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1、大医精诚大医精诚 尚美至善尚美至善The guideline of COPD大医精诚大医精诚 尚美至善尚美至善大医精诚大医精诚 尚美至善尚美至善DEFINITION OF COPDGlobal 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
2、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
3、response of the lungs to noxious particles or gases”大医精诚大医精诚 尚美至善尚美至善Barnes PJ. N Barnes PJ. N EnglEngl J Med 2000;343:269 J Med 2000;343:269大医精诚大医精诚 尚美至善尚美至善INFLAMMATIONSmall airway diseaseSmall airway diseaseAirway inflammationAirway inflammationAirway remodelingAirway remodelingParenchymalParench
4、ymal destruction destructionLoss of alveolar attachmentsLoss of alveolar attachmentsDecrease of elastic recallDecrease of elastic recallAIRFLOW LIMITATION大医精诚大医精诚 尚美至善尚美至善How to treat COPD?1.Access and Monitor Desease2.Reduce Risk Factors3.Manage stable COPD4.Manage Exacerbation大医精诚大医精诚 尚美至善尚美至善Acce
5、ss and Monitor DeseaseSymtoms: Chronic cough , Sputum ， dyspnea et.Spirmetry (gold standard): (post bronchodilator ) FEV1/FVC70%大医精诚大医精诚 尚美至善尚美至善COPD分期与分级分期与分级Thank you！大医精诚大医精诚 尚美至善尚美至善Reduce Risk Factors大医精诚大医精诚 尚美至善尚美至善Manage stable COPD Recommnedation 1 Spirometry should be obtained to diagnose
6、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)大医精诚大医精诚 尚美至善尚美至善Manage stable COPD Rec
7、ommnedation 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)大医精诚大医精诚 尚美至善尚美至善Manage stable COPD Recommnedation 3 For stable COP
8、D 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)大医精诚大医精诚 尚美至善尚美至善Manage stable COPD Recommnedation 4 ACP、ACCP、ATS and ERS recommend that clinicians pres
9、cribe 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 /m
10、oderate-quality evidence)大医精诚大医精诚 尚美至善尚美至善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
11、COPD and FEV1 60% predicted。.（weak recommendation /moderate-quality evidence)大医精诚大医精诚 尚美至善尚美至善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 /
12、moderate-quality evidence) clinicians may consider pulmonary rehabilitation for symtomatic patients or exercise-limited patients with an FEV150%predicted。（weak recommendation /moderate-quality evidence) 大医精诚大医精诚 尚美至善尚美至善Manage stable COPD Recommnedation 7 ACP、ACCP、ATS and ERS recommend that clinicia
13、ns shoulde precribe continued oxygen therapiy in patient with COPD who have severe resting hypoxemia（PaO255mmHg or SaO288%.（strong recommendation /moderate-quality evidence)大医精诚大医精诚 尚美至善尚美至善0: 0: High RISKHigh RISKFEVFEV1 1 80%80%I: MildI: MildFEVFEV1 1 80%80%II: ModerateII: ModerateFEVFEV1 179-50%7
14、9-50%III: SevereIII: SevereFEVFEV1 150-30%50-30% IV: Very Severe IV: Very Severe FEV FEV1 130%30%GOLDGOLD指南指南指南指南(2010)(2010)Active reduction of risk factorsActive reduction of risk factors； influezainflueza vaccination vaccination Add short-Add short-acttingactting bronchodilator bronchodilator（whe
15、n neededwhen needed） Add regular treatment with one or more Add regular treatment with one or more long-acting bronchodilatorslong-acting bronchodilators（when when neededneeded）；）；）；）； Add rehabilitationAdd rehabilitationAdd inhaled Add inhaled glucocorticosterglucocorticoster - -oidsoids if repeated if repeatedexacerbationsexacerbationsAdd long term Add long term oxygen if chronic oxygen if chronic respiratory failure. respiratory failure. Consider surgical Consider surgical treatmenttreatment大医精诚大医精诚 尚美至善尚美至善THANK YOU!
