内科学慢支肺气肿-蔡映云

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1、ChapterfiveChronicObstructivePulmonaryDiseases(COPD)lobalInitiativeforChronicbstructiveungiseaseGOLDDefinitionofCOPDMainlyincludingchronicbronchitisandpulmonaryemphysemaChronicairflowlimitationProgressingslowlyPartialreversibilityAbnormalinflammatoryresponseofthelun

2、gstonoxiousparticlesorgasesClinicalsignificanceThefourthleadingcauseofdeathand>16millionpersonsareaffectedintheunitedstates.TheincidenceofCOPDinChinesepeopleaged40yearsandaboveis8.3%ItisestimatedthatCOPDwillrisefromthesixthtothethirdmostcommoncauseofdeathworldwideby

3、2020ChronicbronchitisChronicnonspecificinflammationinmucosaanditsperipheraltissuesoftrachiaandbronchusObstructivepulmonaryemphysemaAbnormalpermanentenlargementofairspacesdistaltotheterminalbronchiolewithdestructionoftheirwallsandwithoutobviousfibrosisEtiology1.Smoki

4、ng(mostimportant)EpidemicalinformationPathologicalexaminationEffectsofgivingupsmokingAnimalexperimentEtiologyEtiology2.AirwayResponsivenessIncreasedairwayresponsivenessisclearlyasignificantpredictorofsubsequentdeclineinpulmonaryfunctionEtiology3.RespiratoryInfection

5、sTheimportantcauseofexacerbationTheassociationofrespiratoryinfectiontothedevelopmentandprogressionofCOPDremainstobeprovenEtiology4.OccupationalExposuresOccupationaldustsandfumesLessimportantthantheeffectofcigarettesmokingEtiology5.IndoorandoutdoorAirPollutionEtiolog

6、y6.PassivesmokingexposureExposureofchildrentomaternalsmokingresultsinsignificantlyreducedlunggrowthInuterotobaccosmokeexposurealsocontributestosignificantreductionsinpostnatalpulmonaryfunctionEtiology7.Geneticfactorsα1antitrypsindeficiency1~2%ofCOPDpatientsinheritse

7、vereα1ATdeficiencyOthergeneticriskfactorsEtiology8.OtherfactorsClimateColdweatherVariationofatmospherictemperatureImmunologicalanddefensivedisturbanceImbalancebetweensympatheticandparasympatheticnervessystemsNaturalHistoryFEV1%normallevelatage20Pathophysiology1.Airf

8、lowobstructionFEV1/FVC↓ReducedFEV1seldomhasapparentresponsestoinhaledbronchodilatorTheelasticrecoiloflung↓Theresistanceoftheairflow↑Pathop