COPD的发病机制与诊断、治疗--华山医院呼吸科课件.ppt

* 2001年的GOLD报告中出现的0极（高危期）不再作为COPD的一个级别，因为没有证据显示符合“高危期”标准的个体（肺功能正常，有症状）一定会进展到下一级COPD 从图可以看到，戒烟者在五年内的肺功能下降缓慢，而持续吸烟者的肺功能则下降明显。同时复吸者在随后的随诊中也能发现其肺功能显著下降，而吸烟者戒烟后，其下次的随诊的肺功能显著改善。由此可见，戒烟能迅速改善COPD患者的肺功能。 肺脏健康研究1（LHS1）为一项多中心、随机临床试验。收入轻至中度COPD吸烟者5887例，随机分入接受专业戒烟干预组（SI）或普通治疗组（UC），其中SI组患者再随机分入常规是用异丙托溴氨吸入治疗组（SI-A）和安慰剂组（SP-I）组。随访记录吸烟状态与肺功能变化，每年1次，共5年。评估吸烟状态与FEV1下降率的关系。SP-I组和UC组患者随访5年的结果。 除了短期戒烟外，长期戒烟对COPD患者也是非常有帮助的。图中可以看到，持续戒烟者和吸烟者的FEV1下降趋势明显不同，吸烟者肺功能下降明显，间断戒烟者次之，而持续戒烟者肺功能下降显著延缓。长期戒烟可延缓COPD患者肺功能的下降。 Key Point Smokers with airflow obstruction have fewer respiratory symptoms. The Lung Health Study was a randomized, multicenter clinical trial designed to determine whether a smoking cessation intervention with or without the regular use of a bronchodilator can slow the rate of decline in FEV1 in smokers in the early stages of COPD. Smokers (N=5887) aged 35 to 60 years of age with mild-to-moderate airway obstruction (defined as FEV1 of 55% to 90% of predicted and FEV1/FVC 0.70) who were otherwise healthy were recruited between November 1986 and January 1989 and followed up for 5 years. Participants were randomly assigned to 1 of 3 groups: Usual care (UC) who received no intervention Smoking intervention and the inhaled bronchodilator ipratropium bromide (SIA) Smoking intervention and an inhaled placebo (SIP). Smoking intervention consisted of a 12-session smoking cessation program combining behavior modification and use of nicotine gum. Those who quit entered a maintenance program aimed at preventing relapse. All participants completed annual health questionnaires and lung function measurements. Participants were classified as sustained quitters if they were determined to be nonsmokers at all annual visits and continuous smokers if they were still smoking at all annual visits. There were no differences among the 3 treatment groups in the prevalence of cough, phlegm, wheezing, or shortness of breath at baseline. Respiratory symptoms were recorded at baseline and then annually. Partici