深刻认识COPD急性加重PPT.pptVIP

* COPD在气道慢性炎症的基础上，在微生物、污染等诱发因素的作用下，气道炎症加剧，引起支气管狭窄，水肿，粘液分泌增加，从而导致呼气性气流受限，肺动态过度充气，出现急性加重症状。另一方面，肺部炎症溢出，导致全身性的炎症反应。 COPD exacerbations are associated with increased upper and lower airway and systemic inflammation. The airway inflammatory responses cause oedema, bronchospasm, and increased sputum production, leading to worsening airflow limitation and development of dynamic hyperinflation, which is a main cause of dyspnoea, the most common symptom of an exacerbation. Systemic inflammation increases at exacerbation and although the causes of this response in COPD are not clear, there is probably a spill-over of inflammatory markers from the lungs. Reference Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet. 2007;370:786-796. * ISOLDE/TRISTAN研究和UPLIFT研究 * * These long-term data suggest that, after the first hospitalised exacerbation, the course of COPD is generally composed of two phases. The first is a prolonged period of stable risk until the second hospitalised exacerbation, either a 5-year interval between the first two hospitalised exacerbations, given that the patient remains alive, or more relevant to the patient, a less than 2-year span until the next COPD hospitalisation or death. The second phase, delineated by the second hospitalised exacerbation in the patient’s life, seems to significantly modify the trajectory of the disease course. From this point on, severe exacerbations increase in intensity, with eight severe exacerbations expected in a 6-year period, including 3e4 severe exacerbations in the last year alone. 一旦发生第2次需住院的AECOPD，则再发AE的风险逐渐升高，间隔时间逐渐缩短 * * Indeed, the inflammatory response may contribute to the pathogenesis of disease, as pathogens may use the inflammatory responses to enhance their proliferation and infection of new hosts. Thus inhibition of inflammation may improve not only the symptoms that are direct consequences of inflammation, but may also have a beneficial effect on the infection itself.