The-third-leading-cause-of-death-in-the-world-COPD,-the-chronic-obstructive-pulmonary-disease-you-must-know

Dr. Long Chelsea98.comHuizhou Education_One Million Dragon's Great Health

Cardiovascular and cerebrovascular diseases, malignant tumors, chronic respiratory diseases and diabetes are collectively called the "Four Major Chronic Diseases" by the World Health Organization. According to data from the World Health Organization: as the world’s third leading cause of death, 600 million people worldwide currently suffer from COPD; the global prevalence of COPD with grade II or above is 10.1%±4.8% or higher. Male 11.8%±7.9%, female 8.5%±5.8%.

COPD, the full name is chronic obstructive pulmonary disease (COPD), including bronchitis and emphysema, the third week of November every year on Wednesday is "World COPD Day." COPD is a common preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation, usually caused by abnormal airways and/or alveoli caused by significant exposure to toxic particles or gases. A long-term lung disease that makes it difficult for people to breathe and further develops into a common chronic disease of pulmonary heart disease and respiratory failure. Inflammation is the core mechanism of the progression of COPD. It can cause structural changes in the lungs, small airway stenosis and destruction of lung parenchyma, and ultimately lead to damage to the attachment of alveoli and small airways, and reduce lung elasticity.

The weather suddenly becomes cold in winter, when COPD is most prone to attack or acute exacerbation. The mortality of COPD patients is mainly related to the number of acute attacks. The statistics are as follows: (1) No acute attacks occur each year, and their five-year survival rate is higher than 80%; (2) Acute attacks 1-2 times per year, fifth The annual survival rate is about 50%-60%; (3) Acute attacks are more than 3 times a year, and the five-year survival rate is about 30% or less. Then it is not difficult to find that how to reduce the number of acute attacks has become the key to prolonging the life of COPD patients. A 5-year study in the United States showed that the incidence of lung cancer in patients with COPD is as high as 16.7/1000 person-years. The incidence is higher in the elderly, mild to moderate COPD, and low body mass index. Diffusion dysfunction is independent of lung cancer. The predictor, the most common pathological type is squamous cell carcinoma (44%) (this paper was published in the American Journal of Respiratory and Critical Care Medicine on October 15, 2011). According to a report from the World Economic Forum, the global treatment cost for COPD is estimated to rise from USD 2.1 trillion in 2010 to USD 4.8 trillion in 2030.

Cause

The pathogenic factors of COPD can be simply divided into environmental factors and individual factors, but the most important factor is smoking. About 80% patients are caused by smoking. The prevalence of COPD in smokers is 2-8 times higher than that of non-smokers. The longer they smoke and the more they smoke, the greater the risk of COPD. In addition, the hazards of passive smoking are similar to those of active smoking. Therefore, the hazards of secondhand smoke should not be underestimated.

Occupational dust and chemical substances (smoke, allergens, industrial waste gas and indoor air pollution, etc.) concentration or exposure for too long may cause the occurrence of COPD; chlorine, nitrogen oxides, and sulfur dioxide in the working environment , Silicon dioxide, coal dust, etc. may cause effects; air pollution is closely related to respiratory diseases. Studies have proved that short-term exposure to high-concentration outdoor air pollution can significantly increase the number of acute exacerbations, hospitalization rates, and mortality of COPD patients, and is closely related to the decline of lung function. Air pollution is more sensitive to children and women.

In addition, individual factors, such as genetic factors (family history), imbalance of proteases and anti-proteases, congenital developmental abnormalities, lung development problems, pregnant women smoking or passive smoking, childhood malnutrition, improper feeding methods, repeated childhood respiratory infections, etc. Is an important factor. Therefore, the prevalence of COPD in poor areas will be higher than in economically developed areas.

Although the symptoms of this disease do not usually appear in people under 55 years of age, the changes in the lungs are many years earlier. From the onset to the formation of COPD, the obvious symptoms generally take 5-10 years. During this period, the condition is likely to be "quiet", and after 5 or 10 years, more serious symptoms will develop. Therefore, early prevention is the top priority. The investigation showed that: 71.2% patients believed that the disease restricted exercise and leisure life, 62.7% felt physical pain, 45.8% sleep quality was seriously affected.

Grade

According to the consensus of international experts, COPD can be divided into 4 levels:

The first level is usually a little cough and other symptoms;

The second level, a little shortness of breath when doing strenuous activities;

The third level, shortness of breath occurs when doing housework, going to the toilet, or going upstairs;

The fourth level, in theory, is that in a resting state, you will be out of breath while sitting on the bed.

It is worth noting that when patients with COPD have shortness of breath, go up and down stairs or feel dyspnea after exercise, and even become "out of breath" when they develop calm, they are mostly in the middle and late stages and often miss the best. The timing of treatment, lung ventilation function has been damaged by more than 50%. therefore,Health management is the first opportunity to prevent COPD.

The incidence of chronic obstructive pulmonary disease in China

According to data from the World Health Organization, China's COPD mortality rate ranks first in all countries, and the prevalence of COPD among people aged 40 and above is also the highest in the world. Moreover, the prevalence data has increased unabated over the years and has become a very serious one. Public health issues. At the same time, compared with the common smoking risk factors in European and American countries, the more prominent problem in China is pollution. With the aging of the population, air pollution, smoking and other factors, the prevalence of COPD is still on the rise. On April 10, 2018, the international authoritative medical journal "The Lancet" published the first results of a large-scale population study "Chinese Adult Lung Health Research" completed by Chinese scholars, revealing the prevalence of COPD in China, and for the first time clearly The number of chronic obstructive pulmonary patients in China is about 100 million. Most of them are smoking men, and 2.5 people die from COPD every minute. In 2018, the incidence of chronic obstructive pulmonary disease in China over the age of 40 increased to 13.7%. Among patients with acute exacerbation of chronic obstructive pulmonary disease requiring hospitalization, the 5-year mortality rate exceeded 50%. In China, 1.28 million patients die of chronic pulmonary obstruction each year, with a mortality rate of 17.6%, which has exceeded the mortality rate and death toll from coronary heart disease. If you don’t intervene in time,future30China will have 6,500More than ten thousand people died of chronic lung obstruction. At present, the annual per capita medical expenses for COPD in China exceeds 1.1Ten thousand.

China is the number one smoking country, with 350 million smokers, one quarter of the global smoking population, and China’s cigarettes account for 42% of the world’s total cigarette production.. After the 2003 "Framework Convention on Tobacco Control" was passed, Western countries have strengthened their guidance on smoking control, such as banning smoking in public places, raising tobacco taxes, etc., to control tobacco production and sales from all sides. In China, the tax revenue contributed by the tobacco industry accounts for about 10% of the national GDP. At the same time, the tobacco industry generates tens of millions of jobs every year, which has made it difficult for China to control tobacco. In May 2010, China issued the "Decision Regarding a Total Smoking Ban in the National Medical and Health System from 2011". Officials from the Ministry of Health stated that "The Ministry of Health can only control hospitals and require medical institutions across the country to ban smoking indoors next year." This illustrates the Chinese government's tobacco control The work still has a long way to go.

According to the "Environmental Performance Index 2018", China's air quality ranking only surpasses India, Bangladesh, and Nepal, and ranks fourth from the bottom among 180 countries and regions. There is a long way to go to improve air quality. In addition to relying on the government's atmospheric treatment, ordinary people should also pay attention to wearing masks, timely protection of the respiratory tract, and thorough purification of indoor air to reduce the inhalation of PM2.5 particles and reduce the risk of COPD.

The incidence of chronic obstructive pulmonary disease in the United States

2019In the United States, there are about 1500Ten thousand people are diagnosed with COPD, approximately 1210,000 people died of the disease. In 2020, researchers from the National Jewish Health Center and dozens of major institutions have proposed new standards for the diagnosis of COPD. If the new diagnostic criteria are adopted, the number of people diagnosed with COPD in the United States will increase by 15% to 36%, or about 2 million to 5 million people. Overall, the number of COPD cases in the United States has increased by 41% since 1982, involving white women with 1%-3% and white men with 4%-6%. Approximately 14% American adults aged 40-79 suffer from COPD.

In the U.S. and U.K.,80%To 95%Of patients with chronic obstructive pulmonary disease are smokers. The relevant information published in the American Journal of Preventive Medicine on December 16, 2019 and in the BMC Pulmonary Medicine on October 16, 2019 shows that inhalation of heated tobacco vapor through e-cigarettes will increase the incidence The chance of asthma and COPD. The data also shows that people who regularly use e-cigarettes and combustible cigarettes may be 6 times more likely to develop COPD than people who do not use any tobacco products.

The total cost of COPD hospitalization in the United States is US$33 billion per year, and the total cost of COPD resident services is US$256 million per year. The average cost per hospitalization for these services is US$376; the annual cost of COPD emergency visits is 148 million US dollars, the average cost per visit for these services is US$237.

Incidence of COPD in Canada

In Canada, COPDIt is the fourth leading cause of hospitalization among men and the sixth leading cause of hospitalization among women. Approximately 500,000 people over the age of 35 have been diagnosed with COPD. It is estimated that a comparable number of middle-aged Canadians may also have COPD, but they did not realize it. This is the only chronic disease with increasing mortality.

In COPD cases, 80% to 90%,Smoking is the main reason. Similarly, the role of first-time smoking is clearly defined. Although the definition of second-hand smoke is not clear, exposure to second-hand smoke may also play an important role. Another important risk factor is occupational exposure to dust (such as coal dust, grain dust) and some smoke. Exposure to non-specific dust may increase the harmful effects of smoking. In COPD patients, outdoor air pollution is associated with worsening symptoms, including shortness of breath. Recurrent respiratory infections in childhood and exposure to second-hand smoke in childhood lead to decreased respiratory function, which may cause people to suffer from COPD. The genetic defect of α-1-antitrypsin (an anti-protease that protects lung tissue from damage) is also associated with an increased risk of COPD.

In addition to the obvious impact of COPD on patients and their families, the impact on the Canadian healthcare system is also important. The annual direct cost of COPD (that is, diagnosis, hospitalization, emergency room visits) is approximately $2,000 per patient. In addition, the indirect costs related to job loss and absenteeism are about 1,000 Canadian dollars per patient; the total cost per COPD patient is about 1998.6/year, and Canadian medical care loses 1.67 billion Canadian dollars. Another statistical data shows that: the total average cost of outpatient, inpatient and inpatient services are 114 Canadian dollars, 774 Canadian dollars and 8,669 Canadian dollars respectively, and the average total cost is 9557 Canadian dollars.

Treatment and auxiliary treatment methods

1. Medication

According to a study titled POET-COPD published in the New England Journal of Medicine, the long-acting anticholinergic drug Silvat (Troponium Bromide) is compared with the long-acting beta-receptor anti-agonist salmeterol. Reduce the risk of acute exacerbation of COPD by 17%. Oral thiocyanate-containing drugs such as carbocysteine can also significantly reduce the acute attack rate of COPD. Compared with oral medicines, inhaled medicines have fast onset, strong action, high safety, and less side effects, and are more suitable for long-term use. Compared with inhaled drugs, long-term adverse reactions of oral or injected drugs are more common. Changes in medications for outpatients, including antibiotics and corticosteroids, are classic drugs. What needs to be reminded is that a large number of antibiotics will not only cure chronic obstructive pulmonary disease, but it will also easily cause the body to become dependent on drugs, which will cause trouble for future treatment.

In March 2019, Circassia Pharmaceuticals announced that the U.S. Food and Drug Administration (FDA) has approved a supplementary new drug application (sNDA) for Tudorza Pressair (aclidinium bromide, aclidinium bromide inhalable powder). New data has been added to the prescribing information, including data from the Phase IV ASCENT clinical study: In patients with COPD with cardiovascular disease and/or important cardiovascular risk factors, Tudorza Pressair can effectively reduce the deterioration of COPD without Increase in major adverse cardiovascular events (MACE). In addition, according to clinical observations, the use of tiotropium bromide in early COPD may reverse the condition. Based on the results of clinical trials, Zhong Nanshan's team clearly advocated continuous drug intervention for confirmed early COPD patients. This can significantly improve patients' symptoms and save their lung function.

2. Surgical treatment

Some people with severe COPD symptoms may have difficulty breathing. In some cases, the doctor may recommend lung surgery to improve breathing. Not everyone is suitable for lung surgery. Those who can be operated on include: you must have enough strength to undergo the operation, you must participate in pulmonary rehabilitation, and you cannot be a current smoker. There are three types of surgery: Bullectomy is an operation in which a doctor removes one or more bullae or bullae from the lungs; Lung Volume Reduction Surgery (LVRS) is a surgery that helps patients with severe emphysema affect the upper lung lobes; transplant.

Founded in 2008 and headquartered in Minneapolis, USA, Nuvaira is a private medical device company dedicated to the development of minimally invasive products to provide treatment options for patients with chronic obstructive pulmonary disease and asthma. The company has developed a new type of catheter system that targets the treatment process of lung denervation (TLD) to activate airway nerves to treat COPD and asthma. Nuvaira has obtained more than 70 patents worldwide. Its proprietary technology and accompanying procedures have been used to complete AIRFLOW-2, COPD clinical trials (RCT) and RELIEF-1 asthma trials last year. Nuvaira's Nuvaira™ lung denervation system received CE Mark approval in January 2016. Nuvaira™ pulmonary denervation system is a catheter-based treatment system for COPD and asthma. This system is used in the treatment process of TLD. TLD is a simple one-time bronchoscopy operation that uses a special catheter (dNerva™ dual-cooled radiofrequency catheter) to provide ablation treatment, destroy overactive nerves in the lungs, and open blocked airways to improve breathing. TLD is similar to anticholinergic drugs (a class of drugs that block the action of the lung neurotransmitter acetylcholine), which can innervate the parasympathetic nerves of the lungs, and can continuously improve lung function, exercise capacity and quality of life. Currently, TLD is only used in clinical research.

3. Oxygen therapy

Assisted oxygen therapy is a COPD treatment method that provides you with supplemental oxygen or extra oxygen. Although oxygen therapy is very common in hospitals, it can also be used at home. It can also be used to assist in the treatment of fibropneumonia, severe asthma, invasive cystic fibrosis, sleep apnea, etc. There are several types of equipment used to deliver oxygen at home. Your healthcare provider will help you choose the best equipment for you. Oxygen is usually delivered through the tip of the nose (oxygen tube) or mask. Oxygen equipment can be connected to other medical equipment, such as continuous positive airway pressure ventilator and ventilator. Oxygen therapy can help you feel better and stay active.

Oxygen therapy time: >15 hours per day.

Oxygen therapy method: nasal cannula is generally used with a flow rate of 1-2 liters/min.

Oxygen therapy goals: oxygen saturation above 90%, oxygen partial pressure above 60 mmHg.

4. Adjuvant therapy

Complementary therapy/complementary therapy refers to many therapies, philosophies and practices that are not considered traditional or standard healthcare. Some examples of complementary therapies include yoga, singing, wind music (music therapy), etc. In rehabilitation training, some practical and easy-to-master rehabilitation exercise methods, such as abdominal breathing, lip reduction breathing, and breathing exercises, are very effective. Abdominal breathing means that the abdomen is raised when inhaling, and recessed when exhaling, so that excess lung air can be expelled. These techniques cannot treat COPD, but they can improve symptoms and quality of life. In addition, traditional methods such as Tai Chi, Qigong, massage, and acupuncture can also improve COPD.

How to reduce the number of acute attacks?

(1) Quitting smoking early is the most effective measure to prevent COPD and reduce the deterioration of the disease. Avoiding going out or wearing a mask on a haze day is one of the ways for individuals to prevent the lungs from being inhaled by the haze and lungs;

(2) A drop in temperature will cause acute exacerbation of COPD patients. Cold and warmth and avoiding colds are the primary protective measures. Also pay attention to oral and nasal cavity hygiene, maintain indoor air circulation, avoid crowds gathering places, and avoid contact with patients with respiratory infections to prevent acute attacks;

(3) COPD patients need to pay special attention to hypoxia and avoid carbon dioxide retention problems in life, which is also the key to reducing the number of acute attacks;

(4) Treatment of comorbidities: control the comorbidities of COPD (cardiovascular disease, myocardial infarction, hypertension, diabetes, gastroesophageal reflux, etc.) and help control the symptoms of AECOPD (acute exacerbation of chronic obstructive pulmonary disease).

5, Chinese Medicine Law

Traditional Chinese medicine believes that the formation of COPD is mostly due to the lungs being invaded by a variety of external pathogens for a long time, repeated coughing and wheezing, causing the lung's Xuansu dysfunction. "The result is that the clear qi cannot be transported to nourish the whole body, and the turbid qi is difficult to be discharged from the body and stays in the chest. During the acute episode of COPD, pathological products such as phlegm, blood stasis, and heat become the main causes of the disease. Therefore, the treatment of the acute episode is based on the basic principle of removing pathogens. According to the different manifestations of the disease, choose to resolve phlegm, remove blood stasis, and clear heat Equal governance. The remission period of COPD is to strengthen the body and consolidate the cost. Strengthening the body can regulate the immune mechanism of the body, improve the immunity of the respiratory tract, and prevent recurrent infections. At the same time, the function of the body's endocrine system can be regulated by kidney therapy, thereby improving the body's disease resistance and reducing the incidence of respiratory failure and respiratory infections.

According to modern pharmacological research, some commonly used drugs in the remission stage have anti-inflammatory, antispasmodic, anti-cough and phlegm effects, thereby improving the nutritional status of the whole body. For example, ephedra can relax bronchial smooth muscle; aster has expectorant and antibacterial effects; Pinellia has anti-inflammatory effects; licorice can promote secretion of throat and bronchus, which is beneficial to the discharge of sputum; Danshen has inhibitory effects on many bacteria, and can also be obvious Inhibit the chemotaxis of white blood cells. All in all, the most basic pathological changes of COPD are spleen and kidney deficiency, blood stasis and phlegm obstruction. Adopting the traditional Chinese medicine therapy of strengthening the spleen and kidney, promoting blood circulation and removing blood stasis can not only relieve symptoms such as cough, expectoration, and dyspnea, but also improve the patient's immunity, improve the quality of life of the patient, and prolong the life span. In addition, traditional methods such as Tai Chi, Qigong, massage, and acupuncture also have certain auxiliary effects. Regarding acupoint therapy, please continue to follow the blog post of Dr. Long, a registered dietitian and registered health manager in Canada.

6, Nutritional therapy

According to the nutritional assessments conducted in 2015 and 2019 by the relevant nutrition institutions in the United States, a healthy and balanced diet has the following beneficial health effects on COPD patients: reducing inflammation, maintaining and improving muscle strength, improving lung function, reducing metabolism and heart disease Risk and so on.

General diet management includes:

(1) Complex carbohydrates: complex carbohydrates contain long chains of sugar molecules (that is, carbohydrate foods with high cellulose, high vitamins and high minerals). The human body needs time to break down these molecules. In this way, complex carbohydrates provide relatively sustained energy release. Foods containing complex carbohydrates include: fresh fruits and starchy vegetables, whole grains, whole wheat bread and pasta, fungus and mushrooms. If people with COPD want to gain weight, eating a variety of complex carbohydrates and healthy sources of fat and protein can help. In addition, if people with COPD want to reduce excess body fat, replacing refined carbohydrates with complex carbohydrates, healthy proteins and healthy fats can promote weight loss. For specific methods, please consult and participate in the "Canada Boss Dragon Detoxification Body Sculpting Immune Repair Training".

(2) Foods rich in fiber: According to statistics from the American Lung Association, people with COPD should aim for approximately 20-30 grams of fiber per day. Foods that contain a lot of fiber (vegetarian) include: fruits and vegetables, nuts and seeds, whole grains (such as oats and quinoa), vegetables, protein, etc. It should be noted that the cellulose mentioned here is not crude fiber, which basically cannot be digested and absorbed.

(3) High-protein food: A study in the International Journal of Chronic Obstructive Pulmonary Disease found that Vietnamese people with COPD have an increased demand for protein. Adding protein-rich foods to meals and snacks may help improve nutritional status and quality of life. High-protein foods include: meat and poultry, fish, eggs, nuts and seeds, fermented soy products, fermented milk products, etc. Protein sources can help increase muscle mass and help people gain weight when needed. In addition, adding high-quality protein sources to meals and snacks or exchanging refined carbohydrate sources with healthy protein may promote weight loss. For specific methods, please consult and participate in the "Canada Boss Dragon Detoxification Body Sculpting Immune Repair Training".

(4) Mono- and polyunsaturated fats: Mono- and polyunsaturated fats are healthy fats that can help reduce oxidized cholesterol. Some foods that contain these fats include: certain vegetable oils, such as olive, coconut, and avocado oil; certain fish, including salmon; nuts and seeds; and avocados. People with COPD who want to gain weight should try to add these fats to their diet. If they want to lose weight, they should limit the intake of all bad fats and refined carbohydrates, while omega-3 needs to be retained because of its anti-inflammatory properties. For specific methods, please consult and participate in the "Canada Boss Dragon Detoxification Body Sculpting Immune Repair Training".

(5) Water intake: Insufficient water can make sputum thick, cause constipation, dry skin and oral mucosa, etc. Therefore, the intake of water in COPD patients is very important.

(6) Salt intake: Be careful not to take too much salt. When you usually cook, you should put less salt or control salt intake on the dinner table to achieve the purpose of fully limiting salt intake; low-salt food choices, daily Gradually develop the habit of choosing low-salt foods in life, such as using low-salt fresh fish, chicken, and beef instead of pickled vegetables, salted fish, and jerky.

(7) Calcium intake: Calcium is indispensable for maintaining skeletal muscle exercise. In addition, the application of antihypertensive drugs or diuretics is one of the causes of calcium loss. Therefore, it is necessary to consume foods rich in calcium in moderation. Foods rich in calcium: lemons, oranges, bananas, rape, fermented soy products, fermented milk products, fish, meat, preserved fruits, etc.

"Canada Boshilong Health Management Center" recommends people with COPDAvoid or limit the following food types:

(1) Simple carbohydrates: Simple carbohydrates provide less nutrition than complex carbohydrates. Foods composed of simple carbohydrates include: cane sugar, ordinary chocolate and candies, cakes and other sugary desserts, sugary drinks, processed foods, white bread, pasta, white rice, etc.

(2) Unhealthy fat: Many high-fat foods are nutritious foods, and people can incorporate them into a healthy diet. However, many highly processed foods are high-fat foods, and people with COPD should avoid or limit them to promote overall health. COPD patients must avoid or limit the following high-fat foods: fast food, bacon (some brands are also available) and other processed meats, fried foods, sweet pastries, margarine, ice cream, refined vegetable oils, etc.

Recommended nutrients

Calcium-magnesium mixture, VB, VC, VE, coenzyme Q10, resveratrol, garlic essence, echinacea, hyssop, gynostemma and so on. Please consult Dr. Long who lives in China, Japan and Canada on how to choose and match appropriately according to your personal physique and disease course.

to sum up

Today’s chronic obstructive pulmonary disease has a high prevalence rate, high incidence rate, high disability rate, high fatality rate, high economic burden rate and low awareness rate of "five high and one low" status. The onset time is too long, and many people always feel that It is related to work pressure. In fact, this misunderstanding is due to the neglect of cardiovascular and cerebrovascular diseases, tumors and cancers, which have a high mortality rate, so that the disease will be delayed, and the disease will become more severe. Therefore, we give health management recommendations for preventing or reducing COPD symptoms:

(1) In addition to a healthy air environment and work environment, smoking cessation is the top priority;

(2) As the onset takes a long time, prevention or early detection is very important;

(3) The earlier the treatment, the lower the cost, especially the intervention of functional nutrients, which is very effective;

(4) Daily diet, more anti-inflammatory foods and less pro-inflammatory foods;

(5) In daily life, choose more exercise methods to improve cardiopulmonary function, especially traditional Chinese health maintenance;

(6) Weight management is an important measure to prevent or reduce COPD symptoms.

Finally, if you accidentally suffer from COPD, you must actively treat it to avoid the development of serious illness; learn to manage your own health, we will teach you a set of specific measures and methods. COPD is directly related to inflammation and obesity, please pay attentionHuizhou website(Chelsea98.com/blog) on high-quality blog posts "Inflammation of Traditional Chinese Medicine and Inflammation of Western Medicine", "Q&A of Frequently Asked Questions about Detoxification and Body Sculpting", "Types of Body Fat and Secrets of Weight Loss" etc.

references:

1. https://bestpractice.bmj.com/topics/zh-cn/7/epidemiology

2. https://bestpractice.bmj.com/topics/zh-cn/7/guidelines

3. http://www.chinacdc.cn/jkzt/jkcj/aer_10157/201511/t20151117_122044.html

4. "The Affiliated Hospital of Binzhou Medical University Formulary (2018 Edition)"

5. https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd

6, https://www.cdc.gov/copd/infographics/copd-costs.html

7, https://www.thoracic.org/statements/copd.php

8. https://lunghealth.ca/lung-disease/a-to-z/copd/fitness-for-breath/

9https://www.lungsask.ca/about-us/news-room/backgrounders-and-information-sheets/copd-fact-sheet

*** Every article is carefully written, edited and checked by Huizhou experts, please trust the experts’ suggestions,If you have any questions, please email info@chelsea98.com ***

Chelsea98.com--Wise Week Million Dragon's Great Health Project Dr. Kyle Long, registered dietitian, registered health manager, from Smart Week Smart Financial Education Group-Sincere, clear and efficient personalized FAH financial quotient and health quotient education

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