呼吸内科临床药学实践剖析.ppt

* 谢 谢！ COPD是一种可以预防和可以治疗的疾病，常伴有一些明显的全身效 应，可对患病个体带来严重后果。 气道不完全可逆性气流受限为其特征。 气流受限通常呈进行性加重，并与气道对有害微粒或气体的异常炎症反应有关。 首先我们还是来看看权威的GOLD是怎么说的， * 皮肤挫伤发生率增加 * * * Other Treatment Options for AECB More as a preventative measure, local irritants such as dust, pollutants, or cigarette smoke should be removed. Symptomatic therapy for exacerbations in chronic bronchitis include bronchodilator therapy which may slow the decline of lung function in those COPD patients who are bronchodilator responsive. Inhaled anticholinergic agents appear to produce greater bronchodilatation than inhaled ?-agonists. The role of long-acting inhaled ?-agonists is unclear but preliminary reports suggest that mild symptomatic improvement and small increases in pulmonary function are associated with their use (Balter and Grossman, 1997). Low-flow oxygen therapy should be administered if hypoxemia is present. It is important not to administer excess oxygen which may lead to progressive hypercapnia. The use of oral or IV corticosteroids is recommended for most patients with chronic bronchitis and demonstrable airflow obstruction during exacerbations. Although the optimal dose of corticosteroids is unknown, most clinicians prescribe prednisone in a daily dose of 30 to 40 mg, decreasing the dose to zero over the next 7 to 10 days. Theophylline products have less bronchodilator effect than ?2-agonists or anticholinergic agents (Balter and Grossman, 1997). COPD严重程度的肺功能分级 分级 特征 I:轻度 FEV1 /FVC70%，FEV1 ≥80%预计值 II:中度 FEV1 /FVC70%，50%≤FEV1 80%预计值 III:重度 FEV1 /FVC70%，30%≤FEV1 50%预计值 IV:极重度 FEV1 /FVC70%，FEV1 30%预计值,或FEV1 50%预计值合并慢性呼衰 COPD全面评估 风险 (气流受限GOLD 分级) 风险 (急性加重病史) 2 1 0 (C) (D) (A) (B) mMRC 0-1 CAT 10 4 3 2 1 mMRC 2 CAT 10 症状(mMRC or CAT评分)) (C) (D) (A) (B) mMRC 0-1 CAT 10 mMRC 2 CAT 10 症状 如果mMRC 0-1 或 CAT 10: 症状较少(A or C) 如果mMRC 2 或CAT 10: 症状较多(B or D) 首先评估症状（根据mMRC或CAT评分） COPD全面评估 COPD的全面评估：患者症状 GOLD推荐mMRC(改良英国医学研究理事会)问卷，评估呼吸困难程度 COP