重叠综合症ppt课件

ACOS 呼吸内科 材料来源 Mainteachingpoints 重叠综合征是同时具有哮喘和慢阻肺特点的气流受限性疾病 除了吸入激素和支气管扩张药物外 有必要明确和排除可避免的危险因素 比如吸烟 肺功能快速下降的重叠综合征病人多见于哮喘合并吸烟的患者 引言 ACOS PhenotypeofCOPD asthma ACOS COPD PrevalenceofACOS Differentcriteriadifferentoutcome BurdenofACOS AndersenH HighhospitalburdeninoverlapsyndromeofasthmaandCOPD Clin Respir J 2013 7 342 6 FattahiF AtopyisariskfactorforrespiratorysymptomsinCOPDpatients resultsfromtheEUROSCOPstudy Respir Res 2013 14 10 ChungJW KongKA LeeJH LeeSJ RyuYJ ChangJH Characteristicsandself ratedhealthofoverlapsyndrome Int J Chron Obstruct Pulmon Dis 2014 9 795 804 PATHOPHYSIOLOGYOFACOS 基因GENE病理和气道功能STRUCTURALCHANGES临床表现MANIFESTATION Gene Th2inflamation CigarettesmokingcanalterairwayinflammationinasthmafrombeingeosinophilictoneutrophilicwithincreasedCD8 cells thusbecomingsimilartothatseeninCOPD Step wiseapproachtodiagnosingACOS AsthmaACOS childhoodasthmawithpersistentwheezefromthefirstyearsoflifeintoadulthoodLongstandingasthmawithouttakingICSadult onsetasthmasevereordifficult to treatasthma COPDACOS Avaliablefeatures 对慢阻肺患者如果在40岁以前被医生诊断过哮喘 该病人推荐诊断ACOS RecallbiasLackoflungfunctiontestingtypicalsymptomsandrespondtoICS thoroughinterview Eos ACOS Spirometry GINAandGOLD Diagnosisofdiseasesofchronicairflowlimitation asthma COPDandasthma COPDoverlapsyndrome ACOS updated2015 AvailablefromURL http www ginasthma org Accessed 13April2015 SputumEosinophilCounts Management Individualizedmanagement ICSmaybeconsideredinpatientswithACOSwithsignificantsputumeosinophilia eosinophilcount 3 Disability FutureACOSStudies First whichgenesarethegeneticriskfactorsfordevelopingACOS thesecondquestioniswhatarethemolecularpathwaysofACOS Third whatisthenaturalcourseorprognosisofACOS Conclusions ACOSmaybeaninterimtermapplicabletopatientsinwhomitisdifficulttodistinguishbetweenasthmaandCOPD Analternativeapproachtochronicobstructiveairwaydiseaseistodescriberatherthantocategorizethedisease 谢谢