COPD Defined and Acute Exacerbation Management慢性阻塞性肺疾病定义及急性加重期管理.pptVIP

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COPD Defined and Acute Exacerbation Management慢性阻塞性肺疾病定义及急性加重期管理.ppt

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NEW COPD GOLD CLASSIFICATION Defining COPD To be familiar with the new GOLD classification system OBJECTIVES COPD DEFINED BY GOLD COPD as a disease state is characterized by airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. OLD SUBTYPES Chronic bronchitis: chronic productive cough for 3 months in 2 consecutive years. Emphysema: Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of airspace walls without obvious fibrosis. Chronic obstructive asthma: Asthma with airflow obstruction that does not remit completely Looks at 3 things: Symptoms FEV1 History of exacerbations REVISED GOLD CLASSIFICATION GRADING SYMPTOMS In patients with FEV1/FVC 0.70 GOLD 1 Mild FEV180% GOLD 2 Moderate 50%FEV180% GOLD 3 Severe 30%FEV150% GOLD 4 Very severe FEV130% GRADING SEVERITY OF AIRFLOW HISTORY 74 YO M with COPD p/w SOB x 2 days. At baseline he does not have any physical limitations. His last spirometry three years ago showed mild COPD. He was never given any inhalers besides a rescue inhaler that he seldom uses. He has never been intubated, but gets about 3 exacerbations per year. 2 days ago he required it around the clock after having URI symptoms. He has increased greenish sputum over the past couple of days. He called 911 after waking up SOB. He was given duonebs and placed on CPAP. What classification is he? CASE COPD is characterized by airflow limitation, progressive, and has an enhanced chronic inflammatory response. Revised GOLD classification uses FEV1, symptoms, history of exacerbations It’s still important to know the OLD FEV1 classification system because it’s used in the NEW GOLD classification. For diagnosis and exacerbation treatment of COPD, see the newly revised COPD mini lecture! SUMMARY Global Strategy for the Diagnosis, Management, and Prevention of COPD Updated 2013 Uptodat