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1、大医精诚尚美至善TheguidelineofCOPD大医精诚尚美至善大医精诚尚美至善DEFINITIONOFCOPDGlobalInitiativeforChronicObstructiveLungDisease(GOLD)WHO/NHLBIInitiative2010“COPDisadiseasestatecharacterisedbyairflowlimitationthatisnotfullyreversible.Theairflowlimitationisusuallybothprogressiveandassociatedwithanabnormalinflammatoryresponseofthelungstonoxiousparticlesorgases”“COPDisadiseasestatecharacterisedbyairflowlimitationthatisnotfullyreversible.Theairflowlimitationisusuallybothprogressiveandassociatedwithanabnormalinflammatory。
2、responseofthelungstonoxiousparticlesorgases”大医精诚尚美至善BarnesPJ.NEnglJMed2000;343:269大医精诚尚美至善INFLAMMATIONSmallairwaydiseaseAirwayinflammationAirwayremodelingParenchymaldestructionLossofalveolarattachmentsDecreaseofelasticrecallAIRFLOWLIMITATION大医精诚尚美至善HowtotreatCOPD?•1.AccessandMonitorDesease•2.ReduceRiskFactors•3.ManagestableCOPD•4.ManageExacerbation大医精诚尚美至善AccessandMonitorDesease•Symtoms:Chroniccough,Sputum,dyspneaet.•Spirmetry(goldstandard):(postbronchodilator)FEV1/FVC〈70%大医精诚尚美至善COPD分期与分级Thanky。
3、ou!大医精诚尚美至善ReduceRiskFactors大医精诚尚美至善ManagestableCOPD•Recommnedation1Spirometryshouldbeobtainedtodiagnoseairflowobstructioninpatientswithrespiratorysymptoms(strongrecommendation/moderatequalityevidence)Spirometryshouldnotbeusedtoscreenforairflowobstructioninpatientswithoutrespiratorysymptoms(strongrecommendation/moderatequalityevidence)大医精诚尚美至善ManagestableCOPD•Recommnedation2ForstableCOPDpatientswithrespiratorysymptomsandFEV1between60%and80%predicted,ACP、ACCP、ATS、andERSsuggestthattreatmentwithinh。
4、aledbronchodialatorsmaybeused。(weakrecommendation/low-qualityevidence)大医精诚尚美至善ManagestableCOPD•Recommnedation3ForstableCOPDpatientswithrespiratorysymptomsandFEV1﹤60%predicted,ACP、ACCP、ATS、andERSsuggestthattreatmentwithinhaledbronchodialatorsmaybeused。(strongrecommendation/moderate-qualityevidence)大医精诚尚美至善ManagestableCOPD•Recommnedation4ACP、ACCP、ATSandERSrecommendthatcliniciansprescribemonotherapyusingeitherlong-actinginhaledeanticholinergicsorlong-actinginhaledeB-agonistsforsymtomaticpatientswit。
5、hCOPDandFEV1﹤60%predicted。cliniciiansshouldbasethechoiceofthespecificmonotherapyonpatientpreference、cost、adverseeffectprofile.(strongrecommendation/moderate-qualityevidence)大医精诚尚美至善ManagestableCOPD•Recommnedation5ACP、ACCP、ATSandERSrecommendthatcliniciansmayadministercombinationinhaledetherapies(long-actinginhaledeanticholinergicsorlong-actinginhaledeB-agonists、inhaledecorticosteroids)forsymtomaticpatientswithCOPDandFEV1﹤60%predicted。.(weakrecommendation/moderate-qualityevidence)大医精诚尚美至善Managesta。
6、bleCOPD•Recommnedation6ACP、ACCP、ATSandERSrecommendthatcliniciansshouldprescribepulmonaryrehabilitationforsymtomaticpatientswithCOPDandFEV1﹤50%predicted。(strongrecommendation/moderate-qualityevidence)cliniciansmayconsiderpulmonaryrehabilitationforsymtomaticpatientsorexercise-limitedpatientswithanFEV150%predicted。(weakrecommendation/moderate-qualityevidence)大医精诚尚美至善ManagestableCOPD•Recommnedation7ACP、ACCP、ATSandERSrecommendthatcliniciansshouldeprecribecontinuedoxygentherapiyinpatientwithCOPDwhohav。
7、esevererestinghypoxemia(PaO255mmHgorSaO288%..(strongrecommendation/moderate-qualityevidence)大医精诚尚美至善0:HighRISKFEV1≥80%I:MildFEV1≥80%II:ModerateFEV179-50%III:SevereFEV150-30%IV:VerySevereFEV130%GOLD指南(2010)Activereductionofriskfactors;influezavaccinationAddshort-acttingbronchodilator(whenneeded)Addregulartreatmentwithoneormorelong-actingbronchodilators(whenneeded);AddrehabilitationAddinhaledglucocorticoster-oidsifrepeatedexacerbationsAddlongtermoxygenifchronicrespiratoryfailure.Considersurgicaltr。
8、eatment大医精诚尚美至善THANKYOU!。
本文标题:COPD2011诊治新指南
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