英文ppt课件chronicobstructive pulmonary

OBSTRUCTIVE PULMONARY DISEASE Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that combines chronic bronchitis and its symptoms of chronic cough to improving lung function and reducing the accelerated decline in lung function; preventing and effectively treating complications; reducing mortality; and avoiding or minimizing treatment side effects Management is focused on smoking cessation, domiciliary oxygen therapy for hypoxemia, vaccination against influenza viruses and Streptococcus pneumoniae, and symptomatic relief of bronchospasm The only two available treatment options that have been proven to achieve the aims of treatment are smoking cessation and long-term oxygen therapy in severe COPD The pharmacologic treatment of stable COPD is purely symptomatic and somewhat controversial One short-acting B2 agonist or an inhaled anticholinergic agent as needed One short-acting B2 agonist, an inhaled anticholinergic agent, or a combination of the two, and if the combination of the two is ineffective, the addition of other bronchodilators (such as theophylline) The ethvlene diamine salt of theophylline (aminophylline) can be given orally or parenterally; in addition to bronchodilatation, it stimulates respiration and has cardiotonic and diuretic properties and may increase diaphragmatic contractility, especially in the setting of hypoxemia or muscle fatigue Parenteral administration of theophylline is rarely indicated in the chronic obstructive syndromes, except during episodes of respiratory failure when agents cannot be given orally Responsiveness to B2-agonists does seem to predict steroid responsiveness in a great many patients with smoking-related COPD; however, a poor bronchodilator response does not preclude a good response to steroids. High-potency inhaled steroids may improve pulmonary function in a minority of patients with COPD, especially those who have significant responses to B2-agonists STEROIED PROEF Aangedui vir evaluasie van later stadia Ook om omkeerbaarheid by vroeer stadia te evalueer. Prednisoon 40 mg daagliks vir 14 dae FEV1 verbeter met 15% of 200 ml - behandel soos asma STEROIED PROEF 2 FEV1 verbeter met 10% en simptomaties beter - indien laatstadium oorweeg lae dosis orale steroiede en optimaliseer brongodilatore Geen objektiewe respons - stop kortisoon, brongodilatore en ondersteun Brongodilatore kan kollabering vererger Steroid responsiveness does not appear to be an all-or-nothing phenomenon, but rather appears to fall along a continuous spectrum FEV1 is a main prognostic factor in COPD, and this variable should be measured regularly Smoking cessation is essential at all stages of COPD All COPD guidelines recommend yearly influenza vaccination ATS also recommends pneumococcal vaccination and patient education Exacerbations are the main cause of medical intervention and hospitalization of these patients Patients with COPD have, on average, three exacerbations per year, and when two of three “cardinal” symptoms are present, antibiotic therapy has benefit. These cardinal symptoms are increase dyspnea, increased sputum volume, and increased sputum purulence As many as 50% of these episodes are due to bacteria, most commonly nontypable Haemophilus influenzae, but also Moraxella catarrhalis and Streptococcus pneumoniae Supplemental oxygen remains the cornerstone of modern therapy Several well-conducted studies showed that long-acting inhaled B2 agonists are indeed effective as symptomatic relievers in COPD, resulting in a significant decrease in dyspnea and an improved quality of life The role of long-term treatment with inhaled glucocorticoids in pure COPD without an asthmatic component is much less clear than their role in treating asthma Pharmacologic treatment of exacerbations Short-acting inhaled B2 agonists and Systemic glucocorticoids as cornerstone pharmacologic treatment In severe exacerbations of COPD with acute respiratory failure, the use of a short course (7 to 14 days) of systemic glucocorticoids appears effective Antibiotics are recommended in all current guidelines and are almost always used in general practice in the treatment of COPD exacerbations Asthma is a disease of airways that is characterized by increased responsiveness of the tracheobronchial tree to a multiplicity of stimuli. It is manisfested physiologically by a widespread narrowing of the air passages, which may be relieved spontaneously or as a result of therapy, and clinically by paroxysms of dyspnea, cough and wheezing. Asthma is an episodic disease, acute exacerbations being interspersed with symptom free-periods. The pathophysiologic hallmark of asthma is a reduction in airway diameter brought about by contraction of smooth muscle, vascular congestion, edema of the bronchial wall, and thick, tenacious secretions The available agents for treating asthma can be devided into two general categories: drugs that inhibit smooth muscle contraction (beta-adrenergic agonists, methylxanthines and anticholinergics) and agents that prevent and / or reverse inflammation (glucocorticoids, mast cell-stabilizing agents and mediator-receptor antagonists) The goal of chronic therapy is to achieve a stable, asymptomatic state with the best pulmonary function possible With respect to pharmacologic interventions, in general, the simplest approach works best. Side effects of glucocorticoid excess begin to appear more frequently when the dose exceeds 2.0 mg/d Mild intermittent asthma Intermittent brief symptoms 1 - 2 / week Brief exacerbations Nocturnal symptoms 2 / month Asymptomatic between episodes Severe persistent asthma Continuous symptoms Frequent exacerbations Nocturnal symptoms - frequent Activities limited Low-dose inhaled corticosteroids are now considered firstline therapy in patients with asthma as they more effectively than any other treatment Failure to employ early corticosteroid treatment when indicated may result in irreversible loss