MANAGEMENT OF COPD IN PATIENTS 慢性阻塞性肺疾病患者的药物治疗ppt课件.ppt

CARDIOVASCULAR EVENTS AND THERAPY Calverley et al Thorax 2010 CVS TREATED COPD AND THERAPY Calverley et al Thorax 2010 人类需要伟大思想家的指引。中国人说：天不生仲尼，万古如长夜。正是有了老子、释迦牟尼、苏格拉底、柏拉图、亚里士多德，人类才从根本上告别了荒昧，走向人文、理性、高贵。 人类需要伟大思想家的指引。中国人说：天不生仲尼，万古如长夜。正是有了老子、释迦牟尼、苏格拉底、柏拉图、亚里士多德，人类才从根本上告别了荒昧，走向人文、理性、高贵。 人类需要伟大思想家的指引。中国人说：天不生仲尼，万古如长夜。正是有了老子、释迦牟尼、苏格拉底、柏拉图、亚里士多德，人类才从根本上告别了荒昧，走向人文、理性、高贵。 Grazie per aver scelto di utilizzare a scopo didattico questo materiale delle Guidelines 2011 libra.Le ricordiamo che questo materiale è di proprietà dell’autore e fornito come supporto didattico per uso personale. PHARMACOLOGICAL MANAGEMENT OF COPD IN PATIENTS WITH CHRONIC CO-MORBIDITIES Professor Peter Calverley University Hospital Aintree Liverpool UK A RUMSFELD MOMENT! Does having COPD influence the choice of therapy for a co-morbidity? Does taking a treatment for a co-morbidity improve the outcome in COPD? Does taking a treatment for COPD affect the co-morbidity? BETA –BLOCKERS AND COPD Good data for the benefits of selective beta-blockade in congestive heart failure, rate control of AF Longstanding worry that beta-blockade might precipitate bronchospasm So most people avoided beta-blockers in COPD Now we have evidence for safety and a reason why this is the case BETA-BLOCKERS, COPD AND VASCULAR SURGERY 1205 COPD patients, 462 receiving therapy with BB pre-surgery Van Gestel et al AJRCCM 2008 Why COPD is not asthma –bronchodilator testing is not helpful Change in FEV1 (L), Post-bronchodilator Subject Group Percent Smoker Controls Percent Non-smoker Contr Percent COPD Subjects 35 30 25 20 15 10 5 0 35 30 25 20 15 10 5 0 35 30 25 20 15 10 5 0 0.15 0.05 -0.65 -0.55 -0.25 -0.05 0.25 0.35 0.45 0.55 0.65 0.75 0.85 0.95 1.05 1.15 1.25 1.35 -0.45 -0.35 -0.15 THE STATIN STORY STATINS AND COPD OUTCOMES IN LOW RISK PATIENTS Mancini et al JACC 2006 STATINS AND EXACERBATIONS Mortenson E et al Respir Res 2009 Systemic Effects of COPD: Target Organs Lung Infections Lung Cancer Weight loss Mus