英文精品课件chronicobstructive pulmonary disease and asthma

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1、ChronicObstructivePulmonaryDiseaseandAsthmaUpdateJohnL.Faul,MDFCCPAssistantProfessor,DivisionofPulmonary/CriticalCareMedicineStanfordUniversityCOPD:OutlineEpidemiologyDefinitionsMedicalmanagementHypoxiaInfectionsVaccinationUniversalProblemCOPD:epidemiology14millionintheUSw

2、ithCOPD12.5millionwithchronicbronchitis1.65millionwithemphysema4thleadingcauseofdeathinUS3rdmostfrequentdiagnosisofpatientsreceivinghomecarePrevalenceofCOPDintheUS*Age-adjustedto2000USpopulation.†Representsastatisticallysignificantdifferencefromrateamongmales.Manninoetal.MM

3、WR.2002;51(SS-6):1-16.Rate/1,000Population*020304050607080901980198219841986YearMaleFemaleTotal101988199019921994199619982000Since1987,theprevalenceofCOPDamongwomenhasbeensignificantlyhigherthanthatamongmen†††††††††††††††COPD:TheUsualSuspectsCOPD:riskfactorstobaccosmokingac

4、countsfor80-90%oftheriskofdevelopingCOPDageofstarting,totalpack-yearsandcurrentsmokingstatusarepredictiveofmortalityonly15%ofsmokersdevelopclinicallysignificantCOPDalpha1-antitrypsindeficiency(accountsforlessthan1%ofallCOPDcases)occupationalexposurestodustsandfumesLungfunct

5、iondeclineswithageElastictissueislostinemphysemaCOPD:definitionsChronicbronchitis---aclinicaldefinition:“thepresenceofchronicproductivecoughfor3monthsineachof2successiveyearsinapatientinwhomothercausesofchroniccoughhavebeenexcluded”Emphysema---apathologicdefinition:“abnorma

6、lpermanentenlargementoftheairspacesdistaltotheterminalbronchiolesaccompaniedbydestructionoftheirwalls”Pinkpuffers&BluebloatersCOPD:HyperinflationIncreasedretrosternalairspaceFlatdiaphragmsIncreasedAPdiameterCOPDCOPD:OxygentherapyOxygentherapyinCOPD:extendslifeinhypoxemicp

7、atientsNOTTtrial,AnnIntMed1980;93:391-398MRCtrial,Lancet1981;1:681-685strengthenscardiacfunction,improvesexerciseperformanceandADLswhenFEV1<1.0L(or<50%predicted)anABGshouldbedoneHomeO2costsintheUS/yr:$2,400,000,000OxygenDissociationCurve1008060BelowPaO2=60mmHg,Hemoglobinrap

8、idlylosesoxygencarryingcapacity(West:TextbookofPhysiology)HemoglobinSaturation%406