Table of Contents

I. Do you know about "lungs"?

1 What are the functions of the lungs?
2 How can food choke in the lungs?
3 Where does the inhaled oxygen go?
4 What is the purpose of the lung function test?
5 What is asthma? Can it be cured?
(1) What is asthma?
(2) Who is prone to bronchial asthma?
(3) Can asthma be cured?
6 What is chronic lung disease and emphysema?
(1) Risk factors for chronic obstructive pulmonary
disease
(2) Treatment of chronic obstructive pulmonary
disease
7 What is pulmonary fibrosis?
8 Is snoring also a disease?
(1) Do I have an obstruction when I snore? Will I be
deprived of oxygen?
(2) How to treat dangerous snoring?
Ⅱ. how to read and understand the laboratory test?
1 Teach you how to read blood work
(1) What are white blood cells?
(2) What are neutrophils?
(3) What are lymphocytes?
(4) What are eosinophils?
(5) What is C-reactive protein?
2 A tube of blood to help you find the "allergy culprit"
3 How do I know I'm hypoxic?
 Ⅲ. what are the factors of lung "damage"?
1 Are smoking, occupation, environment, and age
associated with lung disease?
(1) Smoking is harmful to health
(2) Pay attention to environmental pollution
(3) What is your occupation?
(4) Did you have any respiratory disease as a
child?
(5) The harm of obesity on respiratory function
(6) The elderly are vulnerable to respiratory
diseases
2 Other systemic diseases can also affect the lungs
(1) Cerebrovascular disease
(2) Spinal cord injury
(3) Thoracic deformity of the spine
(4) After chest surgery
Ⅳ . experts teach you the correct pulmonary
rehabilitation
1 What is pulmonary rehabilitation?
(1) What are the components of pulmonary
rehabilitation?
(2) How is pulmonary rehabilitation implemented?
(3) What are the benefits of pulmonary
rehabilitation?
(4) How does pulmonary rehabilitation work?
(5) Who needs pulmonary rehabilitation?
2 How to cough up sputum properly?
(1) How to make the "phlegm" come out by itself?
(2) How to cough properly?
(3) How to do it?
 (4) How to cough in chronic airway disease - pump
cough
(5) Coughing skills in different positions
3 Exercise helps pulmonary rehabilitation
(1) The benefits of exercise are many
(2) Which exercises are suitable and convenient to
perform?
(3) How much should I exercise?
(4) Under what circumstances is it not advisable to
do exercise?
(5) Under what circumstances should the exercise
be stopped immediately?
4 Oxygen Therapy
(1) What is oxygen therapy?
(2) Types of oxygen therapy
(3) Should I take oxygen for a long time?
(4) How do I know if I am hypoxic?
(5) Is oxygen addiction a problem?
5 Nebulized inhalation therapy
(1) What is nebulized inhalation therapy?
(2) What are the advantages of nebulizer
inhalation therapy?
(3) What are the commonly used nebulizing drugs?
(4) How does the atomization pump work?
(5) When do I need to do nebulization?
6 How should I use inhalation medication?
(1) The usual medication (not asthma also need to
use)
(2) Relieving drugs in acute exacerbations
7 Nutritional therapy
 (1) Supplementation of high quality protein
(2) Low-salt diet
(3) Diet should be light
(4) Multivitamin supplementation
(5) Avoid eating too cold, too hot and hard food,
and drink more water appropriately
(6) Homemade lung benefit soup
8 Daily life guidance
(1) Quit smoking in daily life
(2) Maintain a standard weight
(3) Avoid contact with allergens in daily life
(4) Vaccination on time
(5) Live in a suitable environment to cultivate the
body and lungs
(6) Special environment to do self-protection
(7) Record the peak flow rate measurement value
(8) Regular use of medication, when necessary, go
out with first aid drugs
9 Mental health and breathing
(1) Patients with chronic respiratory diseases are
mostly combined with psychological disorders
(2) Timely recognition of psychological disorders
can improve the quality of life of patients with
respiratory diseases
V. How to return to society
1 The ultimate goal of pulmonary rehabilitation -
return to society
2 Attention to social reintegration
 Preface
As a doctor who has been working in the clinical field for
many years, I have seen too many patients who are
depressed because of long-term medication or
hospitalization, and I have also faced numerous families who
are tired of running around to take care of their patients.
Long-term hospitalization and over-dependence on
medication make many patients' families overwhelmed.
Therefore, in the course of daily treatment, we have been
committed to promoting "pulmonary rehabilitation" as a
treatment method among patients. Years of clinical practice
have proven that systematic pulmonary rehabilitation is
quite effective for respiratory patients. Through the daily
care and auxiliary treatment of patients, together with the
intake of nutrients and diet, we can overcome the disease
and restore health. The integrated use of pulmonary
rehabilitation treatments effectively reduces the burden of
patients and family members and, more importantly,
significantly improves the quality of life of patients.
President Xi Jia-ning often said, "There are many
diseases that we cannot cure, what we need to do is to
improve the function of patients, so that they can have the
ability and confidence to return to their families and society."
These words benefited me and my team and made us
determined to promote "pulmonary rehabilitation". As a
physician who loves my profession, I want to make my
patients happy, happy to be healthy and enjoy a normal life
with their families.
So I organized a group of like-minded people to write
this 　 book , aiming to make the complicated and obscure
clinical knowledge into easy-to-understand daily information
in the form of cartoons, so that patients and their families
can easily and systematically learn about the medical
treatment, care, rehabilitation and nutrition of respiratory
diseases. It also allows medical colleagues to have a more
comprehensive and detailed understanding of the treatment
of pulmonary rehabilitation.
In clinical work, we can make professional judgments
and detailed explanations based on the statements of
patients or families, but it is far more difficult than we think
when it comes to presenting this information through words
and pictures. In the process of writing this comic, we
repeatedly discussed and consulted books and materials,
trying to bring together our years of knowledge and
experience and present it to our readers and friends with the
most precise language and funny drawings. The drawing of
the cartoon has been changed several times, and it took a
lot of time to discuss and polish just the design style and
color mixing. In addition, we have added some digital
elements for easy understanding. If readers have doubts
about a certain rehabilitation action, examination and
nursing operation in the book, they can scan the
corresponding QR code in the book to understand the
relevant information more intuitively.
Now that the book has finally been released, I am proud
of the team's achievement on the one hand, and deeply
grateful to those who have helped us on the other. Thank
you to the leaders of the institute who supported me during
the publication process; thank you to everyone in the team
who worked side by side with me; thank you to the artists
who worked so hard and did their best to draw the book.
Because of you, I was able to take the "high, precise, and
sophisticated" life sciences and draw it into such a
"grounded" book. It may not be perfect, but it carries the
sincere heart of us doctors, and I hope it can help patients
and families suffering from respiratory diseases.
I. Do you know about "lungs"?

1 What are the functions of the lungs?

◆ Lungs are the organ of gas exchange.
◆ The lungs are protected by the thorax and separated
by the heart, one on each side. The normal lungs are light
red, soft and elastic like a sponge, and gradually turn dark
red or dark gray as we age and inhale more air pollutants.
 ◆ "Exhalation" is to expel carbon dioxide produced in the
body from the lungs, and "inhalation" is to inhale oxygen
from the air into the lungs.

Breathe　 out

Inhalation

2 How can food choke in the lungs?

◆ The openings of human esophagus and trachea are
right next to each other.
◆ When breathing, the airway of the trachea is open.
 ◆ When food is swallowed, the food passage is open and
the airway is closed, and food does not enter the airway.
If the abdominal pressure is high or the swallowing
function is impaired, the food may choke into the lungs.

Inhalation

Feeding
3 Where does the inhaled oxygen go?
◆ The inhaled oxygen goes to the lungs first, and then
the blood transports oxygen to the brain, heart, skeletal
muscles and other organs throughout the body.
◆ The organs metabolize and produce carbon dioxide,
which is then transported back into the lungs through the
blood and eventually exhausted into the air.

◆ The lungs are directly connected to the outside world

and are therefore greatly influenced by the environment.
4 What is the purpose of the lung
function test?
(Pulmonary function tests are commonly referred to
as blowing lung function below)
◆ Lung function tests can detect respiratory diseases as
early as possible.
-
 ◆ The lung capacity of adult men is about 3500 ml, and
that of women is about 2500 ml.
◆ Pulmonary function should be checked in all cases in
the following diagram.
5 What is asthma? Can it be cured?
(1) What is asthma?
 Bronchial　 normal　 state

Bronchial　 asthma　 attack　 state

◆ Bronchial asthma is a chronic bronchial disease in
which the patient's bronchial tubes become swollen and
narrow due to allergic inflammation, making breathing
difficult.

◆ Typical symptoms include cough, chest tightness and

wheezing, often attacking and intensifying at night and/or
early in the morning, with most patients relieved on their
own or with treatment.
◆ Symptoms tend to appear or worsen with exposure to
the following items or in the following situations

(2) Who is prone to bronchial asthma?

 Bronchial asthma can develop at any age, and most of
them start before the age of 4 to 5. Some patients can
recover spontaneously or greatly reduce in adolescence.
◆ It is currently believed that people with the following
characteristics may become asthmatic in the future.

Parents　 with　 bronchial　 asthma　 or　 other　 allergic　 diseases

Recurrent　 viral　 infections　 of　 the　 respiratory　 tract　 during　 infancy　 and　
childhood

Allergies　 to　 a　 variety　 of　 foods　 and　 medications　 occur　 in　 childhood
 Exposure　 to　 smoke　 (smoking)　 in　 the　 mother　 and　 early　 postnatal　
period

Highly　 allergic　 to　 house　 dust　 mites

Low　 birth　 weight

(3) Can asthma be cured?

◆ Long-term management of asthma.
 Â- Long-term, regular and scientific use of
medication
Â- Master inhalation therapy, which is the most
effective, economical and safe treatment
method
◎ Avoid exposure to allergens
Â- Active treatment of infections, gastro-
oesophageal reflux, allergic rhinitis (sinusitis)

◆ Daily attention.
Â- The most important thing is to quit smoking and
avoid passive smoking
◎ Do not keep pets
 ◎ Do not place and use perfumes and scented
candles indoors
Â- No hair coloring
Â- Changing bed sheets and pillowcases frequently
◎ Do not lay carpet
◆ It is important to have "long-term cooperation" with a
regular physician, not only during the acute attack but also
during the remission period after the acute attack. Establish
a long-term medication management plan, monitor peak
flow rate regularly, and establish a follow-up schedule.

Regular　 monitoring　 of　 peak　 flow　 rates

6 What is chronic lung disease and

emphysema?
 The scientific name is "chronic obstructive pulmonary
disease" (COPD).
◆ Over 40 years old.
◆ Most of them have a long history of smoking.

◆ The main manifestations are chronic cough, coughing

sputum, and shortness of breath after activity.

Barrel-shaped　 thorax
◆ Chronic obstructive pulmonary disease (COPD) is a
preventable and treatable disease that can cause systemic
symptoms.
 Lung　 Cancer

Cardiovascular　 system　 diseases

Pulmonary　 arterial　 hypertension

Pulmonary　 fibrosis
 Osteoporosis

Nasal　 Symptoms

Lower　 respiratory　 tract　 infections

Venous　 thromboembolism

Depression
 Skeletal　 muscle　 weakness

(1) Risk factors for chronic obstructive

pulmonary disease
◆ Smoking: 80% to 95% of people with slow obstructive
pulmonary disease are smokers or exposed to secondhand
smoke. About half of these people will develop slow-onset
lung, and the earlier the age of starting to smoke, the more
likely they are to develop slow-onset lung.
◆ Atmospheric pollution or occupational exposure: coal
mining, gold mining, cotton textile, welding, etc.
◆ Children of parents with a history of chronic
obstructive pulmonary disease have a significantly higher
prevalence of chronic obstructive pulmonary disease than
the general population.
◆ Patients who are lean, malnourished, and have a low
body mass index have a significantly higher prevalence of
severe slow-onset lung and a higher rate of death from slow-
onset lung.
(2) Treatment of chronic obstructive pulmonary
disease
◆ The importance of quitting smoking: Quitting smoking
is the most effective way to reduce the onset and delay the
course of chronic obstructive pulmonary disease, and is
beneficial to improving quality of life.
 ◆ Exercise therapy: gradually increase the intensity of
exercise.

◆ Breathing training: abdominal breathing, lip

contraction breathing.
 ◆ Respiratory muscle training should also be combined
with work and rest, and it is recommended to wear oxygen
clips to monitor the training.
◆ 1 time per day for 30 minutes; or 2 times per day for
15 minutes. Train 4 to 5 days a week.
◆ The training time should not be too long to avoid
fatigue.
◆ Long-term home oxygen therapy: Especially the partial
pressure of oxygen is lower than 55mmHg and requires long
time low-flow oxygen, 1~2L/min, more than 15 hours per
day.
 ◆ Drug therapy: including bronchodilators, expectorant
drugs, anti-infective drugs.
◆ Inhalation therapy, which can act directly on the
airway and reduce systemic adverse effects, is the preferred
means of drug treatment.
◆ Pay attention to the recognition of acute exacerbation
of chronic obstructive pulmonary disease, and go to the
hospital as soon as possible when the condition shown in the
figure below occurs.

Increased　 airway　 inflammation

 Coughing　 up　 yellow　 sputum

asthma

Fever

7 What is pulmonary fibrosis?

Pulmonary fibrosis is a fatal respiratory disease that
causes widespread fibrosis of the interstitial lung tissue
caused by pathogenic factors that damage the lung tissue,
resulting in the lung becoming "smaller" and making the
lung tissue thicker and unable to exchange oxygen.

Normal
 Fibrosis

In pulmonary fibrosis, a dry cough and gradually

increasing dyspnea may occur.
 ◆ There are many causative factors of interstitial lung
fibrosis, such as: physical and chemical factors (asbestos,
radioactive damage, mineral dust, inhalation of harmful
gases, exposure to pigeon droppings, animal fur, moldy
withered grass, etc.).
◆ Some rheumatic immune system diseases, such as
systemic lupus erythematosus, rheumatoid arthritis, dry
syndrome, dermatomyositis, scleroderma, etc., can also be
accompanied by pulmonary fibrosis.
If you develop the above symptoms, you need to go to a
respiratory specialist promptly.

8 Is snoring also a disease?

◆ According to the relevant research, 20%-30% of the
population will snore, among which Obstructive sleep apnea
hypopnea syndrome (OSAHS) accounts for 4%-10%, and the
incidence will gradually increase with age.

◆ When there is obstruction, the body does not get

enough oxygen, and although the sleep lasts long, the
quality of sleep is actually greatly reduced. Lightly, it leads
to a person not getting good rest and drowsy performance
during the day, and over time, it will lead to various
cardiovascular diseases, and in the most serious case, death
can occur during sleep.

Prone to traffic accidents: highly susceptible to

instant naps

Endocrine disorders: diabetes, metabolic disorders

Cardiovascular diseases: hypertension, stroke,

coronary heart disease, etc.

Reduced quality of life: frequent nodding off

 Disturbing others' rest: loud snoring affects others'
sleep

Decreased ability to work: poor concentration,

memory loss

The most serious cases can directly lead to sudden

death at night!!!

Normal　 people　 have　 a　 clear　 airway　 during　 sleep

Narrow　 airway　 and　 "restricted"　 airflow　 in　 hypoventilated　 patients

Complete　 airway　 obstruction,　 airflow　 interruption,　 apnea　 in　 OSAHS　

patients

(1) Do I have an obstruction when I snore? Will I

be deprived of oxygen?
--How to screen for OSAHS
◆ Judging from experience, if the sound of snoring in a
quiet room exceeds the usual sound of talking, apnea is
highly suspected.
 ◆ The current golden indicator for OSAHS diagnosis,
polysomnography, is a completely non-invasive test that
requires only a few electrode patches to determine the
extent of the condition. (It requires a night off at a hospital
sleep center).

◆ Portable sleep apnea monitor for patients who do not

want to rest in the hospital and can wear it and monitor it at
home.

(2) How to treat dangerous snoring?

◆ General treatment
Â-　 Weight　 loss:　 diet,　 fitness,　 drugs,　 surgery

◎　 Position:　 sleeping　 in　 the　 lateral　 position

◎　 Quit　 smoking　 and　 alcohol:　 Quit　 smoking　 and　 alcohol　 to　 improve　
the　 body's　 sensitivity　 to　 hypoxic　 stimuli
◎ No sedative sleep medication
Â- Raise the head of the bed appropriately
Â- Avoid overexertion during the day
◆ Ventilator therapy
 ◆ Oral orthodontic appliances

◆ Surgical Procedures
There is a certain degree of trauma, and recurrence is
also possible after surgery. For the elderly, people with
combined hypertension, coronary heart disease and diabetes
should choose surgical treatment carefully.
Ⅱ. how to read and understand
the laboratory test?

1 Teach you how to read blood work

(1) What are white blood cells?
◆ White blood cells are a type of cell in the blood that
can defend the body against bacteria, virus, foreign body
invasion or cancer cell attack, and are the body's defense
warriors.
◆ When there is an infection present in the body, the
white blood cells tend to be elevated.
◆ Leukocytes are a big family with five types, namely
neutrophils, eosinophils, basophils, lymphocytes and
monocytes. They each have different functions.
(2) What are neutrophils?
◆ In healthy people, neutrophils account for 50% to 70%
of total white blood cells.
◆ Neutrophilia is seen in bacterial infections.
Neutrophils perform defense functions by eating
invading microorganisms and the body's own necrotic cells.
When the "enemy" is too strong, neutrophils will selflessly
kill the "enemy" by "dying together" and form pus together.

Neutrophils
 Microorganisms　 and　 self　 necrotic　 cells

(3) What are lymphocytes?

◆ Lymphocytes, the smallest white blood cells, are
important cells for the body's immune response function and
are responsible for the body's defense.

◆ If a foreign substance invades the body, the

lymphocytes will increase and gather to destroy and get rid
of it from the body.
 ◆ Lymphocytosis is commonly associated with viral
infections.
(4) What are eosinophils?
◆ Eosinophils are a type of white blood cells, accounting
for 0.5% to 5% of the total white blood cells.
◆ Its main job is to phagocytose antigen-antibody
complexes, mainly in response to allergic reactions as well as
reactions to helminths.
◆ Eosinophilia is commonly associated with allergic
diseases such as bronchial asthma, drug allergy, urticaria,
food allergy and parasitic infections.

(5) What is C-reactive protein?

◆ C-reactive protein is a protein that rises sharply in the
blood plasma when the body is infected or when there is
tissue damage.
 ◆ It is a sensitive and objective indicator of bacterial
infection.
◆ The C-reactive protein can distinguish whether it is a
bacterial or viral infection and avoid the misuse of
antibiotics.

2 A tube of blood to help you find the

"allergy culprit"
◆ Allergen testing can now be obtained by a simple
blood test to find out the substance causing the allergy.
 ◆ It can be pollen, animal fur, or food such as peanuts,
and possibly medicine.
◆ When it is clear that you are allergic to a substance,
you need to avoid contact with these substances.
◆ People who need allergen screening are eczema,
urticaria, allergic rhinitis, asthma, psoriasis, etc.

3 How do I know I'm hypoxic?

◆ Blood gas analysis is a test to understand the
respiratory function and acid-base balance status of the body
by drawing arterial blood.
 ◆ The normal pH of human body is 7.35~7.45. Blood gas
analysis can determine whether the body is acidic or
alkaline.
◆ Blood gas analysis can also determine whether there is
hypoxia and whether carbon dioxide is normal in the body.
Ⅲ. what are the factors of lung
"damage"?

1 Are smoking, occupation,

environment, and age associated with
lung disease?
(1) Smoking is harmful to health
◆ In China, more than 60% of adult males smoke,
China's tobacco consumption occupies the first place in the
world, and at least 2.5 million people around the world get
sick every year due to smoking, so it is an indisputable
medical conclusion that smoking is harmful to health.
◆ Smoking directly damages the respiratory tract and is
the primary risk factor for respiratory disease. Respiratory
diseases account for most of the six major fatal diseases
caused by smoking (including chronic obstructive pulmonary
disease, lower respiratory tract infections, tuberculosis, lung
cancer, ischemic heart disease, and cerebrovascular
disease).
When smoking, the respiratory tract is the first part of
the body where smoke enters. There are as many as 200 or
more toxic substances in smoke, and smoke over the years
can irritate the respiratory mucosa, reduce its defense
function against the outside world, and damage the
physiological structure of the respiratory system itself,
leading to infection, inflammation, ventilation disorders,
asthma, cancer and many other serious and deadly
respiratory diseases.
Secondhand smoke is also an important risk factor for
respiratory diseases. Some surveys show that if the husband
smokes, then the wife's probability of developing respiratory
diseases can be increased twice.

(2) Pay attention to environmental pollution

◆ China's rapid economic development and the rapid
increase in industrial manufacturing have produced a large
amount of toxic gases, making the phenomenon of
atmospheric pollution increasingly serious.
 ◆ The incidence of respiratory diseases is directly related
to atmospheric pollution and changes in meteorological
conditions. When atmospheric pollution is severe, the
defense function of the respiratory tract is impaired and the
incidence of respiratory diseases increases significantly.
◆ When the content of sulfur dioxide or soot in the air is
greater than 1000μg/cm2, the incidence of acute bronchitis
increases; the increase of suspended coal dust is associated
with upper respiratory tract infection; harmful gases such as
automobile exhaust and formaldehyde emitted from house
decoration are important risk factors for bronchial asthma
and lung cancer.
(3) What is your occupation?
◆ When you come to the respiratory clinic, the doctor
often asks, "What do you do for a living?" You may feel
strange, "What does my profession have to do with me
coming to see a doctor?" In fact, in our "Classification and
Catalogue of Occupational Diseases", respiratory diseases
are ranked first.
◆ Dust workers are prone to pneumoconiosis, and even if
these patients stop dust exposure, pneumoconiosis still
progresses; exposure to high concentrations shortens the
length of service, and the age of onset tends to be younger,
and the condition is more severe. The number of
pneumoconiosis and the number of people exposed to dust
are the highest in the world.
◆ Pigeon breeders and farmers are prone to allergic
pneumonia; occupational groups with long-term exposure to
plant-based dusts such as cotton, flax and soft hemp are
prone to cotton dust disease; and those with long-term
exposure to irritating chemicals are prone to chronic
obstructive pulmonary disease.

(4) Did you have any respiratory disease as a

child?
Many people suffer from chronic respiratory diseases in
adulthood because they had respiratory-related diseases
during childhood.
 ◆ Chronic obstructive pulmonary disease in adulthood is
associated with early childhood lower respiratory tract
infections, vitamin A deficiency, and poor fetal lung growth in
utero.
◆ Children who have had asthma as children are likely to
develop severe respiratory disease in adulthood due to
reduced lung function if it is not well controlled.
◆ Having suffered from whooping cough and measles as
a child, you are prone to bronchiectasis as an adult.
(5) The harm of obesity on respiratory function
◆ With the modernization of people's lifestyles, changes
in dietary structure and reduction in physical activity, the
incidence of overweight and obesity is gradually increasing.
More than 1.6 billion adults worldwide are overweight, and at
least 400 million of them meet the criteria for obesity.
◆ Obesity refers to excessive accumulation of body fat
and/or abnormal distribution. International usually use the
body mass index (BMI) to classify the degree of obesity, that
is, BMI 24 to 27.9 is overweight, BMI more than 28 is obese.
We can use a simple formula to calculate BMI = weight (kg) /
height (m2).
◆ The accumulation of adipose tissue in the chest wall
and abdomen in obese people restricts the movement of the
diaphragm, decreases the compliance of the thoracic cavity,
and impairs the ventilation function in adults and children. It
is associated with many respiratory diseases, such as sleep
breathing disorders, bronchial asthma, chronic obstructive
pulmonary disease, and lung infections.

(6) The elderly are vulnerable to respiratory

diseases
◆ Today's medical level is improving, people's life
expectancy is greatly extended, the population tends to be
aging, and respiratory diseases, including lung infections,
chronic bronchitis, chronic obstructive pulmonary disease,
sleep breathing disorders and lung cancer are common
diseases among the elderly.
As the human body ages, the structure of the respiratory
system begins to degenerate, the cough reflex weakens, the
respiratory mucosa atrophies, and the secretion function
decreases, leading to a decrease in defense ability, which
makes it easier for disease-causing substances to enter the
respiratory tract and cause infectious diseases of the
respiratory system; the respiratory muscle strength
decreases and the thoracic mobility weakens, leading to a
decrease in the ventilation function of the lungs and making
it easy to develop slow-onset lung.

2 Other systemic diseases can also

affect the lungs
(1) Cerebrovascular disease
◆ Cerebrovascular diseases, including the commonly
referred to as cerebral hemorrhage or cerebral infarction, not
only affect tissue oxygen supply but also tend to cause lung
infections due to impaired consciousness, loss of cough
reflex and difficulty in swallowing, and prolonged bed rest.
 ◆ Patients with severe cerebrovascular disease are
highly susceptible to pulmonary infections due to impaired
consciousness, loss of cough reflex, decreased respiratory
defense, reduced body resistance, bed rest and pulmonary
stasis.
◆ Acute cerebrovascular disease can also cause
neurogenic pulmonary edema.
(2) Spinal cord injury
◆ Respiratory disease is the leading cause of death after
spinal cord injury, with the probability of death due to
pulmonary infection being the greatest.
 ◆ The main muscles of inspiration are the diaphragm,
the external intercostal muscles and the auxiliary respiratory
muscles. Spinal cord injury can lead to impairment of
diaphragm function, which can lead to impaired ventilation in
patients, as well as lung infection and atelectasis due to
weak coughing power.
◆ Sleep apnea can be caused by prolonged supine
position and use of sedative drugs after spinal cord injury.
(3) Thoracic deformity of the spine
◆ Severe spinal thoracic deformity will lead to a series of
problems such as reduction of thoracic volume, compression
of lung parenchyma, restriction of diaphragm movement,
curvature of airway, obstruction of lung ventilation, and
reduction of lung capacity, which will seriously affect the
respiratory function of patients.
In more serious cases, due to alveolar atrophy, excessive
intrapulmonary tension causes circulatory obstruction,
pulmonary hypertension, which in turn leads to pulmonary
heart disease and early death at a later stage.

(4) After chest surgery

 ◆ Thoracic surgery damages the respiratory muscles and
destroys the integrity and stability of the thorax, which,
together with anesthesia, surgical trauma, intraoperative
bleeding, postoperative pain, and prolonged postoperative
lying, all seriously affect the patient's respiratory function.

◆ Complications such as lung infection and pleural

effusion are likely to occur after chest surgery, aggravating
respiratory dysfunction.
Ⅳ. experts teach you the
correct pulmonary

rehabilitation
 

1 What is pulmonary rehabilitation?

Pulmonary rehabilitation is the development of
individualized and comprehensive intervention programs for
patients with chronic respiratory diseases to improve
physiological and psychological status, reduce symptoms,
enhance body function, improve quality of life, reduce
readmission rates and costs, and help patients return to their
families and society.

(1) What are the components of pulmonary

rehabilitation?
◆ Pulmonary rehabilitation is not limited to exercise
therapy; education, behavioral interventions, psychological
interventions, and outcome evaluation are all part of a
comprehensive pulmonary rehabilitation program.

(2) How is pulmonary rehabilitation

implemented?
 ◆ Pulmonary rehabilitation is patient-centered,
individually tailored, and accomplished by a multidisciplinary
treatment team.

(3) What are the benefits of pulmonary

rehabilitation?
◆ Improve exercise tolerance
◆ Improve the feeling of difficulty in breathing
◆ Improving the ability to perform activities of daily
living
◆ Improve health-related quality of life
◆ Improve bad mood and optimize sleep quality
◆ Improves muscle strength, endurance and mass
◆ Reduced hospitalization dates and medical expenses
(4) How does pulmonary rehabilitation work?
(5) Who needs pulmonary rehabilitation?
◆ Chronic respiratory diseases, mainly including.
Â- Chronic obstructive pulmonary disease
Â- Bronchial asthma
Â- Lung cancer
Â- Interstitial lung disease
Â- Before and after lung reduction surgery
◆ Secondary respiratory dysfunction, mainly including.
Â- Thoracic and abdominal surgery
Â- Thoracic and spinal deformities
Â- Central nervous system disorders
Â- Neuromuscular diseases

2 How to cough up sputum properly?

(1) How to make the "phlegm" come out by
itself?

◆ A method that can be done by yourself - Active Circuit

Breathing Technique (ACBT)
ACBT is divided into three parts: respiratory control,
thoracic expansion, and forceful puffing.
Â- Breathing control 3 to 4 times
Â- Let your shoulders relax, breathe gently and
slowly, and try to draw your breath into your
stomach

Â- Thoracic expansion 3 to 4 times

Â- Perform a deep inhalation, not too fast. The
main emphasis is on the inhalation, the
 exhalation is relaxed and does not require
deliberate force

Â- Breathe hard 1 to 2 times

Â- Open your mouth into an O-shape and move
like you are fogging up your glasses with warm
breath. To exhale hard, tighten the muscles of
both the abdomen and chest. The sound
sounds like a sigh, but harder

◆ The method that requires some gadgets to

accomplish: positive expiratory pressure technique
 ◆ Methods that require the help of others to complete:
Percussion techniques

Place　 your　 hand　 in　 the　 shape　 of　 a　 cup　 and　 tap　 the　 patient's　
back　 with　 appropriate　 weight
◎ It should be noted that patients whose pain is
not well controlled after surgery do not
tolerate percussion well; special attention
 should be paid to the strength of percussion in
patients with osteoporosis and coagulation
disorders
(2) How to cough properly?
◆ Cough is a common symptom of respiratory diseases,
caused by inflammation, foreign bodies, physical or chemical
irritation of the trachea, bronchial mucosa or pleura.

◆ Coughing has the protective effect of removing foreign

bodies and secretions from the respiratory tract.
◆ Coughing is divided into four stages: full inspiration,
vocal hilar closure, raising the intrathoracic and intra-
abdominal pressures, and vocal hilar opening and gas
expulsion.
Â- Stage 1: Need to inhale enough air to prepare
for a strong cough
Â- Phase 2: Close our vocal chambers and prepare
the abdominal and intercostal muscles
◎ Stage 3: The prepared abdominal and
intercostal muscles start to exert themselves
Â- Stage 4: Open the vocal chambers and exhale
the air with force
(3) How to do it?
To make coughing easier, it is also encouraged to try
postural adjustments to provide assistance with coughing.
◆ During the first stage of deep inhalation, you can
increase the amount of inhalation by looking upward,
shrugging your shoulders, sitting as straight as possible, and
raising your arms up.
◆ In the second stage, to help the vocal folds close, tell
yourself to hold it after a deep inhalation.
◆ The movements of the third and fourth stages are
continuous together. Therefore, after we hold a deep
inhalation, do bend our body forward, look down or similar
movements to help us cough and also to help protect our
airway.

Less　 favorable　 positions,　 such　 as　 supine,　 are　 less　 convenient　 for　
coughing
(4) How to cough in chronic airway disease -
pump cough
◆ In the first stage of coughing, we need to perform
deep inhalation first, but for patients with asthma and
chronic obstructive pulmonary disease, doing deep
inhalation is not encouraged, and pump coughing is an
option in this case.
◆ 3 moderately strong puffs + 3 short, light coughs.
 
(5) Coughing skills in different positions
◆ Self-assisted coughing with elbow support in prone
position.

◆ Self-assisted coughing in a long sitting position.

Stretch　 the　 body　 and　 neck　 backward　 and　 inhale　 fully

Curl　 your　 body　 to　 increase　 your　 exhalation　 when　 you　 exhale

Arms　 swing　 into　 a　 butterfly　 to　 increase　 thoracic　 expansion

Exhale　 with　 the　 body　 close　 to　 the　 legs　 to　 help　 exhale
◆ Self-assisted coughing in the end sitting position.
Fold　 your　 hands　 above　 your　 belly　 button　 and　 tilt　 your　 head　 back　
and
Helps　 with　 inhalation

When　 exhaling,　 push　 your　 hand　 upward　 and　 inward,　 bend　 forward　
and　 exhale　 hard

3 Exercise helps pulmonary

rehabilitation
(1) The benefits of exercise are many

Improve physical performance

Reduce the risk of falls (especially in older patients)

Relieve shortness of breath

Improve the quality of life

Helps loosen sputum for easy expulsion

Makes the mood happy

Increase muscle strength, improve balance, flexibility

and agility
(2) Which exercises are suitable and convenient
to perform?
(3) How much should I exercise?
◆ In general, you should keep exercising 5 to 7 days a
week and 20 to 90 minutes a day, which includes the warm-
up exercise that cannot be ignored.
◆ It is not advisable to overexert yourself. When you first
start exercising, it is safest and feasible to position the level
of exercise at a level where you can have a conversation
during exercise.
◆ The recommended way of exercise is to choose
interval training, such as exercising for 3 minutes,
performing 5 minutes of finishing exercise, and so on for 3 to
5 cycles.
◆ Everyone's exercise tolerance and condition is
different. Please let your doctor or therapist evaluate you
first before exercising more safely and efficiently.
(4) Under what circumstances is it not advisable
to do exercise?
 Physical　 discomfort,　 such　 as　 cold,　 fever,　 etc.

Within　 1　 to　 2　 hours　 of　 the　 end　 of　 the　 meal

When　 encountering　 weather　 changes　 or　 bad　 weather,　 such　 as　 heat,　
wind,　 rain,　 fog,　 cold,　 etc.

(5) Under what circumstances should the

exercise be stopped immediately?
4 Oxygen Therapy
(1) What is oxygen therapy?
 ◆ The treatment method to correct the patient's hypoxic
state by increasing the oxygen concentration in the inhaled
gas is called oxygen therapy.
Hypoxia refers to a series of pathological processes that
cause changes in the body's function and metabolism and
even morphology and structure due to insufficient oxygen
supply or impaired utilization of tissues.
◆ Oxygen therapy refers to all kinds of treatment for
hypoxia, except for the elimination of the cause of hypoxia,
all can be given oxygen therapy.
(2) Types of oxygen therapy
◆ Nasal catheter oxygen inhalation method: This oxygen
inhalation method is simple and easy to use. It is only
suitable for low-flow oxygen supply. If the flow rate is
relatively high, it will be unbearable due to the flow rate and
impact force, and at the same time, it will easily lead to
dryness of airway mucosa.

◆ Mask oxygen inhalation method: Put the mask closely

over the mouth and nose and fix it with elastic band, which is
suitable for more serious oxygen deficiency, the oxygen
concentration can reach 40%~50%, and it feels more
comfortable without mucous membrane irritation and dry
blowing feeling.
 ◆ Transnasal high-flow oxygen therapy is a form of
oxygen therapy that delivers a certain oxygen concentration
of air-oxygen mixed with high-flow gas directly to the patient
through a nasal plug catheter without sealing, which can
rapidly improve oxygenation. The advantages are high-flow
warming and humidifying oxygen delivery, thus protecting
the airway mucosa, enhancing the clearing ability of mucosal
cilia, diluting respiratory secretions, and maintaining the
patency and moistness of the airway.

◆ Mechanical ventilation oxygen administration method:

That is, when mechanical ventilation is performed with
various artificial ventilators, oxygen therapy is performed by
using the oxygen supply device on the ventilator, and the
oxygen concentration given by the ventilator is more
accurate and constant.
 ◆ Hyperbaric oxygen therapy is to breathe pure oxygen
or high concentration oxygen under high pressure, generally
the oxygen concentration exceeds 80%, which can increase
the blood oxygen content several times or even tens of times
compared with conventional oxygen absorption, and can
narrow the intravascular bubbles and reduce tissue edema. It
has remarkable efficacy for carbon monoxide poisoning,
decompression sickness, ischemic-hypoxic encephalopathy,
and sudden deafness.

(3) Should I take oxygen for a long time?

Blood gas analysis should be performed to find out
whether long-term oxygen is needed if you have the
following diseases.
Â- Chronic obstructive pulmonary disease
Â- Chronic respiratory failure
Â- Patients with cardiovascular diseases, such as
coronary artery disease, cardiac insufficiency
(4) How do I know if I am hypoxic?
 Â- Dizziness, headache, tinnitus, blurred vision,
weakness of limbs
Â- Nausea, vomiting, shallow fast and weak
breathing, fast and weak heartbeat
Â- Severe impairment of consciousness and
bruising of the skin, lips and nails all over the
body may occur
(5) Is oxygen addiction a problem?
◆ Oxygen is indispensable for life, and it can effectively
adjust the physiological state of the body, but oxygen has no
addictive properties.
◆ Since the first clinical use of oxygen in World War II,
there has not been a single case of oxygen addiction
reported worldwide in the decades since it was first used.

5 Nebulized inhalation therapy

(1) What is nebulized inhalation therapy?

◆ Nebulized inhalation is a form of drug delivery in which

drugs are inhaled into the airways and lungs with breathing,
and is an important treatment for respiratory-related
diseases.
(2) What are the advantages of nebulizer
inhalation therapy?
◆ High therapeutic index of local drug delivery:
Compared with oral and injectable drug delivery methods,
nebulized therapy is faster and more effective because the
drug acts directly on the target organ.
 ◆ Good safety: high local drug concentration, but small
overall dose, only a few tenths of the systemic dose, less
systemic adverse reactions.
◆ Easy to use: It does not require deliberate cooperation
from the patient and is easy to grasp by children.
(3) What are the commonly used nebulizing
drugs?

Bronchodilators:　 ipratropium　 bromide,　 compound　 ipratropium　 bromide

Glucocorticoids　 for　 inhalation:　 Budesonide　 suspension　 for　 inhalation,　

which　 can　 be　 mixed　 with　 commonly　 used　 nebulized　 drugs,　 should　
be　 used　 within　 30　 minutes　 after　 mixing　 and　 stored　 at　 8~30℃,　 not　
refrigerated.

Expectorant:　 acetylcysteine　 solution　 for　 inhalation,　 ready　 to　 use,　

remaining　 solution　 needs　 to　 be　 kept　 in　 the　 refrigerator　 and　 used　
 within　 24　 hours.

(4) How does the atomization pump work?

Nebulized　 inhalation
(5) When do I need to do nebulization?

6 How should I use inhalation

medication?
(1) The usual medication (not asthma also need
to use)

◆ Cymbalta 3-step inhalation method

 You can use Symbic® DuPont® in three simple steps: "Rotate",
"Click" and "Inhale".

Rotate the red base in any direction to the end

Then reverse the direction to the end to hear the "click" sound

Deep exhalation followed by a strong and deep "inhale" with the mouthpiece in
place
◆ Three-step inhalation method of sulforaphane
 Open
Hold the shell with one hand, place the thumb of the
other hand on the thumb stem and push the thumb outward
until it is fully open

Push away
Hold the nozzle of the collimator to yourself and push the
slide outward until it clicks to indicate that the collimator is
ready to absorb the drug

Inhalation
Place the mouthpiece in the mouth and inhale deeply
and smoothly from the paracentesis, do not inhale through
the nose, then take the paracentesis out of the mouth,
continue to hold your breath for 10 seconds and close the
paracentesis
◆ Silicea inhalation method

(2) Relieving drugs in acute exacerbations

The medication should be used with caution during acute
exacerbations and should not be used during normal times.

◆ Inhalation method of Ajinomoto and Ventolin aerosol

7 Nutritional therapy

(1) Supplementation of high quality protein

 ◆ Daily protein intake is 1.2 to 1.5 grams per kilogram of
body weight. Eat more chicken, eggs, shrimp, lean pork, fish,
milk, soy products, etc. to increase muscle strength.

-
(2) Low-salt diet
◆ Limit salt intake to less than 6 grams of salt per day.

(3) Diet should be light

◆ Low-fat diet, less spicy and fried food, less overly
sweet and pickled food, pickles or canned food.
(4) Multivitamin supplementation
◆ Ensure high fiber, adequate calorie and mineral intake,
cod liver oil, carrots, tomatoes and yellow green vegetables
and fruits, food oil with high calcium content, fish, meat,
bananas, yams, rape, dried fruit. Supplement food vitamins,
such as prevention of constipation: mustard, cabbage,
spinach, celery, and ripe bananas, etc.

(5) Avoid eating too cold, too hot and hard food,
and drink more water appropriately
(6) Homemade lung benefit soup
 Lotus Seed and Lily Soup
Ingredients: lotus seeds 15 grams, dried lily 15 grams,
1 egg, sugar appropriate amount
Directions: Remove the core of lotus seeds, put them in
a casserole with 100 contracts, add an appropriate amount
of water and cook with a gentle fire until the flesh of lotus
seeds is rotten, then add eggs and sugar. The eggs can be
consumed after they are cooked.

Luo Han Guo Snow Pear Soup

Ingredients: snow pear, Luo Han Guo, red dates,
Chinese wolfberry, rock sugar
Practice: wash the snow pear, cut into pieces; Luohan
fruit, red dates, wolfberry wash, in Luohan fruit tied a small
hole.
Put all these ingredients and icing sugar into a pot, add
water and simmer for half an hour.
Efficacy: moisten the lungs to stop cough, beauty, drink
more on the body is very good, pear is "hundred fruit of the
clan", because of its fresh juicy, sweet and sour, so also has
"natural mineral water". Pear is rich in B vitamins, can
protect the heart, reduce fatigue, expectorant cough, throat
care.

Silver Fungus and Red Date Soup

Ingredients: 20 grams of silver fungus (about half), 20
red dates, 60 grams of rock sugar (according to the taste of
each person to add or reduce the amount)
Directions: Put the silver fungus in water, remove the
tip, tear it into small pieces, put it into a pot with red dates
and rock sugar, add 6 bowls of water, bring it to a boil on
high heat, then change to a gentle fire and cook for half an
hour, then remove from heat.
Efficacy: Moisten the lungs and stop coughing. For
people who suffer from cold and cough, it is written in the
"Essential Recipe" by Yu Monk in the Tang Dynasty that
boiling red dates, silver fungus and rock sugar together in
soup can stop coughing and moisten the lungs.

8 Daily life guidance

(1) Quit smoking in daily life
◆ Research shows that smoking is hazardous to health
and is the primary risk factor for respiratory diseases.

Secondhand smoke is also an important risk factor for

respiratory diseases. Surveys show that the probability of
family members suffering from respiratory diseases is
greatly increased when someone in the family smokes.
 ◆ Quitting smoking is the most effective and economical
way to reduce the incidence and delay the course of
respiratory diseases, so let's stay away from tobacco and
reduce the burden for the respiratory system.
(2) Maintain a standard weight

(3) Avoid contact with allergens in daily life

In the process of breathing, organic or inorganic dust in
the external environment, including various microorganisms,
allergens, dust particles and harmful gases can be inhaled
into the respiratory tract to cause various diseases.

◆ After identifying the allergens, you should try to avoid

contact with them in your daily life to avoid inducing related
respiratory diseases.
(4) Vaccination on time
◆ The autumn and winter seasons are characterized by
variable weather, large temperature differences and dry
climate, and are a period of high incidence of respiratory
diseases, so influenza and other related vaccinations should
be actively administered.

◆ 23-valent pneumococcal polysaccharide vaccine

(PPV23)
Â- Recommended for high-risk groups over 2 years
of age, including.
Immunocompetent but chronically ill people over
65 years of age
People with weakened immune function
Living or working in high-risk environments (e.g.,
long-term hospitalized elderly,
(Medical staff, etc.)
Â- It can be given at any time throughout the year
or at the same time as the flu vaccine, and
children should receive the vaccine when they
are older than 2 years old. Generally, only one
vaccination is required, but for those who are
weak, a second catch-up vaccination is
required 5 years after the initial vaccination
 Influenza vaccine
Â- The following groups are recommended as
priority vaccine recipients.
Pregnant women
Family members and caregivers of infants under 6
months of age
Children 6 months old to 5 years old
Aged 60 and above
Patients with specific chronic diseases
Medical Staff
◎ The best time to receive influenza vaccination is
before the start of the annual influenza
season. In China, especially in the northern
region, winter and spring are the annual
influenza epidemic seasons, so September and
October are the best time for vaccination. Of
course, vaccination after the start of influenza
also has a preventive effect
(5) Live in a suitable environment to cultivate
the body and lungs
◆ Suitable temperature and humidity, good air quality,
quiet and comfortable environment
 ◆ Keep a good rest, go to bed early, get up early,
exercise in the morning and breathe fresh air.

◆ Use air purifiers at home to improve air quality;

minimize going out in hazy weather and be sure to take
protective measures.
 ◆ Pay attention to seasonal and weather changes,
protect yourself from heat and cold, avoid wind, sun and
rain, and go out to reduce the chance of illness and infection.

(6) Special environment to do self-protection

◆ In special working environment, they are prone to
respiratory diseases. For example: long-term exposure to
cement makes you susceptible to cement pneumoconiosis;
long-term exposure to coal and dust makes you susceptible
to silicosis and coal workers' pneumoconiosis; long-term
exposure to asbestos makes you susceptible to asbestosis.
◆ Long-term exposure to irritating chemicals makes you
susceptible to chronic obstructive pulmonary disease caused
by irritating chemicals.
◆ So you need to do self-protection, such as wearing a
mask, and you need to pay attention to keep warm and
avoid getting cold in general.

(7) Record the peak flow rate measurement

value
Peak flow rate is a simple peak flow meter used to
measure an indicator of the patient's lung function that
reflects the degree of restriction of the patient's exhaled
breath.
 ◆ Monitoring peak flow rate results at home should be
greater than 70%, if it is less than 70%, it suggests the need
for medical attention.
◆ Record the peak flow rate value Special reminder: blow
once in the morning and once before going to bed, and blow
before medication, use the maximum explosive force to
blow, blow three times each time, and take the best value.
(8) Regular use of medication, when necessary,
go out with first aid drugs

9 Mental health and breathing

(1) Patients with chronic respiratory diseases
are mostly combined with psychological
disorders
◆ Chronic respiratory disease is a physical and mental
co-morbidity, and psychological disorders are one of the risk
factors that increase mortality in patients with chronic
respiratory disease. Such patients commonly suffer from
anxiety, depression and other psychological disorders.

◆ Anxiety can cause dyspnea to worsen, and dyspnea in

turn worsens anxiety, forming a vicious circle.
(2) Timely recognition of psychological
disorders can improve the quality of life of
patients with respiratory diseases
◆ Timely and correct assessment of the psychological
condition of patients with chronic respiratory diseases, giving
effective psychological interventions and enhancing patients'
confidence in treatment are of great significance to improve
patients' quality of life.
◆ The main goal of psychological intervention is to make
patients understand their condition objectively, to help them
build up their ability to cope with the disease, to encourage
them to establish appropriate psychological catharsis
channels and to cultivate stable emotions.
 ◆ Strengthen the positive influence of the patient's
family on the patient, divert the patient's attention and
reduce the symptoms of respiratory distress.
◆ You can address the causes of patients' anxiety,
channel and comfort them, let them face the reality, use
more encouraging words, and establish the determination to
overcome the disease.
V. How to return to society

1 The ultimate goal of pulmonary

rehabilitation - return to society
◆ In the stabilization period of chronic respiratory
disease, patients can fully work and study normally.
◆ Outpatient clinics often have young bronchial asthma
patients asking, "Doctor, I'm only in my twenties, I'm not
married, I haven't found a job yet, what am I going to do in
the future?" At this time, the doctor will definitely tell him
firmly: "Yes, you can! You can have a normal life!"
2 Attention to social reintegration
Follow the advice given to you by your doctor about your
daily life.
◆ Women should ensure adequate nutrition when they
are pregnant and do pre-conception and prenatal checkups.
◆ Communicate with your primary care physician more
often, have regular outpatient reviews, and talk to your
primary care physician about anything that makes you feel
uncomfortable.

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