GOLD_英汉对照翻译_2011Dec30.ppt

1、 Global Initiative for Chronic Obstructive Lung Disease,2011版GOLD英汉对照教学幻灯 韩振军编译 December 2011,This slide set is restricted for academic and educational purposes only. Use of the slide set, or of individual slides, for commercial or promotional purposes requires approval from GOLD. 临泉县人民医院 呼吸科 韩振军编译，

2、仅供教学使用,lobal Initiative for Chronicbstructiveungisease,G OLD, Global Initiative for Chronic Obstructive Lung Disease,Description of Levels of Evidence,GOLD Website Address,,GOLD Objectives,Increase awareness of COPD among health professionals, health authorities, and the genera

3、l public提高医疗卫生工作者，官员，以及公众对COPD的认识。 Improve diagnosis, management and prevention改善提高COPD的诊断、治疗、预防 Decrease morbidity and mortality减少罹患率、死亡率 Stimulate research激励研究,Global Strategy for Diagnosis, Management and Prevention of COPD, 2011: Chapters,Definition and Overview Diagnosis and Assessment Therapeu

4、tic Options Manage Stable COPD Manage Exacerbations Manage Comorbidities,REVISED 2011,Global Strategy for Diagnosis, Management and Prevention of COPD, 2011: Chapters,Definition and Overview Diagnosis and Assessment Therapeutic Options Manage Stable COPD Manage Exacerbations Manage Comorbidities,REV

5、ISED 2011,Global Strategy for Diagnosis, Management and Prevention of COPD Definition of COPD,COPD, a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways a

6、nd the lung to noxious particles or gases.（与既往定义同）COPD是一种可防可治的常见疾病。并以持久存在的、不断加重的气流受限为特征。气流受限的进展与肺及气道对有害气体、颗粒不断增强的慢性炎症反应有关。 Exacerbations and comorbidities contribute to the overall severity in individual patients.急性加重与合并症是病人整体健康状况的最大威胁。,Global Strategy for Diagnosis, Management and Prevention of COP

7、D Mechanisms Underlying Airflow Limitation in COPD,AIRFLOW LIMITATION,Global Strategy for Diagnosis, Management and Prevention of COPDBurden of COPD,COPD is a leading cause of morbidity and mortality worldwide. The burden of COPD is projected to increase in coming decades due to continued exposure t

8、o COPD risk factors and the aging of the worlds population. COPD is associated with significant economic burden.,Global Strategy for Diagnosis, Management and Prevention of COPD Risk Factors for COPD,Lung growth and development肺的生物自然过程 Gender性别 Age 年龄 Respiratory infections呼吸系统感染 Socioeconomic statu

9、s社会经济地位 Asthma/Bronchial hyperreactivity哮喘/气道高反应性 Chronic Bronchitis慢性支气管炎,Genes遗传因素 Exposure to particles粉尘暴露 Tobacco smoke吸烟 Occupational dusts, organic and inorganic有机、无机职业粉尘 Indoor air pollution from heating and cooking with biomass in poorly ventilated dwellings室内空气污染（尤其是在通风不良的室内燃烧生物燃料做饭） Outdo

10、or air pollution室外空气污染,Global Strategy for Diagnosis, Management and Prevention of COPD Risk Factors for COPD,Genes,Infections,Socio-economic status,Aging Populations,Global Strategy for Diagnosis, Management and Prevention of COPD, 2011: Chapters,Definition and Overview Diagnosis and Assessment The

11、rapeutic Options Manage Stable COPD Manage Exacerbations Manage Comorbidities,REVISED 2011,Global Strategy for Diagnosis, Management and Prevention of COPDDiagnosis and Assessment: Key Points,A clinical diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum pr

12、oduction, and/or a history of exposure to risk factors for the disease.临床诊断COPD条件：呼吸困难、咳嗽、咳痰，以及危险因素的暴露史 Spirometry is required to make the diagnosis; the presence of a post-bronchodilator FEV1/FVC 0.70 confirms the presence of persistent airflow limitation and thus of COPD. 肺通气功能检查是必须的！吸入支气管扩张剂后FEV1

13、/FVC 0.70 说明气流受限，可诊断之。,Global Strategy for Diagnosis, Management and Prevention of COPDDiagnosis and Assessment: Key Points,The goals of COPD assessment are to determine the severity of the disease, including the severity of airflow limitation, the impact on the patients health status, and the risk

14、of future events. 对COPD评估的目的是确定疾病的严重程度，包括1，气流受限的程度 ；2，对病人整体健康状况的影响；3，发生事件的危险系数。 Comorbidities occur frequently in COPD patients, and should be actively looked for and treated appropriately if present. 合并症在COPD病人中发生频率很高，只要存在，就应当高度关注，并且积极处置这些合并症。,SYMPTOMS,chronic cough,shortness of breath,EXPOSURE TO

15、RISK FACTORS,tobacco,occupation,indoor/outdoor pollution,SPIROMETRY: Required to establish diagnosis,Global Strategy for Diagnosis, Management and Prevention of COPD Diagnosis of COPD,sputum,Global Strategy for Diagnosis, Management and Prevention of COPDAssessment of Airflow Limitation: Spirometry,

16、Spirometry should be performed after the administration of an adequate dose of a short-acting inhaled bronchodilator to minimize variability.通气功能检查应在吸入足够剂量的短效支气管扩张剂后进行，以便减少检查结果的差异。 A post-bronchodilator FEV1/FVC 0.70 confirms the presence of airflow limitation.吸入支气管扩张剂后 FEV1/FVC 0.70 即可确定气流受限存在 Wher

17、e possible, values should be compared to age-related normal values to avoid overdiagnosis of COPD in the elderly.测定值还应该做年龄相关正常值的比照，避免对老年人的作出COPD的过度诊断。,Spirometry: Normal Trace Showing FEV1 and FVC,1,2,3,4,5,6,1,2,3,4,Volume, liters,Time, sec,FVC,5,1,FEV1 = 4L FVC = 5L FEV1/FVC = 0.8,Spirometry: Obst

18、ructive Disease,Volume, liters,Time, seconds,5,4,3,2,1,1,2,3,4,5,6,FEV1 = 1.8L FVC = 3.2L FEV1/FVC = 0.56,Normal,Obstructive,Determine the severity of the disease, its impact on the patients health status and the risk of future events (for example exacerbations) to guide therapy. Consider the follow

19、ing aspects of the disease separately:确定疾病的严重程度，以便指导治疗。因为它影响患者整体健康状况和可能发生进一步事件（如急性加重）的风险。主要从一下几个方面评估： current level of patients symptoms 当前症状的严重程度。 severity of the spirometric abnormality通气功能的异常程度。 frequency of exacerbations 急性加重发生的频率。 presence of comorbidities. 合并症的存在与否。,Global Strategy for Diagnos

20、is, Management and Prevention of COPD Assessment of COPD: Goals,Global Strategy for Diagnosis, Management and Prevention of COPDAssessment of COPD,Assess symptoms 1，评估症状。 Assess degree of airflow limitation using spirometry 2，评估气流受限程度（即通气功能检查） Assess risk of exacerbations 3，评估急性加重的风险。 Assess comorbi

21、dities 4，评估合并疾病情况。,The characteristic symptoms of COPD are chronic and progressive dyspnea, cough, and sputum production. COPD的特征性症状是慢性、进行性的呼吸困难，咳嗽，咳痰。 Dyspnea: Progressive, persistent and characteristically worse with exercise.呼吸困难：进行性，持续性，并以活动时加重为特征。 Chronic cough: May be intermittent and may be u

22、nproductive.慢性咳嗽：可以是间歇的，断断续续的，也可能不出现。 Chronic sputum production: COPD patients commonly cough up sputum. 慢性咳痰：COPD患者咳痰是常见的。,Global Strategy for Diagnosis, Management and Prevention of COPDSymptoms of COPD,Assess symptoms Assess degree of airflow limitation using spirometry Assess risk of exacerbatio

23、ns Assess comorbidities,Use the COPD Assessment Test(CAT) or mMRC Breathlessness scale,Global Strategy for Diagnosis, Management and Prevention of COPDAssessment of COPD,COPD Assessment Test (CAT): An 8-item measure of health status impairment in COPD (). Breathlessness Measurem

24、ent using the Modified British Medical Research Council (mMRC) Questionnaire: relates well to other measures of health status and predicts future mortality risk.,Global Strategy for Diagnosis, Management and Prevention of COPDAssessment of Symptoms,Global Strategy for Diagnosis, Management and Preve

25、ntion of COPDModified MRC (mMRC)Questionnaire,英国医学研究会改良呼吸困难量表(the Modified British Medical Research Council (mMRC) Questionnaire )韩振军翻译 Please tick in the box that applies to you (one box only) 根据你的情况在下表中作标记（只能标记一个） Grade 0. I only get breathless with strenuous exercise.( ) 0分：我仅仅在剧烈运动时才出现呼吸困难。( ) G

26、rade 1. I get short of breath when hurrying on the level or walking up a slight hill. ( ) 1分：我只是在快步走或者爬坡时出现呼吸困难。 ( ) Grade 2. I walk slower than people of the same age on the level because of breathlessness, or I have to stop for breath when walking on my own pace on the level.( ) 2分：我因为呼吸困难比同龄人走得慢，

27、或者按正常人速度行走时我必须停下来喘息。 ( ) Grade 3. I stop for breath after walking about 100 meters or after a few minutes on the level.( ) 3分：我行走几分钟后或者100米就出现呼吸困难。 ( ) Grade 4. I am too breathless to leave the house or I am breathless when dressing or undressing.( ) 4分：因为呼吸困难我无法离开房间，或者穿衣脱衣时就出现呼吸困难。 ( ),慢阻肺评估测试表（CAT

28、） the COPD Assessment Test(CAT) 韩振军编译修订,Assess symptoms Assess degree of airflow limitation using spirometry Assess risk of exacerbations Assess comorbidities,Use spirometry for grading severity according to spirometry, using four grades split at 80%, 50% and 30% of predicted value,Global Strategy f

29、or Diagnosis, Management and Prevention of COPDAssessment of COPD,Global Strategy for Diagnosis, Management and Prevention of COPDClassification of Severity of Airflow Limitation in COPD*,In patients with FEV1/FVC 80% predicted GOLD 2: Moderate 50% FEV1 80% predicted GOLD 3: Severe 30% FEV1 50% pred

30、icted GOLD 4: Very Severe FEV1 30% predicted *Based on Post-Bronchodilator FEV1,Assess symptoms Assess degree of airflow limitation using spirometry Assess risk of exacerbations Assess comorbidities,Use history of exacerbations and spirometry. Two exacerbations or more within the last year or an FEV

31、1 50 % of predicted value are indicators of high risk,Global Strategy for Diagnosis, Management and Prevention of COPDAssessment of COPD,Global Strategy for Diagnosis, Management and Prevention of COPDAssess Risk of Exacerbations,To assess risk of exacerbations use history of exacerbations and spiro

32、metry: 评估急性加重的风险是通过急性加重的病史和通气功能： Two or more exacerbations within the last year or an FEV1 50 % of predicted value are indicators of high risk.一年内2次/2次以上急性加重病史，或者 FEV1 50 % 预测值即为高风险。,Global Strategy for Diagnosis, Management and Prevention of COPDCombined Assessment of COPD从三个方面综合评估COPD（CAC）,Assess

33、symptoms评估症状 Assess degree of airflow limitation using spirometry评估气流受限程度 Assess risk of exacerbations评估急性加重的风险 Combine these assessments for the purpose of improving management of COPD 综合这些评估结果的目的是： 提高COPD的治疗,Global Strategy for Diagnosis, Management and Prevention of COPDCombined Assessment of COP

34、D,Risk (GOLD Classification of Airflow Limitation),Risk (Exacerbation history), 2,1,0,(C),(D),(A),(B),mMRC 0-1 CAT 10,4,3,2,1,mMRC 2 CAT 10,Symptoms (mMRC or CAT score),Global Strategy for Diagnosis, Management and Prevention of COPDCombined Assessment of COPD,(C),(D),(A),(B),mMRC 0-1 CAT 10,mMRC 2

35、CAT 10,Symptoms (mMRC or CAT score),If mMRC 0-1 or CAT 2 or CAT 10: More Symptoms (B or D),Assess symptoms first,Global Strategy for Diagnosis, Management and Prevention of COPDCombined Assessment of COPD,Risk (GOLD Classification of Airflow Limitation),Risk (Exacerbation history), 2,1,0,(C),(D),(A)

36、,(B),mMRC 0-1 CAT 10,4,3,2,1,mMRC 2 CAT 10,Symptoms (mMRC or CAT score),If GOLD 1 or 2 and only 0 or 1 exacerbations per year: Low Risk (A or B) If GOLD 3 or 4 or two or more exacerbations per year: High Risk (C or D),Assess risk of exacerbations next,Global Strategy for Diagnosis, Management and Pr

37、evention of COPDCombined Assessment of COPD,Risk (GOLD Classification of Airflow Limitation),Risk (Exacerbation history), 2,1,0,(C),(D),(A),(B),mMRC 0-1 CAT 10,4,3,2,1,mMRC 2 CAT 10,Symptoms (mMRC or CAT score),Patient is now in one of four categories: A: Les symptoms, low risk B: More symtoms, low

38、risk C: Less symptoms, high risk D: More Symtoms, high risk,Use combined assessment,Global Strategy for Diagnosis, Management and Prevention of COPDCombined Assessment of COPD,Risk (GOLD Classification of Airflow Limitation),Risk (Exacerbation history), 2,1,0,(C),(D),(A),(B),mMRC 0-1 CAT 10,4,3,2,1,

39、mMRC 2 CAT 10,Symptoms (mMRC or CAT score),Global Strategy for Diagnosis, Management and Prevention of COPDCombined Assessment of COPD,When assessing risk, choose the highest risk according to GOLD grade or exacerbation history,Global Strategy for Diagnosis, Management and Prevention of COPDAssess C

40、OPD Comorbidities,COPD patients are at increased risk for: COPD患者增加了罹患下列疾病的风险： Cardiovascular diseases 心血管疾病 Osteoporosis 骨质疏松症 Respiratory infections 呼吸系统感染 Anxiety and Depression 焦虑和抑郁 Diabetes 糖尿病 Lung cancer 肺癌 These comorbid conditions may influence mortality and hospitalizations and should be

41、looked for routinely, and treated appropriately. 这些合并症可以影响COPD病人的死亡率、住院时间，应该予以常规检查，恰当治疗。,Global Strategy for Diagnosis, Management and Prevention of COPDDifferential Diagnosis: COPD and Asthma,Global Strategy for Diagnosis, Management and Prevention of COPDAdditional Investigations,Chest X-ray: Seld

42、om diagnostic but valuable to exclude alternative diagnoses and establish presence of significant comorbidities. 胸部 X-ray：虽然诊断价值少，但有排除诊断的价值，并能发现一些合并症 Lung Volumes and Diffusing Capacity: Help to characterize severity, but not essential to patient management.肺容量及弥散功能：对于病人治疗不是必须的。 Oximetry and Arteria

43、l Blood Gases: Pulse oximetry can be used to evaluate a patients oxygen saturation and need for supplemental oxygen therapy. 血氧定量和动脉血气分析： 脉冲式血氧测定可以评估患者血氧饱和度，决定氧疗与否。 Alpha-1 Antitrypsin Deficiency Screening: Perform when COPD develops in patients of Caucasian descent under 45 years or with a strong f

44、amily history of COPD.仅用于45岁以下原因不明及明显COPD家族史的患者。（中国不常见）,Exercise Testing: Objectively measured exercise impairment, assessed by a reduction in self-paced walking distance (such as the 6 min walking test) or during incremental exercise testing in a laboratory, is a powerful indicator of health status

45、 impairment and predictor of prognosis.运动试验：参阅6分钟步行测试相关内容 Composite Scores: Several variables (FEV1, exercise tolerance assessed by walking distance or peak oxygen consumption, weight loss and reduction in the arterial oxygen tension) identify patients at increased risk for mortality. 综合评分，见前述,Globa

46、l Strategy for Diagnosis, Management and Prevention of COPDAdditional Investigations,Global Strategy for Diagnosis, Management and Prevention of COPD, 2011: Chapters,Definition and Overview Diagnosis and Assessment Therapeutic Options Manage Stable COPD Manage Exacerbations Manage Comorbidities,REVI

47、SED 2011,Global Strategy for Diagnosis, Management and Prevention of COPDTherapeutic Options: Key Points,Smoking cessation has the greatest capacity to influence the natural history of COPD. Health care providers should encourage all patients who smoke to quit. 戒烟是对COPD自然过程干预最强的措施。应该鼓励所有病人戒烟。 Pharma

48、cotherapy and nicotine replacement reliably increase long-term smoking abstinence rates.药物疗法和尼古丁替代品确实能增加长期吸烟者的戒除效率。 All COPD patients benefit from regular physical activity and should repeatedly be encouraged to remain active.所有COPD患者都得益于规律的体育锻炼，应该予以鼓励。,Appropriate pharmacologic therapy can reduce C

49、OPD symptoms, reduce the frequency and severity of exacerbations, and improve health status and exercise tolerance. 恰当的药物治疗能减轻COPD的症状，减少急性加重发生的频率和强度，提高整体健康状况，增加运动耐量。 None of the existing medications for COPD has been shown conclusively to modify the long-term decline in lung function.目前没有任何一种药物能够缩短C

50、OPD的病程，缓解肺功能的衰退。 Influenza and pneumococcal vaccination should be offered depending on local guidelines.根据当地的指南，可以提供流感疫苗、肺炎球菌疫苗的接种。,Global Strategy for Diagnosis, Management and Prevention of COPDTherapeutic Options: Key Points,Global Strategy for Diagnosis, Management and Prevention of COPDTherapeu

51、tic Options: Smoking Cessation,Counseling delivered by physicians and other health professionals significantly increases quit rates over self-initiated strategies. Even a brief (3-minute) period of counseling to urge a smoker to quit results in smoking quit rates of 5-10%. 与主动戒烟相比，通过咨询医生及其他卫生工作者能大大提

52、高戒烟效率。甚至短期（3分钟）敦促的戒烟达到5-10%！ Nicotine replacement therapy (nicotine gum, inhaler, nasal spray, transdermal patch, sublingual tablet, or lozenge) as well as pharmacotherapy with varenicline, bupropion, and nortriptyline reliably increases long-term smoking abstinence rates and are significantly more

53、effective than placebo.尼古丁替代品（尼古丁口香糖等等）和药物疗法（ varenicline, bupropion, and nortriptyline）确实能增加长期吸烟者的戒除效率，显著优于安慰剂。,Brief Strategies to Help the Patient Willing to Quit Smoking,ASK 询问Systematically identify all tobacco users at every visit通过询问每个来访者，确认吸烟者 ADVISE 劝告 Strongly urge all tobacco users to qui

54、t强烈 敦促吸烟者戒烟 ASSESS评价 Determine willingness to make a quit attempt评价是否乐意戒烟 ASSIST帮助Aid the patient in quitting帮助病人戒烟 ARRANGE安排Schedule follow-up contact.安排好随访联系,Global Strategy for Diagnosis, Management and Prevention of COPDTherapeutic Options: Risk Reduction,Encourage comprehensive tobacco-control

55、policies with clear, consistent, and repeated nonsmoking messages. 鼓励制定清晰持久无烟的综合控烟措施 Emphasize primary prevention, best achieved by elimination or reduction of exposures in the workplace. Secondary prevention, achieved through surveillance and early detection, is also important.应该强调，一级预防最好的是消除或者减少工作

56、环境的职业暴露，其次是监测。 Reduce or avoid indoor air pollution from biomass fuel, burned for cooking and heating in poorly ventilated dwellings. 减少或者避免因生物燃料造成的室内空气污染。 Advise patients to monitor public announcements of air quality and, depending on the severity of their disease, avoid vigorous exercise outdoors

57、 or stay indoors during pollution episodes.劝告病人关注公共空气质量报告，依据自己的病情，在空气污染期间，避免室外锻炼，尽量留在室内。,Global Strategy for Diagnosis, Management and Prevention of COPDTherapeutic Options: COPD Medications,Bronchodilator medications are central to the symptomatic management of COPD.控制COPD症状核心药物是支气管扩张剂 Bronchodilat

58、ors are prescribed on an as-needed or on a regular basis to prevent or reduce symptoms. 该类药物可作为必要时，也可以作为基础的规律用药，预防和减少症状 The principal bronchodilator treatments are beta2-agonists, anticholinergics, theophylline or combination therapy.主要的药物是2受体激动剂，抗胆碱类，茶碱类，以及联合应用 The choice of treatment depends on th

59、e availability of medications and each patients individual response in terms of symptom relief and side effects.治疗的选择依据药物的效价和病人症状，可能的副作用等等。,Global Strategy for Diagnosis, Management and Prevention of COPDTherapeutic Options: Bronchodilators,Long-acting inhaled bronchodilators are convenient and more effective for symptom relief than short-acting bronchodilators. 与短效支气管扩张剂相比，长效制剂（吸入）对于解除症状来说，更有效，更便利 Long-acting inhaled bronchodilators reduce