That day, Dr. Li received an uncle in the clinic, accompanied by his daughter to see a doctor. As soon as Grandpa sat down on the opposite side, Dr. Li smelled the strong smell of smoke. Looking at Grandpa's appearance, his body was also very strong, but he leaned forward slightly with his hands on his knees and gasped. Dr. Li had a general idea in his mind, "Grandpa, what's wrong with you?"

"Climbing stairs is hard these days! My home lives on the 4th floor, the original two breaks can climb up, these days climb two steps have to rest, laborious!" Grandpa complained.

"Do you usually have trouble walking? Can you walk fast or climb hills?"

"Before the fast walk uphill can cope, just these two or three years, walking can not catch up with his wife, walk fast panting ah, can only walk slowly."

"I see, grandpa, and you usually brush your teeth, wash your face, put on and take off clothes, do you feel breathless?"

"Then I am all right, capable. But now I compare it with the last two years and I'm still strong..."

"Then, two or three years ago, did you often cough and cough phlegm?"

"Doctor, you can be said, before that, I cough all the year round, a little white sputum, in winter, others do not catch cold, I have to go to the clinic infusion, a cough for two months, more than ten years of old problems, all say I have 'bronchitis'!" In recent years, I have started to catch my breath, and my cough has gotten worse."

"Grandpa, then you see me give you a summary, more than ten years ago, repeated cough, cough white sputum, winter is obvious, nearly 2-3 years began to appear breathing difficulties after activity, and gradually aggravated, right?" Doctor Li repeated the patient's medical history.

"Yes, yes, yes, Doctor, that's it! Grandpa nodded again and again, and his daughter also echoed: "Doctor, I think my father is smoking, an old smoker for more than 40 years, smoking 2 packs a day, and advised him to quit smoking, he also said that he did not smoke more suffocating, you say, how to do this?"

"Did you have trouble breathing when you were young?" Dr. Li thought quickly, asking questions as he took notes.

"No, no, when I was young, I did all the strength work, how tired gas is enough, unlike now, a little activity on the gas is not enough, blocked here can not come out", the uncle said while pointing to the chest, said: "At that time, smoking, more fierce than now, no matter, so it is not the thing to quit smoking!"

"How do you usually eat? Do you have bloating, anorexia? Are you swollen? Is there usually love to sleep, can not wake up the situation ah?"

"You doctor, my lungs are not good, you ask me to eat, ask me if I am swollen, ask me if I like to sleep, these are everywhere, they are not close to each other... So many questions!" Grandpa is a little impatient, said: "I just have a bad trachea, you give me a little fluid on the line!"

The daughter on the side quickly advised: "Doctor, doctor, don't listen to him, we are here to take him to have a good look and treat him systematically.";

Dr. Li was not angry, while patiently persuading, while observing the patient's eyes, lips, looked at the fingers, pressed the calf, and carefully carried out a specialist physical examination, and said: "Uncle, you don't worry, you listen to me for you slowly.";

"From the entire medical history you have presented, including the physical examination I have just conducted, I suspect that you have COPD, the full name of chronic obstructive pulmonary disease." This disease ah, is a common airway disease, but many people have this disease do not know. As you said, the symptoms are very insidious at the beginning, and become more and more significant as the disease progresses. The symptoms of cough and sputum usually appear in the early stage of the disease, and the main manifestations are dyspnea in the later stage. I also found that you have more typical COPD signs, such as clubbing fingers, prolonged exhalation time, barrel chest, low breath sound in both lungs, etc. Of course, this is only my preliminary judgment based on the clinical diagnosis, in order to confirm the diagnosis, you need to do several tests to help diagnose, but also more accurately rule out some possible differential diagnosis. Including asthma, bronchiectasis, pulmonary fibrosis and so on. Those tests are lung function, chest CT, electrocardiogram, then a blood draw, a blood gas analysis and a blood routine."

"So much trouble?" Grandpa was suspicious, "Just give me some fluid to make me feel better and let me go home!"

"Listen to me, Sir. Copd will seriously affect our quality of life, I believe you can also feel, activity endurance is getting worse and worse, the original can walk fast, can climb the building, now a strenuous activity is breathing badly, far behind the peers, we do not take action, you may sit still are breathing, a person can not even wear clothes, really regret it is too late! How can you enjoy a wonderful retirement at 65?"

Seeing Uncle thoughtfully, Dr. Li went on to say, ";COPD not only affects the quality of life, but can also cause disability and death in serious cases!" I was not just asking, asking you to eat, swollen legs, do not make confusion, is to assess whether you have serious complications caused by COPD, such as pulmonary heart disease, pulmonary encephalopathy, listen to the name you should understand, lung disease caused by serious heart and nervous system problems, which can be a great article, high mortality!"

The uncle lost his impatience just now, and the daughter was more anxious, "Doctor, what is the cause of my father's this?" Can you get to the root?";

"I judge that it is still related to a long history of smoking, in simple terms, the inhalation of harmful particles such as tobacco smoke caused chronic airway inflammation, causing obstruction and structural changes in the peripheral small airway, resulting in limited airflow, so you always feel that you can't breathe out." These changes are the result of many years, it is impossible to completely reverse, but we can improve the symptoms through treatment and management, and the quality of life will be greatly improved, but this process requires us to work together with patients and families!" Dr. Xiao Li saw the patient's daughter nodding, and told him: "However, if you give a little fluid as soon as it gets worse, you will continue to carry it without systematic diagnosis and evaluation and treatment, there will always be times when you can't carry it!"

"Doctor, we know! What now? Is it too late?"; The daughter was anxious to cry out, genuinely worried about her father's health.

"Yes, today is earlier than every other day!" Dr. Li expertly wrote out the doctor's advice, "First, you must quit smoking! Second, do the tests I just mentioned as soon as possible."

"Well, I'll check it out!" Grandpa is no longer attached to "immediately infusion".

"After your results come out, I will give you a detailed treatment plan, we will control the COPD, so that you can enjoy a happy retirement life!"

 

World COPD Day is celebrated every year on October 16. The slogan for 2022 is "Lung for life." If you have a long history of heavy smoking, chronic cough, sputum, shortness of breath and other symptoms, find a doctor to screen it!

Author:

Beijing Chaoyang Hospital, Capital Medical University

Department of Respiratory and Critical Care Medicine

Li Ting

 

(The opinions expressed are solely those of the author. Some pictures in this article are from the Internet, if there is infringement, please contact to delete)