COPD诊治新指南.ppt

The guideline of COPD,DEFINITION OF COPD,Global Initiative for Chronic Obstructive Lung Disease(GOLD)WHO/NHLBI Initiative 2010,“COPD is a disease state characterised by airflow limitation that is not fully reversible.The airflowlimitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases”,“COPD is a disease state characterised by airflow limitation that is not fully reversible.The airflowlimitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases”,Barnes PJ.N Engl J Med 2000;343:269,INFLAMMATION,Small airway diseaseAirway inflammationAirway remodeling,Parenchymal destructionLoss of alveolar attachmentsDecrease of elastic recall,AIRFLOW LIMITATION,How to treat COPD?,1.Access and Monitor Desease2.Reduce Risk Factors3.Manage stable COPD4.Manage Exacerbation,Access and Monitor Desease,Symtoms:Chronic cough,Sputum，dyspnea et.Spirmetry(gold standard):(post bronchodilator)FEV1/FVC70%,COPD分期与分级,Thank you！,Reduce Risk Factors,Manage stable COPD,Recommnedation 1 Spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms(strong recommendation/moderatequality evidence)Spirometry should not be used to screen for airflow obstruction in patients without respiratory symptoms(strong recommendation/moderatequality evidence),Manage stable COPD,Recommnedation 2 For stable COPD patients with respiratory symptoms and FEV1 between 60%and 80%predicted，ACP、ACCP、ATS、and ERS suggest that treatment with inhaled bronchodialators may be used。（weak recommendation/low-quality evidence),Manage stable COPD,Recommnedation 3 For stable COPD patients with respiratory symptoms and FEV1 60%predicted，ACP、ACCP、ATS、and ERS suggest that treatment with inhaled bronchodialators may be used。（strong recommendation/moderate-quality evidence),Manage stable COPD,Recommnedation 4 ACP、ACCP、ATS and ERS recommend that clinicians prescribe monotherapy using either long-acting inhalede anticholinergics or long-acting inhalede B-agonists for symtomatic patients with COPD and FEV1 60%predicted。cliniciians should base the choice of the specific monotherapy on patient preference、cost、adverse effect profile.（strong recommendation/moderate-quality evidence),Manage stable COPD,Recommnedation 5 ACP、ACCP、ATS and ERS recommend that clinicians may administer combination inhalede therapies（long-acting inhalede anticholinergics or long-acting inhalede B-agonists、inhalede corticosteroids）for symtomatic patients with COPD and FEV1 60%predicted。.（weak recommendation/moderate-quality evidence),Manage stable COPD,Recommnedation 6 ACP、ACCP、ATS and ERS recommend that clinicians should prescribe pulmonary rehabilitation for symtomatic patients with COPD and FEV1 50%predicted。（strong recommendation/moderate-quality evidence)clinicians may consider pulmonary rehabilitation for symtomatic patients or exercise-limited patients with an FEV150%predicted。（weak recommendation/moderate-quality evidence),Manage stable COPD,Recommnedation 7 ACP、ACCP、ATS and ERS recommend that clinicians shoulde precribe continued oxygen therapiy in patient with COPD who have severe resting hypoxemia（PaO255mmHg or SaO288%.（strong recommendation/moderate-quality evidence),0:High RISKFEV180%,I:MildFEV180%,II:ModerateFEV179-50%,III:SevereFEV150-30%,IV:Very Severe FEV130%,GOLD指南(2010),Active reduction of risk factors；influeza vaccination,Add short-actting bronchodilator（when needed）,Add regular treatment with one or more long-acting bronchodilators（when needed）；Add rehabilitation,Add inhaled glucocorticoster-oids if repeatedexacerbations,Add long term oxygen if chronic respiratory failure.Consider surgical treatment,