英文ppt课件chronicobstructive pulmonary disease （32p）

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1、ChronicObstructivePulmonaryDiseaseChief’sConference:KevinL.GilliamII,M.D.April16,2009EmoryFamilyMedicineWhatisCOPD?Itisasyndromeofprogressiveairflowlimitationcausedbychronicinflammationoftheairwaysandlungparenchyma.Thetermschronicbronchitisandemphysemaarenolongerincludedintheformaldefinitionof

2、COPD,althoughtheyarestillusedclinicallyEmphysema:pathologictermusedtodescribedestructionofthealveolarcapillarymembraneChronicBronchitis:clinicaltermusedtodescribethepresenceofcoughorsputumproductionforatleastathreemonthdurationduringtwoconsecutiveyearsWhogetsCOPD?SmokersSmokersSmokersMorethan8

3、0percentofdeathsfromthediseasearedirectlyattributabletosmoking,andpersonswhosmokeare12to13timesmorelikelytodiefromCOPDthannonsmokers.TheabsoluteriskofCOPDamongactive,continuoussmokersisatleast25percentWhoelseisatriskforgettingCOPD?PeopleofadvancingageThoseexposedtosecondhandsmokeChronicexposur

4、etoenvironmentaloroccupationalpollutantsAlpha1-antitrypsindeficiency(typicallyearly)ChildhoodhistoryofrecurrentrespiratoryinfectionsFamilyhistoryofCOPDWhat’sthePhysiology?Relatedtochronicairwayirritation,mucusproduction,andpulmonaryscarring.Irritationfromenvironmentalpollutants(mostcommonlycig

5、arettesmoke)orageneticpredispositionleadstoairwayinflammation,whichcausesincreasedmucusproductionanddecreasedmucociliaryfunctionThecombinationofincreasedmucusanddecreasedmucociliaryclearanceleadstothehallmarkCOPDsymptomsofcoughingandsputumproductionALittleMorePhysiologyContinuedairwayirritatio

6、nandinflammationcausesscarringwithintheairwaysleadingtoairwayobstructionanddyspneaIrritation,inflammation,mucusproduction,andscarringalsopredisposepatientstorespiratoryinfectionswhichleadsthemtoseekmedicalattentionWithoutsymptomsmanypatientswillnotseekmedicalattentionandthereforediseasecanprog

7、ressbeforediagnosisortreatmentEpidemiologicallySpeaking10millionadultsintheUnitedStateshavebeendiagnosedwithCOPDNationalHealthandNutritionExaminationSurvey(NHANES)suggeststhatroughly10percentoftheadultU.S.populationhasevidenceofimpaired