课件：慢性阻塞性肺疾病现代诊治.ppt

* ? M Saetta * 强调COPD病理生理的局部有四个因素，一个全身因素：将意味着舒利迭在这五个因素中都有作用点 * 最大呼气流量容积曲线 * * * * ? GlaxoSmithKline 2002 * Global initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. NHLBI/WHO workshop report. Bethesda, National Heart Lung and Blood Institute, April 2001; update of the Management sections, GOLD website (). Date updated: July 2003 * The UK General Practice Research Database (GPRD) was used to replicate the SinTu study design to examine the additional effect of a LABA + ICS in reducing COPD morbidity and mortality. A retrospective cohort of 4623 newly diagnosed COPD patients in the UK GPRD from 1990 to 1999, aged 50 years and older and who subsequently had a first hospitalisation, was identified. 3636 patients receiving prescriptions for ICS or LABA within 90 days after discharge from a COPD-related hospital admission were compared with 627 COPD patients receiving other bronchodilators. The Cox survival function adjusted for all confounders of rehospitalisation or death after discharge from a first COPD hospitalisation is presented. Survival in patients treated with ICS without or with LABAs was significantly improved compared with the reference group (p0.04 and p0.001 respectively). ICS+LABA patients had significantly higher survival rates than those on ICS alone, p=0.012. Re-hospitalisation or death within a year occurred in 325 of the comparison group, in 29% of LABA users, in 25% of those on ICS alone, and in 18% of those on ICS and LABA. Significant reductions in risk of re-hospitalisation or death were observed for patients using ICS alone (16% reduction) and those using the combination of ICS+salmeterol (41% reduction) compared with the reference group. Soriano JB, et al. Inhaled corticosteroids with/without long-acting b-agonists reduce the risk of rehospitalisation and death in COPD patients. Am J Respir Med 2003; 2: 67-74 * * 吸入激素抗炎作用的机制。GRC+AP-1，致炎性细胞前