英文精品课件chronicobstructive pulmonary

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1、ChronicObstructivePulmonaryDiseaseCoreClinicalTopics–MDFMR–12/08Whydowecare?FourthleadingcauseofdeathintheUSHalfofcasesundiagnosedObjectivesDiagnoseCOPDaccuratelyManagechronicCOPDsymptomsinanevidenced-basedmannerReviewinterpretationofPFTs/spirometryBeempoweredtohelpyourpatientsquits

2、moking!MoreobjectivesInstructpatientsinproperMDIuseLearnindications&benefitsofpulmrehabPracticeOMTforchroniclungdiseaseReviewmanagementdilemmasinCOPDReflectonyourownmanagementofCOPDpatientsPracticeboardreviewquestionsCOPDCaseFindapartnerandreviewthecaseofSharonBlackbreathWritedownyou

3、ranswers.Turningthemincountsforyourattendancetoday.Case-KeyHistoryPointsAgelessthan40yearsDailysxs–coughandsputumSignificantsmokinghistorySignificantsecondhandsmokeOccupationalexposure??Oldfurnace???PMH-bronchitisCase-Questionstoask…DoessheuseaspacerDoestheCombiventhelpsxsEvertriedto

4、quitsmokingbefore?EverpastPFTsorpeakflows?Familyhistoryoflungdisease?TBexposure?Case–DifferentialDxCOPD–howsevere?InterstitiallungdiseasePreviouslyundiagnosedasthma?CarbonmonoxidepoisoningTuberculosisUpperairwayobstructionCardiacdiseaseCase–DiagnostictestingDiagnosisofCOPDismadebyPFT

5、sNoroleforscreeningasymptomaticptsNoevidencetosupportCXRorCTConsideralpha-1antitrypsinifage<40Case–TherapeuticoptionsLadderconcepttoinformtxdecisionsInhalershavenotbeenstudiedinpatientswithmildCOPDsonoevidenceofbenefitNomedicationdecreasesmortalityinCOPDCase–TherapeuticoptionsSmoking

6、cessationistheonlyinterventioninCOPDthatslowstherateofdeclineoflungfunction.PulmonaryFunctionTestsFVC=ForcedvitalcapacityFEV1=ForcedexpvolumeaverageinfirstsecondofFVC(liters)TLC=TotallungcapacityRV=Residualvolume(TLC–FVC)DiagnosisofCOPDFEV1/FVCRatio<0.70=ObstructionMildFEV1>80%predic

7、tedModerateFEV1–50-80%predictedSevereFEV1–30-50%predictedVerysevereFEV1<30%predictedCOPDSymptomManagementMildShort-actingbronchodilatorModerateLong-actingbronchodilatorSevereSteroidinhaler,TheophyllineHomeO2,PulmrehabEveryoneQuitsmoking,Flu&PNVXCase–NextstepsInterpretPFTs–severeCOPDS

8、mokingcessat