课件：肺功能在慢阻肺中的应用.pptVIP

Air trapping affects patients with COPD. It results in an expansion of the chest wall, which places the respiratory muscles at a mechanical disadvantage.1 Air trapping limits the ability of patients to expand tidal volume when required, for example, during activity. This makes the patient feel breathless or dyspneic. Hyperinflation, resulting from air trapping, can be observed on standard X-rays. Note the wide intercostal spaces in this patient with COPD, which are caused by air trapping. ODonnell DE, Webb K. The etiology of dyspnea during exercise in COPD. Pulmonary and Critical Care Update 14, Lesson 15./downloads/education/online/Vol14_13_18.pdf. Accessed 24 February 2004. 健康人群和慢阻肺患者的运动肺容积变化比较结果显示，慢阻肺患者因肺过度充气导致的通气受限表现非常明显。 * * 旧版的GOLD指南将肺功能——FEV1作为主要的评估指标，但大量研究证明单凭FEV1不足以判断COPD患者的长期预后。 2011年新版GOLD指南指出： COPD的评估应基于患者的症状、急性加重风险、气流受限程度及合并症 对症状和急性加重风险的个体化评估应被纳入稳定期COPD的管理策略 因此，对急性加重风险的考虑已成为COPD评估分级的的重要因素。 Key Point Smokers with airflow obstruction benefit from quitting smoking. The LHS 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 fu