英文精品课件chronicobstructive pulmonary disease and asthma

Chronic Obstructive Pulmonary Disease and Asthma Update John L. Faul, MD FCCP Assistant Professor, Division of Pulmonary/Critical Care Medicine Stanford University COPD: Outline u Epidemiology u Definitions u Medical management u Hypoxia u Infections u Vaccination Universal Problem COPD: epidemiology 14 million in the US with COPD 12.5 million with chronic bronchitis 1.65 million with emphysema 4th leading cause of death in US 3rd most frequent diagnosis of patients receiving home care Prevalence of COPD in the US *Age-adjusted to 2000 US population. Represents a statistically significant difference from rate among males. Mannino et al. MMWR. 2002;51(SS-6):1-16. Rate/1,000 Population* 0 20 30 40 50 60 70 80 90 1980 1982 1984 1986 Year Male Female Total10 1988 1990 1992 1994 1996 1998 2000 Since 1987, the prevalence of COPD among women has been significantly higher than that among men COPD: The Usual Suspects COPD: risk factors tobacco smoking accounts for 80-90% of the risk of developing COPD age of starting, total pack-years and current smoking status are predictive of mortality only 15% of smokers develop clinically significant COPD alpha1-antitrypsin deficiency (accounts for less than 1% of all COPD cases) occupational exposures to dusts and fumes Lung function declines with age Elastic tissue is lost in emphysema COPD: definitions Chronic bronchitis-a clinical definition: “the presence of chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of chronic cough have been excluded” Emphysema-a pathologic definition: “abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of their walls” Pink puffers 93: 391- 398 MRC trial, Lancet 1981; 1: 681-685 strengthens cardiac function, improves exercise performance and ADLs when FEV1 50 mm Hg Therapy at Each Stage of COPD Gold Update 2003 * FEV1/FVC 80% predicted PEF variability 2x/week but 2x/month FEV1 and PEF 80% predicted PEF variability 20-30% Daily low-dose inhaled corticosteroids OR Leukotriene modifier, theophylline 2002 NAEPP GUIDELINES Step 3: Moderate Persistent Asthma Symptoms daily Exacerbations affect activity Nighttime symptoms 1x/week FEV1 and PEF 60-80% predicted PEF variability 30% Low-medium dose inhaled corticosteroids with long-acting Beta agonist OR Leukotriene modifier, theophylline 2002 NAEPP GUIDELINES Step 4: Severe Persistent Asthma Continual Symptoms Exacerbations affect activity Nighttime symp