COPD诊治新指南

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,大医精诚 尚美至善,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 airflow,limitation 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 airflow,limitation 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 disease,Airway inflammation,Airway remodeling,Parenchymal destruction,Loss of alveolar attachments,Decrease of elastic recall,AIRFLOW LIMITATION,How to treat COPD?,1.,Access and Monitor Desease,2.,Reduce Risk Factors,3.,Manage stable COPD,4.,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 RISK,FEV,1,80%,I:Mild,FEV,1,80%,II:Moderate,FEV,1,79-50%,III:Severe,FEV,1,50-30%,IV:Very Severe,FEV,1,30%,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 repeated,exacerbations,Add long term oxygen if chronic respiratory failure.Consider surgical treatment,