慢性阻塞性肺病的新进展2014--caiVIP免费

慢性阻塞性肺病的新进展慢性阻塞性肺病的新进展清华大学第一附属医院呼吸科清华大学第一附属医院呼吸科•GOLD颁布的COPD全球策略2014年最新更新慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(草案)GlobalStrategyforDiagnosis,ManagementandPreventionofCOPD,2013:ChaptersGlobalStrategyforDiagnosis,ManagementandPreventionofCOPD,2013:ChaptersDefinitionandOverviewDiagnosisandAssessmentTherapeuticOptionsManageStableCOPDManageExacerbationsManageComorbiditiesDefinitionandOverviewDiagnosisandAssessmentTherapeuticOptionsManageStableCOPDManageExacerbationsManageComorbiditiesUpdated2013©2013GlobalInitiativeforChronicObstructiveLungDiseaseCOPDCOPD的定义的定义•COPD是一种可以预防和可以治疗的常见疾病,其特征是持续存在的气流受限。气流受限呈进行性发展,伴有气道和肺对有害颗粒或气体所致慢性炎症反应的增加。•急性加重和合并症影响患者整体疾病的严重程度。COPD气流受限的发病机制SmallAirwaysDisease•Airwayinflammation•Airwayfibrosis,luminalplugs•IncreasedairwayresistanceParenchymalDestruction•Lossofalveolarattachments•DecreaseofelasticrecoilAIRFLOWLIMITATION©2013GlobalInitiativeforChronicObstructiveLungDiseaseCOPD的危险因素肺的生长发育性别年龄呼吸道感染社会经济条件哮喘气道高反应性慢性支气管炎基因有害颗粒暴露吸烟职业粉尘，有机物，无机物室内燃料燃烧和通风不良室外空气污染©2013GlobalInitiativeforChronicObstructiveLungDiseaseCOPD的危险因素GenesGenesInfectionsInfectionsSocio-economicSocio-economicstatusstatusAgingPopulationsAgingPopulations©2013GlobalInitiativeforChronicObstructiveLungDiseaseGlobalStrategyforDiagnosis,ManagementandPreventionofCOPD,2013:ChaptersGlobalStrategyforDiagnosis,ManagementandPreventionofCOPD,2013:ChaptersDefinitionandOverviewDiagnosisandAssessmentTherapeuticOptionsManageStableCOPDManageExacerbationsManageComorbiditiesDefinitionandOverviewDiagnosisandAssessmentTherapeuticOptionsManageStableCOPDManageExacerbationsManageComorbiditiesUPDATED2013©2013GlobalInitiativeforChronicObstructiveLungDiseaseSYMPTOMSchroniccoughchroniccoughshortnessofbreathshortnessofbreathEXPOSURETORISKFACTORStobaccotobaccooccupationoccupationindoor/outdoorpollutionindoor/outdoorpollutionSPIROMETRY:RequiredtoestablishdiagnosisSPIROMETRY:RequiredtoestablishdiagnosisCOPD的诊断COPD的诊断sputumsputum©2013GlobalInitiativeforChronicObstructiveLungDiseaseCOPDCOPD的诊断的诊断•任何患有呼吸困难、慢性咳嗽或多痰的患者,并且有暴露于危险因素的病史,在临床上需要考虑COPD的诊断。•作出COPD的诊断需要进行肺功能检查,吸入支气管扩张剂之后FEV1/FVC<0.70表明存在气流受限,即可诊断COPD。COPDCOPD评估评估•COPD评估的目的是决定疾病的严重程度,包括气流受限的严重程度,患者的健康状况和未来的风险程度(例如急性加重、住院或死亡),最终目的是指导治疗。©2013GlobalInitiativeforChronicObstructiveLungDiseaseCOPDCOPD的评估的评估症状评估气流受限采用肺功能严重度分级急性加重风险评估合并症评估©2013GlobalInitiativeforChronicObstructiveLungDisease*改良英国MRC呼吸困难指数(modifiedbritishmedicalresearchcouncil,mMRC)*COPD评估测试(COPDassessmenttest,CAT)。症状的评估©2013GlobalInitiativeforChronicObstructiveLungDiseaseGlobalStrategyforDiagnosis,ManagementandPreventionofCOPDModifiedMRC(mMRC)Questionnaire©2013GlobalInitiativeforChronicObstructiveLungDisease气流受限的评估气流受限程度仍采用肺功能严重度分级,即FEV1占预计值80%、50%、30%为分级标准。COPD患者的气流受限的肺功能分级分为4级(Grades),即:GOLD1—轻度,GOLD2—...