HARMACOLOGICAL MANAGEMENT OF COPD IN PATIENTS 慢性阻塞性肺疾病患者的药物治疗

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1、GrazieperaversceltodiutilizzareascopodidatticoquestomaterialedelleGuidelines2011libra.Lericordiamochequestomaterialeèdiproprietàdell’autoreefornitocomesupportodidatticoperusopersonale.PHARMACOLOGICALMANAGEMENTOFCOPDINPATIENTSWITHCHRONICCO-MORBIDITIESPr

2、ofessorPeterCalverleyUniversityHospitalAintreeLiverpoolUKARUMSFELDMOMENT!DoeshavingCOPDinfluencethechoiceoftherapyforaco-morbidity?Doestakingatreatmentforaco-morbidityimprovetheoutcomeinCOPD?DoestakingatreatmentforCOPDaffecttheco-morbidity?BETA–BLOCKERS

3、ANDCOPDGooddataforthebenefitsofselectivebeta-blockadeincongestiveheartfailure,ratecontrolofAFLongstandingworrythatbeta-blockademightprecipitatebronchospasmSomostpeopleavoidedbeta-blockersinCOPDNowwehaveevidenceforsafetyandareasonwhythisisthecaseBETA-BLO

4、CKERS,COPDANDVASCULARSURGERY1205COPDpatients,462receivingtherapywithBBpre-surgeryVanGesteletalAJRCCM2008WhyCOPDisnotasthma–bronchodilatortestingisnothelpfulChangeinFEV1(L),Post-bronchodilatorSubjectGroupPercentSmokerControlsPercentNon-smokerContrPercent

5、COPDSubjects3530252015105035302520151050353025201510500.150.05-0.65-0.55-0.25-0.050.250.350.450.550.650.750.850.951.051.151.251.35-0.45-0.35-0.15THESTATINSTORYSTATINSANDCOPDOUTCOMESINLOWRISKPATIENTSMancinietalJACC2006STATINSANDEXACERBATIONSMortensonEeta

6、lRespirRes2009SystemicEffectsofCOPD:TargetOrgansLungInfectionsLungCancerWeightlossMuscleweaknessOsteoporosisAnginaAcutecoronarysyndromesDepressionDiabetesMetabolicsyndromeSystemicInflammationOxidatitiveStressDepressionPepticulceration/refluxDepressionFr

7、omWMacNeeTREATMENTANDCOMPLICATIONSDepression–common,oftenassociatedwithfatigue.Interactionwiththerapymorelikelywithsystemictreatment.Corticosteroidspossibly–roflumilastunprovenReflux–GIissueswiththeophyllinesandPDEIVinhibitorsMetabolismanddiabetes–ocsas

8、sociatedwithhyperglycaemiabutthisisafeatureofacuteexacerbations.MoredatafromroflumilastMusclesCOPDsafetypoolplacebo(N=5,491)(%)rof500(N=5,766)(%)MostfrequentlyreportedAEsAllAEs62.867.2COPDexacerbations23.119.8Diarrhoea2.610.1Weig