COPD2011诊治新指南

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.Theairflowlimitationisusuallybothprogressiveandassociatedwithanabnormalinflammatoryresponseofthelungstonoxiousparticlesorgases”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Thankyou！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、andERSsuggestthattreatmentwithinhaledbronchodialatorsmaybeused。（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-agonistsforsymtomaticpatientswithCOPDandFEV1﹤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ManagestableCOPD•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、ATSandERSrecommendthatcliniciansshouldeprecribecontinuedoxygentherapiyinpatientwithCOPDwhohavesevererestinghypoxemia（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.Considersurgicaltreatment大医精诚尚美至善THANKYOU!