2011GOLD指南11-30.pptVIP

* * * Speaker notes Assessment of patients with COPD has revealed that they are at increased risk, relative to the general population, for a wide range of systemic comorbidities.1,2 These include cardiovascular conditions, such congestive heart failure (CHF), arrhythmias, and hypertension; metabolic diseases, such as diabetes; osteoporosis; increased risk for ulcers; malignancies; and depression.1-4 References Agusti AG, Noguera A, Sauleda J, Sala E, Pons J, Busquets X. Systemic effects of chronic obstructive pulmonary disease. Eur Respir J. 2003;21:347-360. Sevenoaks MJ, Stockley RA. Chronic Obstructive Pulmonary Disease, inflammation and co-morbidity--a common inflammatory phenotype? Respir Res. 2006;7:70-78. Luppi F, Franco F, Beghé B, Fabbri LM. Treatment of chronic obstructive pulmonary disease and its comorbidities. Proc Am Thorac Soc. 2008;5:848-856. Chatila WM, Thomashow BM, Minai OA, Criner GJ, Make BJ. Comorbidities in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;5:549-555. * Speaker Notes The high prevalence of COPD and comorbidity with other serious medical conditions should prompt evaluation of COPD patients for comorbid conditions and assessment of patients who smoke with common comorbidities (e.g., cardiovascular disease, hypertension, diabetes) for COPD using spirometry. * * * * * * * * 2011 GOLD更新 GOLD-2011 定义  COPD患者评估（合并症） 治疗策略 COPD的定义 慢性阻塞性肺病，是一种可防可治的常见病， 以持续气流受限为特征，通常为进行性，与气道 和肺针对有害微粒或气体慢性异常炎症反应有关。 急性加重和合并症加剧患者病情的整体严重程度。 COPD急性加重的定义 COPD急性加重是急性事件，患者病情 超越了日常的逐日变化，以呼吸系统症状 恶化为特征，从而导致药物治疗的变化。 临床上，任何有呼吸困难，慢性咳嗽或 有咯痰，和/或有接触本病的危险因素史 患者，都应考虑COPD的诊断。 COPD的诊断 必须进行肺功能测定：FEV1/FVC0.7 以证实存在不完全可逆的气流受限。 COPD的诊断 COPD严重度分级 将避免使用“期”一词 引入“肺功能分类”一词 维持分界点（cut-off points) 80 %预计值（GOLD 2） 50 %预计值（GOLD3） 30 %预计值（GOLD4） GOLD-2011 COPD的评估 症状评估 气流受限程度 急性加重发作风险 COPD合并症 GOLD-2011 症状