医学英语课件资料：Chronic Obstructive Pulmonary Disease

1、Physicians Framework forChronic Obstructive Pulmonary Disease (COPD)1FRAMEWORK2Our Framework:IntroductionDefinitionCharacteristicsEpidemiologySymptomsEtiology and PathogenesisMain causesImmunologic PathologyDiagnosisSpirometryCXR, CTArterial blood gas testManagementLifestyle changeMedication OxygenS

2、urgery Prognosis and Prevention1INTRODUCTION3Definition of COPDEmphysemaCOPDPulmonary Heart DiseaseAbnormal chronic dilation of distal terminal bronchiolesIncompletely reversible airwayobstructionChronic BronchitisNon-specific inflammationAECOPD4Acute exacerbationCOPDNot fully reversible airway obst

3、ructionThe diagnostic characteristic of COPD.“Smokers cough”Smoking is the most common cause of COPD.UnclearPathogenesis is complicated and undefined.HardNo cure for COPD, only treatments to help patients breathe better.Characteristics of COPD52EPIDEMIOLOGY6Epidemiology of COPDGlobal overview2010: A

4、ffected 4.8% of the population worldwide*2012: 3rd leading cause of death*Endemic overview (China)2003 morbidity: 8.2% in 20245 adults over 40 years oldSex and ageMen exceeds women: Tobacco useOlder exceeds younger: 34-200/1000 (65 years old)Related indexesLabor force, Quality of lifeMorbidity, Mort

5、ality, Disability-adjusted life years73SYMPTOMS8Symptoms of COPDCoughProlonged cough with or without sputum.Shortness of breathProgressive manifestation.Auscultation (听诊)Wheezing sound.Take more efforts to breathe out than to breathe in.94PATHOGENESISETIOLOGY10ETIOLOGY11EtiologySMOKINGAIR POLLUTIONE

6、XPOSURESGENETICSOTHEREXACERBATIONSCAUSE12SMOKINGAIR POLLUTIONEXPOSURESGENETICSOTHEREXACERBATIONSCAUSEEtiology13Tobacco smoking - MalePercentage of males smoking tobacco as of the late 1990s early 2000s.Male Smoking by Country by Emilfaro. Licensed under CC BY-SA 3.0 via Commons - /wiki/File:Male_Smo

7、king_by_Country.png#/media/File:Male_Smoking_by_Country.png14Percentage of females smoking tobacco as of the late 1990s early 2000s.Female Smoking by Country by Emilfaro. Licensed under CC BY-SA 3.0 via Commons - /wiki/File:Female_Smoking_by_Country.png#/media/File:Female_Smoking_by_Country.pngTobac

8、co smoking - Female15 Cigarrete Marujuana Cigar Water pipeCauses 1 : Smoking16SMOKINGAIR POLLUTIONEXPOSURESGENETICSOTHEREXACERBATIONSCAUSEEtiology17Cause 2 : Air pollutionLight fireTransportationIndustry18SMOKINGAIR POLLUTIONEXPOSURESGENETICSOTHEREXACERBATIONSCAUSEEtiology19Cause 3 : Occupational ex

9、posureMain infectious source Dusts / powderChemicalsFumesIrritant gasSulfur dioxideSusceptible areaCoal miningGold miningRock excavatingCement manufacturing20SMOKINGAIR POLLUTIONEXPOSURESGENETICSOTHEREXACERBATIONSCAUSEEtiology21Cause 4 : Genetics1-antitrypsin deficiency (AAT)Glutathione-s-transferas

10、e geneTissue inhibitor of matrix metalloproteinase 2 geneIL-10 IL13tumor necrosis factor geneHeme oxygenase 1 gene22SMOKINGAIR POLLUTIONEXPOSURESGENETICSOTHEREXACERBATIONSCAUSEEtiology23Cause 5 : OthersOther causes : Socioeconomic statusAir qualityCrowded roomMalnutritionHigh airway responsivenessLu

11、ng dysplasia, poor growth of lungsBirth factorsInfectious disease24SMOKINGAIR POLLUTIONEXPOSURESGENETICSOTHEREXACERBATIONSCAUSEEtiology25PATHOGENESIS261. Pathogenic change of lungSmokerNon-smokerSpecimens from the Small Airways in the Lung of a Nonsmoker and Smoker with COPD.Cosio MG et al. N Engl J

12、 Med 2009;360:2445-2454.27PathologyKey words : Air limitationChronic incompletely reversible poor airflow Air trappinginability to breathe out fully Emphysemabreakdown of lung tissueObstructive Bronchiolitissmall airways disease282. Immunologic pathologySethi S, Murphy TF. N Engl J Med 2008;359:2355

13、-2365.Overview of Innate Defense in the Human Respiratory Tract.292. Immunologic pathologySethi S, Murphy TF. N Engl J Med 2008;359:2355-2365.Overview of Innate Defense in the Human Respiratory Tract.302. Immunologic pathologySethi S, Murphy TF. N Engl J Med 2008;359:2355-2365.Overview of Innate Def

14、ense in the Human Respiratory Tract.312. Immunologic pathologyInitial Response to Cigarette Smoke Step 1 in the Process Leading to COPD.Cosio MG et al. N Engl J Med 2009;360:2445-2454.322. Immunologic pathologyCosio MG et al. N Engl J Med 2009;360:2445-2454.Proliferation of T Cells Step 2 in the Pro

15、cess Leading to COPD.33The Adaptive Immune Reaction Step 3 in the Process Leading to COPD.2. Immunologic pathologyCosio MG et al. N Engl J Med 2009;360:2445-2454.343. Current research stageNo evidenced cause-and-effect relationship between autoimmunity and COPD mechanismProposed bacterial or viral e

16、xacerbation modelInteractions between bacterial and viral exacerbationVicious-circle hypothesis of infection and inflammation of COPDAcute exacerbation from pre-existed chronic pulmonary disease355DIAGNOSIS36010203Diagnosis of COPDSpirometry CXR, CTArterial blood gas testCOPD37SpirometryMeasures the

17、 amount of airflow obstructionDetect COPD Evaluate severity Set treatment goalsExclude AsthmaHeart failureEtc.FEV1 / FVC38GOLD grade. Classification of severity of airflow limitaion in COPD (based on post-bronchodilator FEV1)SeverityFEV1% predictedMild (GOLD 1)80Moderate (GOLD 2)5079Severe (GOLD 3)3

18、049Very severe (GOLD 4)30 or chronic respiratory failureNote: FEV1/FVC 70%Spirometry39CXRChest X-ray (CXR)Over-expanded lungsA flattened diaphragmIncreased retrosternal airspaceBullae 40A severe case of bullous emphysema.A lateral chest x-ray of a person with emphysema.CXR41Axial CT image of the lun

19、g of a person with end-stage bullous emphysema.Computed tomography(CT)the distribution of emphysema CT42Modern blood gas analyzerArterial blood gas testAn arterial blood gas (ABG)Determine the need for oxygenpH of the bloodPartial pressure of carbon dioxide and oxygenBicarbonate levelConcentrations

20、of lactate, hemoglobin, several electrolytes, oxyhemoglobin, carboxyhemoglobin and methemoglobin 436MANAGEMENT44Management 01020304Lifestyle change MedicationOxygenSurgery45Lifestyle change 01 Quit smoking The most important step! Avoid lung irritantsSecondhand smoke DustFumesOther toxic substances46Lifestyle change 01 Pulmonary rehabilitationExercise programPursed lip breathingDisease managementNutritional and psychological counselingInhale Purse 4702Inhaled bronchodilators2 agonists Anticholinergics Corticosteroids MucolyticsAntibioticsVaccinesFlu shotsPneumoco