National Health Commission: White lung is actually a symptom of more serious pneumonia

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Financial Associated Press, December 27, Jiao Yahui, Director of the Medical Affairs Department of the National Health Commission, said that the current white lung has nothing to do with the original strain and vaccination. , and the current popular one is still Omicron. It’s not just that inflammation in the lungs is called white lung. White lung is actually a symptom of more serious pneumonia. Generally speaking, there is more infiltration in lung inflammation, which means that the area of ??white affected area reaches 70~80%. It is clinically called white lung. When white lungs develop, patients may experience hypoxemia or respiratory distress.

National Health Commission: Currently, the proportion of clinical patients with white lung is low

According to People’s Daily, on December 27, the Joint Prevention and Control Mechanism of the State Council held a press conference to introduce the new coronavirus Information about the implementation of "Category B and B" measures for infections. Jiao Yahui, director of the Department of Medical Affairs of the National Health Commission, said that white lung is not called white lung as long as there is inflammation in the lungs. More severe symptoms of pneumonia generally include more infiltration, and when the area of ??the white image area reaches 70-80%, it is colloquially called white lung. Clinically, white lung occurs mainly in elderly patients with serious underlying diseases, but the proportion is very low.

Extended reading

The mortality rate of severe white lung is over 40, experts: the probability of COVID-19 causing white lung is not very high

Dr. Zhang Li said that There are two reasons for lung disease: infection in the lungs themselves, or infection in other parts of the body that triggers the body's inflammatory response. Dr. Gong Zilong reminds everyone to pay special attention to the occurrence of "silent hypoxia". As for whether the new coronavirus will cause white lungs, two medical experts believe that the new coronavirus will indeed affect human lungs, but the probability of causing white lungs is not very high.

“White lung” is also called acute respiratory distress syndrome. It generally refers to the appearance of patients with severe pneumonia under X-ray or CT examination. The lungs appear as a large white area, so it is named.

When the father of former CCTV host Fan Deng passed away, his lungs had turned white in large areas; many elderly people had "silent hypoxia" when they were sent to the hospital. In this cold winter, when medical treatment is at its peak, "white lungs" Gradually it became a hot topic of discussion.

“White lung” is also called acute respiratory distress syndrome. It generally refers to the appearance of patients with severe pneumonia under X-ray or CT examination. The lungs appear as a large white area, so it is named after it. The clinical manifestations are chest tightness, shortness of breath, and difficulty breathing. Patients with white lung have low blood oxygen saturation, which can lead to severe hypoxia.

Can the new coronavirus really cause white lung? Can white lung cause irreversible damage to the lungs? How to warn against white lung at home? ThePaper.com connected with Zhang Li, deputy chief physician of the Respiratory Care Unit of Shanghai Pulmonary Hospital Affiliated to Tongji University, and Gong Zilong, deputy chief physician of the Department of Respiratory and Critical Care Medicine of the Fifth Hospital of Wuhan, Hubei Province. Two front-line doctors discussed issues related to "white lungs" Interpret.

Zhang Li said that there are two reasons for white lung: infection of the lungs themselves, or infection in other parts of the body, which triggers the body's inflammatory response. The inflammatory response is a manifestation of the body's normal physiological defense mechanism, but immune Cells not only kill viruses, but also cause trauma to their own organs, causing the phenomenon of "white lungs."

Gong Zilong also reminded everyone to pay special attention to the occurrence of "silent hypoxia", that is, "happy hypoxia". The patient does not have clinical symptoms such as chest tightness and shortness of breath, but in fact the lungs are severely hypoxic. This phenomenon mostly occurs in the elderly. He suggested that, especially patients with underlying diseases and the elderly, they should always have an "oximeter" at home to monitor oxygen saturation in a timely manner. Once the blood oxygen saturation is found to be lower than 93 in the resting state, they should seek medical treatment in time.

As for whether the new coronavirus will cause white lung, two experts believe that the new coronavirus will indeed affect human lungs, but the probability of causing white lung is not very high.

Conversation

Does COVID-19 cause white lung?

ThePaper Technology: What causes white lung?

Gong Zilong: "White lung" generally refers to the appearance of patients with severe pneumonia under X-ray examination. The lungs appear to be a large white area, hence the name. The formation of white lungs generally indicates that the lungs are infiltrated by inflammation. Clinical manifestations include chest tightness, shortness of breath, and difficulty breathing.

The blood oxygen saturation of patients with white lung is relatively low, which can lead to severe hypoxia; it is mainly caused by bacterial infection in the lungs or the body's inflammatory response.

Zhang Li: There are two reasons for white lung: infection of the lungs themselves, or infection in other parts of the body, triggering an inflammatory response in the human body. The inflammatory response is a manifestation of the body's normal physiological defense mechanism, but immune cells Not only will it kill the virus, it will also cause trauma to your own organs, causing the phenomenon of "white lungs." Specifically, excessive infiltration of inflammatory factors in the human body will cause damage to organs with rich blood supply such as liver, kidneys, and lungs. The most important manifestation is damage to alveolar epithelial cells and capillary endothelium in the alveolar space. , which in turn will lead to a large amount of leakage of some interstitial fluid in the capillaries, leading to pulmonary edema. Some of the interstitial fluid will directly penetrate into the alveoli, causing changes in the transparent lung membrane, thus leading to the occurrence of white lungs.

ThePaper Technology: Why have the number of patients with white lung increased recently? Is it caused by COVID-19?

Gong Zilong: There is no definite answer yet to the causal relationship between COVID-19, pneumonia, and even white lung, but from a phenomenon perspective, COVID-19 does have an impact on patients’ lungs. I attended the seminar some time ago At a national conference, experts from all over the country are also discussing this topic.

As far as I know, most COVID-19 patients have mild symptoms, and severe cases are more common in the elderly and people with underlying diseases. For example, I see about 150 patients a day, and there are only about two or three patients with white lung. In October this year, our hospital sent me to Wuhan Jinyintan Hospital to provide support. Because that period of time had not been fully relaxed, the elderly and children, the two more vulnerable groups, had a smaller chance of being exposed to and infected with the virus on a large scale, and the main ones who got sick were He was a young man, so the patient's symptoms were not so serious during that time. Recently, I have observed that the new coronavirus not only invades the upper respiratory tract of the human body, but also seems to have an impact on the lower respiratory tract, causing the "white lungs" phenomenon. Relatively speaking, the impact on young people is still small. Patients with underlying diseases, especially those with chronic obstructive pneumonia, structural lung disease, diabetes, obesity and other diseases, will be more affected.

Zhang Li: It seems that after the relaxation of restrictions, the symptoms caused by the new crown are more serious and more common than before, but in fact, it is mainly because we have taken protective measures to protect high-risk groups before, and positive patients are generally sent to the hospital. In cabins or designated hospitals, the elderly and children will be protected. But it is different now. It is very possible to bring the virus home subtly, but the immunity of the elderly and children is weak, so the symptoms will be more obvious.

As for the impact of COVID-19 on the lungs, because I work in the intensive care unit, patients are more likely to suffer from white lung. Generally speaking, the probability of severe viral pneumonia should be about one-fifth. . However, overall, the probability of developing white lung among COVID-19 patients who come to the hospital for CT scan is not very high. About 20% of patients have common pneumonia. The so-called common pneumonia means that the virus affects more than the upper respiratory tract and has already had a certain effect on the lower respiratory tract. For these patients, we will also take different treatment measures depending on the situation.

How to treat white lung?

ThePaper Technology: Are there any cases of white lung that left a deep impression on you?

Gong Zilong: White lung generally occurs in the elderly. If the symptoms are mild in young people, it is generally not very difficult to cure. However, I recently admitted a 32-year-old young lady who had underlying medical conditions. Most of them have kidney failure and are relatively obese. The current situation is not very good. There is also an old man in his 90s whose kidney function is not very good and he is also suffering from gastrointestinal bleeding, which is also troublesome.

Information picture of doctors and nurses rescuing patients

Zhang Li: The youngest white lung patient I have ever come into contact with is about 18 years old, and it was caused by adenovirus infection. This child developed very quickly. When we took over, he could still take oxygen through the nasal cannula, but he already needed to be intubated the next day. There was a lot of leakage like watermelon water in the tube, and he died on the third day. Yes, this is the fastest developing white lung patient I have ever seen.

Later, we sent the watery watermelon secretion for second-generation sequencing and found the cause. It was adenovirus pneumonia caused by adenovirus infection, but the specific route of infection and source of infection were not clear.

ThePaper Technology: What is the treatment for white lung?

Gong Zilong: The main guidance manual is the "New Coronavirus Pneumonia Diagnosis and Treatment Plan" issued by the National Health Commission. The main methods include antiviral, hormonal anti-inflammatory, respiratory treatment, etc. In the early stages of the disease, patients can be given antiviral drugs, such as Azivudine and Ritonavir tablets. As for the efficacy of the drug, I used Azivudine when I was supporting at Wuhan Jinyintan Hospital. It is suitable for cases where the CT value of nucleic acid detection is low and the disease is mild. It can reduce the viral load in the human body and reduce severe and critical illness. However, I do not recommend that the media over-promote Azivudine, because this may easily give the public the illusion that Azivudine is a "miracle drug" and cause a rush to grab the drug. In fact, these antiviral drugs can only relieve symptoms but cannot eradicate the virus. Azivudine also has contraindications. For example, it is not recommended for patients with poor liver and kidney function, so it must be taken under the advice of a doctor.

Zhang Li: We also follow the "New Coronavirus Pneumonia Diagnosis and Treatment Plan" and adopt antiviral treatment, anti-inflammatory and anticoagulant treatment, as well as immune support, respiratory support, etc.

The so-called anticoagulation treatment means that as white lungs continue to develop, inflammation in the body continues to increase, forming a waterfall amplification effect. It will cause a large number of micro-thrombi to form in our capillaries, blocking oxygen transportation. So we need to prevent the formation of microthrombi, which is anticoagulation therapy.

Can white lung be prevented?

ThePaper Technology: Can white lung be cured?

Gong Zilong: It is OK if the symptoms are not very serious. Patients with more severe white lung can "save their lives", but they need to go to the hospital for regular review and treatment.

Zhang Li: The mortality rate of severe white lung patients is over 40%, but some people can still be cured. However, it is difficult to restore the lungs to their original clean state. Most patients will be left with the sequelae of pulmonary fibrosis. Experts have previously calculated that one year after being infected with the new coronavirus Delta strain and recovering, the patient's lung function will recover, but the recovery will not last long before showing a downward trend, and this decline is irreversible.

ThePaper Technology: Can white lung be prevented?

Gong Zilong: It cannot be prevented, it can only be said to be an early warning. You can prepare an oximeter at home to monitor blood oxygen saturation. I especially want to remind the elderly to pay attention to the occurrence of "silent hypoxia", also called "happy hypoxia". That is, the patient does not have clinical symptoms such as chest tightness and shortness of breath, but in fact the lungs are severely hypoxic. This phenomenon mostly occurs in the elderly. He suggested that everyone, especially patients with underlying diseases and the elderly, should always have an oximeter at home to monitor oxygen saturation in a timely manner. Once the resting blood oxygen saturation is found to be lower than 93, you should seek medical treatment in time.

Zhang Li: If you do not have the conditions to prepare an oximeter, you can self-test the respiratory rate and heart rate in the resting state. If the respiratory rate is greater than 30 times/min, or other factors such as fever have been ruled out, the heart rate is greater than At 120 times/min, you need to be vigilant. Your body may be deprived of oxygen at this time.