercise Chest tightness , cough, pulmonary function FEV1/FVC<70% and FEV1≥80% predicted.

Collocate: Tiotropium bromide Powder inhalant (single use)

Efficacy: Tiotropium bromide It is a “long-acting anticholinergic drug with sustainable relaxation” Bronchial Smoothing muscles (acting for up to 24 hours), reducing airway stenosis and relieving shortness of breath after exercise.

Usage: 18 μg each time, once a day (inhale at a fixed time, such as in the morning, when using the inhalation device, you need to inhale deeply to ensure that the medicine goes directly to the lungs).

Note: Rinse your mouth with water after inhalation (to avoid dry mouth caused by drug residue in the mouth) Candida Infection); when the dry mouth is obvious, you can take sugar-free throat lozenges to avoid excessive drinking of water (prevention) Nocturia increased Affect sleep).

– Scheme 2: Stable period (GOLD level 2, moderate airflow limitation) —— Long-lasting Bronchodilators Uniting

Typical manifestations: obvious shortness of breath when walking briskly or climbing stairs (3 floors), frequent daily coughing and sputum production, predicted value of pulmonary function FEV1 50%-79%.

Pairing: Tiotropium bromide powder inhalation + salmeterol Casson Powder inhalants

Efficacy: Tiotropium bromide long-acting to relax the airways, salmeterol (long-acting beta-2 receptor agonist) to enhance the diastolic effect, fluticasone (inhaled glucocorticoid) anti-inflammatory, reducing the inflammatory response in the airways and delaying the decrease in lung function.

Usage: 18 μg of tiotropium bromide once daily; 1 inhalation of salmeterol ticasone (containing salmeterol 50 μg+) Fluticasone 250μg), 2 times a day (once in the morning and once in the evening, rinse your mouth after inhalation).

Note: Avoid missing medication (regular medication is required to maintain it) Airway patency ); If you have hoarseness, you need to strengthen mouthwash (rinse your mouth for 30 seconds after each inhalation and spit out the mouthwash).

– Scheme 3: Stable phase (GOLD grade 3-4, severe/extremely severe) —— triple long-acting drug + sputum excretion aid

Typical manifestations: slow walking on flat ground (100 meters), shortness of breath, need for frequent rest, accompanied by chest tightness and wheezing, lung function FEV1 < 50% expected value, long-term home oxygen therapy may be required.

Pairing: Umeclidinium bromide vilanterol inhalation powder aerosol + budigefol inhalation aerosol + Acetylcysteine effervescent tablets

Efficacy: Dual diastolic airway with umeclidinium bromide (long-acting anticholinergic) + vilanterol (long-acting beta-2 agonist), triple anti-inflammatory + diastolic with budesigefol (budesonide + glycopyrronium bromide + formoterol), Acetylcysteine Dilute sputum, reduce airway blockage.

Usage: 1 inhalation of umeclidinium bromide vilanterol (containing 62.5 μg of umeclidinium bromide + 25 μg of vilanterol), once daily; 2 inhalations of budesograf, twice daily; 600 mg of acetylcysteine, once daily (dissolved in warm water, water temperature <40℃, anti-destructive effect).

Note: Family oxygen therapists need to control the oxygen flow rate (1-2 L/min) to avoid high concentration of oxygen inhalation inhibition Respiratory center ); Acetylcysteine may cause mild gastrointestinal discomfort, which can be relieved by taking it after meals.

– Scheme 4: Acute exacerbation phase (bacterial infection induction) —— short-acting diastolic + anti-infective + Anti-inflammatory

Typical manifestations: sudden aggravation of cough and sputum (increased sputum volume, yellow/green purulent sputum), marked exacerbation of shortness of breath (shortness of breath also at rest), accompanied by fever (body temperature ≥38℃), Blood routine Prompt Leukocytes Elevated.

Collocate: Salbutamol Aerosol (short-acting) + Amoxicillin Clavulanate Potassium Tablets + Meprednisolone Film

Efficacy: Salbutamol rapidly relaxes the bronchi (effects within 10 minutes, relieves emergency shortness of breath), Amoxicillin potassium clavulanate kills pathogenic bacteria (controls bacterial infections), Meprednisolone Short-term anti-inflammatory (reduction of acute inflammation of the airways, shortening of the aggravating period).

Usage: Salbutamol 2 sprays each time, no more than 12 sprays per day (use when shortness of breath worsens); Amoxicillin Clavulanate potassium 0.625 g each time, 3 times a day (take after meals) Penicillin It is contraindicated for those with allergies and should be taken for 7-10 days); methylprednisolone 40 mg once a day (take in the morning for 5 consecutive days and cannot be used for a long time).

Note: Frequent use of albuterol (for example, more than 3 times per hour) indicates a serious condition and requires prompt medical attention; there is no need to gradually reduce the dose of methylprednisolone when stopping the drug (short-term use), but long-term use requires a reduction as directed by the doctor.

– Scheme 5: Acute exacerbation phase (companion) Respiratory failure Risk) —— potent relaxation + broad spectrum anti-infection + phlegm reduction

Typical manifestations: pronounced dyspnea at rest (need) Open your mouth to breathe ), lip cyanosis, blood oxygen saturation <90%, accompanied by slight confusion, chest X-ray indicates lung infection.

Collocation: Isoprotropium bromide aerosol + Levofloxacin Piece+ Ambroxol hydrochloride Solution for injection (intravenous)

Efficacy: Ipratropium bromide (short-acting anticholinergic) combined with salbutamol (can be used in combination with an interval of 5 minutes) enhances the diastolic effect Levofloxacin Broad-spectrum antibacterial (covering common pathogenic bacteria of COPD, such as Haemophilus influenzae , Klebsiella pneumoniae ), intravenous use of ambroxol can effectively reduce phlegm and reduce airway blockage.

Usage: Ipratropium bromide 2 sprays each time, 4 times a day; levofloxacin 0.5 g each time, once a day (consecutive administration for 7-14 days, contraindicated under 18 years of age); Ambroxol 30 mg each time, 2 times a day (intravenous drip, not too fast).

Note: Oxygen saturation needs to be monitored immediately and given if necessary Noninvasive ventilators Assisted ventilation; Levofloxacin may cause joint discomfort and avoid strenuous exercise during medication; Regular review of blood routine and chest X-ray (assessment of infection control).

– Scheme 6: Full course of the disease (long-term sputum excretion + infection prevention) —— phlegm-reducing drugs + vaccination assistance

Typical manifestations: There is still a lot of mucus sputum (not easy to cough up) during the stable phase, the number of acute exacerbations ≥ 2 times per year, and it is easy to catch a cold and become infected.

Collocate: Carboxymestane Oral solution + flu Vaccines (vaccinated annually) + pneumococcal vaccine (vaccinated every 5 years)

Efficacy: Carboxymestane Long-term regulation of mucus secretion, dilution of sputum, reduction of airway blockage; reduction of influenza vaccine, pneumococcal vaccine Respiratory infections Risks, reducing the inducements of acute exacerbations.

Usage: Carboxymestane 10 ml each time, 3 times a day (after meals, for 3-6 months); Influenza vaccine once a year in autumn; Pneumococcal vaccine boosted every 5 years after the first vaccination.

Note: Carboxymestane is contraindicated in patients with active gastrointestinal ulcer; mild fever (around 37.5 ℃) may occur after vaccination and resolve spontaneously after 1-2 days of rest without special treatment.

2. “Signals that the drug is effective, suggesting improvement in respiratory function”

After 1-2 weeks (stable period) or 3-5 days (acute exacerbation period) of regular medication, the appearance of these changes indicates that the protocol is effective:

1. Shortness of breath relief: improvement in activity endurance (for example, shortness of breath when walking 100 meters from flat ground becomes shortness of breath when walking 300 meters); difficulty in breathing is reduced when resting, there is no need to open the mouth to breathe, and the cyanosis of the lips disappears.

2. Improved sputum production: reduced sputum volume (from half a bowl to a few bites per day); sputum changed from purulent to white mucus sputum with reduced viscosity and easy coughing up.

3. Reduced acute exacerbations: After regular medication during the stable phase, the number of exacerbations of cough and shortness of breath decreases from 2-3 to 0-1 per month; acute exacerbations of COPD are not easily induced after a cold.

If, after 2 weeks (stable phase) or 7 days (acute exacerbation phase) of medication, there is no relief of shortness of breath, persistent purulent sputum, or Obscurant , If the blood oxygen saturation persists <88%, you need to seek medical attention immediately (be wary of complications such as respiratory failure and cor pulmonale).

3. Uncomfortable medication? Dispose of it as such

– Slight discomfort (common reactions): dry mouth caused by inhalants (such as tiotropium, salmeterol ticasone), taken buccal Sugarless Throat lozenges or drinking more water can relieve it; salbutamol causes mild Panic , rest for 5-10 minutes to relieve the pain and avoid excessive use.

– Apparent discomfort (to be on alert): after levofloxacin administration Rash , itching (anaphylactic reaction), stop the drug immediately and take it orally Loratadine ;Methylprednisolone causes increased blood sugar (especially) Diabetes Patient), subject to monitoring Glycemia , adjust the dose of hypoglycemic drugs as directed by the doctor; if oral leukoplakia (candida infection) occurs after using inhalants, strengthen mouthwash (use after each inhalation) Sodium bicarbonate “Wash your mouth with water”. In severe cases, inhaled glucocorticoids need to be discontinued.

4. Medication courses and precautions

– Effective time: Short-acting bronchodilators (salbutamol, ipratropium bromide) take effect in 10-15 minutes and are suitable for emergency symptom relief; long-acting drugs (titropium bromide, umeclidinium bromide) take 3-5 days to achieve Stable efficacy; anti-infective and anti-inflammatory drugs ( Amoxicillin , methylprednisolone) relieves acute symptoms in 3-5 days.

– Course recommendations:

– Stable period: Long-acting bronchodilators (such as tiotropium bromide) need to be used regularly throughout life, lung function should be evaluated every 3-6 months, and drug dosage or type should be adjusted; phlegm-reducing drugs (such as carboxymestane) should be used continuously for 3- 6 months, and then evaluate whether to continue.

– Acute exacerbation period: Anti-infective drugs need to be used for 7-14 days (to prevent bacterial residues); short-acting diastolic agents and oral hormones (methylprednisolone) should be gradually reduced to discontinued after symptoms are relieved (such as albuterol from 8 times a day spray reduced to 2 sprays).

5. Keep these taboos in mind and avoid making mistakes

– Core principles: Antibiotics should not be abused during the stable phase of COPD (such as amoxicillin, levofloxacin, only used in acute exacerbation of bacterial infection); inhaled glucocorticoids (such as fluticasone, Budesonide ) Do not take it orally for a long time on your own (inhalation dosage form is required to reduce systemic side effects).

– Special populations: Levofloxacin is contraindicated in pregnant women (affects the foetus) Cartilage Developmental), methylprednisolone (may cause fetal malformations); use salbutamol with caution in lactating women (the drug may affect the baby through milk); use levofloxacin and carboxymestane in people with severe liver and kidney insufficiency, the dosage needs to be reduced (to prevent drug accumulation poisoning).

– Avoid wrong combinations: Salbutamol cannot be used with beta-blockers (such as metoprolol, antihypertensive drugs) (the two have opposite effects and will reduce the airway relaxing effect of salbutamol); tiotropium bromide cannot be used with other anticholinergic drugs (such as ipratropium bromide) Frequent use at the same time (increases dry mouth, Urinary retention risk).

6. Do 2 things well to help delay the progression of the disease

1. Respiratory rehabilitation with motor training:

– Stable period: Perform 15-30 minutes of lip-shrinking breathing training every day (inhale through the nose for 2 seconds, and breathe out like a whistle for 4 seconds) to enhance the efficiency of lung ventilation; perform gentle exercise (such as walking) Tai Chi ), gradually increase the amount of activity (as long as it does not cause obvious shortness of breath), and improve exercise endurance.

– Acute aggravation period: Abdominal breathing training can be performed during bed rest (one hand is placed on the abdomen, the abdomen bulges when inhaling, and the abdomen contracts when exhaling) to reduce respiratory muscle fatigue; avoid strenuous exercise (to prevent aggravation of shortness of breath).

2. Life management and prevention:

– Quit smoking: Quitting smoking is the most critical measure to delay the progression of slow-blocking lungs (including second-hand smoke, smoking will directly damage the airway mucosa and aggravate airflow restriction); those who have difficulty quitting smoking can follow the doctor’s advice Nicotine Alternative therapies (like nicotine patches).

– Environmental control: avoiding long-term exposure to dust, fumes, Chemie Gases (such as kitchen fumes, soot), Smog Wear N95 masks when going out every day; maintain air circulation indoors and control the humidity at 50%-60% (dryness can easily irritate the airways).

– Diet: Eat more High protein , High-energy foods (e.g Eggs , fish and lean meat, provide energy for respiratory muscles); avoid high-salt diet (prevent aggravation of edema, especially in patients with cor pulmonale); drink 1500-2000ml of water every day (to help dilute sputum).

COPD treatment is a “long-term management project” that requires a combination of medication, rehabilitation training, and life prevention, and requires regular follow-up visits (once every 3-6 months in the stable period, and within 1 month after cure in the acute exacerbation period). Adjust the plan according to changes in lung function. Patients need to avoid discontinuing their medication on their own due to temporary relief of symptoms, and standardize treatment to maximize respiratory function, reduce complications, and improve quality of life.

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