英文ppt课件chronicobstructive pulmonary disease and asthma

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1、ChronicObstructivePulmonaryDiseaseandAsthmaUpdateJohnL.Faul,MDFCCPAssistantProfessor,DivisionofPulmonary/CriticalCareMedicineStanfordUniversityCOPD:OutlineEpidemiologyDefinitionsMedicalmanagementHypoxiaInfectionsVaccinationUniversalProblemCOPD:epidemiology14millioni

2、ntheUSwithCOPD12.5millionwithchronicbronchitis1.65millionwithemphysema4thleadingcauseofdeathinUS3rdmostfrequentdiagnosisofpatientsreceivinghomecarePrevalenceofCOPDintheUS*Age-adjustedto2000USpopulation.†Representsastatisticallysignificantdifferencefromrateamongmales.

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

4、ctorstobaccosmokingaccountsfor80-90%oftheriskofdevelopingCOPDageofstarting,totalpack-yearsandcurrentsmokingstatusarepredictiveofmortalityonly15%ofsmokersdevelopclinicallysignificantCOPDalpha1-antitrypsindeficiency(accountsforlessthan1%ofallCOPDcases)occupationalexpos

5、urestodustsandfumesLungfunctiondeclineswithageElastictissueislostinemphysemaCOPD:definitionsChronicbronchitis---aclinicaldefinition:“thepresenceofchronicproductivecoughfor3monthsineachof2successiveyearsinapatientinwhomothercausesofchroniccoughhavebeenexcluded”Emphyse

6、ma---apathologicdefinition:“abnormalpermanentenlargementoftheairspacesdistaltotheterminalbronchiolesaccompaniedbydestructionoftheirwalls”Pinkpuffers&BluebloatersCOPD:HyperinflationIncreasedretrosternalairspaceFlatdiaphragmsIncreasedAPdiameterCOPDCOPD:OxygentherapyO

7、xygentherapyinCOPD:extendslifeinhypoxemicpatientsNOTTtrial,AnnIntMed1980;93:391-398MRCtrial,Lancet1981;1:681-685strengthenscardiacfunction,improvesexerciseperformanceandADLswhenFEV1<1.0L(or<50%predicted)anABGshouldbedoneHomeO2costsintheUS/yr:$2,400,000,000OxygenDisso

8、ciationCurve1008060BelowPaO2=60mmHg,Hemoglobinrapidlylosesoxygencarryingcapacity(West:TextbookofPhysiology)HemoglobinSaturation%406