课件：慢阻肺的内科治疗.ppt

* BOLD研究显示64.7%COPD患者存在咳嗽、咳痰、气喘、呼吸困难等任一症状，提示COPD治疗不足。 The prevalence of cough, phlegm, wheezing, and breathlessness respiratory symptoms in patients with COPD was 44.0%, 39.5%,29.3%, and 48.6%, respectively .A total of 64.7% of patients with COPD exhibited at least one of above respiratory symptoms. * * 共抗COPD调查，由中国呼吸病专家咨询小组设计调查方案，采取横断面调查，2006年7月至10月在中国6大城市对258名呼吸科医生何723例COPD稳定期患者进行面对面调查。评估中国部分城市中稳定期COPD患者治疗用药状况。 * * LHS（Lung Health Study）研究是一项双盲、多中心、随机、对照临床试验，研究吸烟和支气管扩张剂早期干预治疗在COPD中的作用。3,923例患者，2年随访结果。前4个月根据患者报告，患者依从性良好比例70%，治疗1年，根据患者报告+装置重量检测，患者依从性良好的比例已降至48%。即使在研究期间，吸入疗法的依从性也会随时间延长而下降。 This LHS program was developed to maintain long-term adherence to an inhald medication regimen in 3,923 special intervention participants(as measured by self-report and medication canister weight).At the first 4-mo follow-up visit ,nearly 70% of participants reported satisfactory or better adherence. Self-reporting by canister weight classified 48% of participants at 1 yr as showing satisfactory or better adherence. * * COPD患者肺功能加速下降的特征。 FEV1持续下降将持续患者的一生，并随着年龄的增长略有加速。非吸烟和对吸烟不敏感的患者FEV1下降减慢，几乎没有发展到临床显著的气流阻塞。 与之形成显著对比的是，对吸烟敏感的患者发展到了不同程度的气流阻塞，最终致残或致死。在这些患者中，戒烟无法恢复FEV1，但可以使随后的FEV1成正常速率地下降 * COPD的病理生理变化包括气流受限和气体陷闭、气体交换异常、粘液高分泌、肺动脉高压。 * * Air trapping in COPD. During expiration small airways narrow but closure is prevented by the elasticity of alveolar attachments. In COPD patients there is a loss of elasticity with greater narrowing in small airways, which may close completely when there is loss of alveolar attachments as a result of emphysema. This results in air trapping and hyperinflation, leading to dyspnea and reduced exercise capacity. An example of how the CAT can be used – to get the total score which measures overall severity, but also to identify very quickly which areas are most affected. 虽然FEV1％预计值对反映COPD严重程度、健康状况及病死率有用，但FEV1并不能完全反映COPD复杂的严重情况 除FEV1以外，已证明体重指数(BMI)和呼吸困难分级在预测COPD生存率等方面有意义 * * 所有噻托溴铵试验均选择了目前应用较为广泛、可信度较高的圣-乔治呼吸问卷(SGRQ)作为健康状况的评估工具。 SGRQ是疾病特异性问卷调查工具，共由三部分组成，用以评价