慢性阻塞性肺疾病copd讲课-新指南.ppt

* COPD patients suffer from reduced expiratory flow. As a result, the lungs may not fully empty before the next breath begins. This is particularly likely if the patient has to breathe faster as a result of physical activity.1 Because the lungs do not fully empty, they become progressively over inflated with each breath. This process is known as air trapping, which leads to hyperinflation.1 Air trapping reduces the ability of the patient to breathe in, which causes the sensation of breathlessness that typifies the disease. O'Donnell DE, Webb K. The etiology of dyspnea during exercise in COPD. Pulmonary and Critical Care Update 14, Lesson 15./downloads/education/online/Vol14_13_18.pdf. Accessed 24 February 2004. * New * 随着认识的深入，对于COPD的理解不再局限于气道和肺。关于COPD营养不良的研究越来越受到重视。并且，近年来国外文献里提出了一个新的概念，叫做COPD的全身效应（systemic effects），全身效应比营养不良更进了一步。这个概念包括营养不良，表现为体重下降、人体组成改变。全身效应还包括为全身炎症反应、和骨骼肌功能障碍等等，以及心血管、神经和骨骼系统改变等等。目前国际上关于COPD全身效应的研究非常多，从基础、到临床都做了广泛而深入的研究。 * * * * CAT：2009年应用 CCQ：2003年应用 CCQ: 有效性、可靠性和敏感性；对急性加重的预测 * Speaker notes Assessment of patients with COPD has revealed that they are at increased risk, relative to the general population, for a wide range of systemic comorbidities.1,2 These include cardiovascular conditions, such congestive heart failure (CHF), arrhythmias, and hypertension; metabolic diseases, such as diabetes; osteoporosis; increased risk for ulcers; malignancies; and depression.1-4 References Agusti AG, Noguera A, Sauleda J, Sala E, Pons J, Busquets X. Systemic effects of chronic obstructive pulmonary disease. Eur Respir J. 2003;21:347-360. Sevenoaks MJ, Stockley RA. Chronic Obstructive Pulmonary Disease, inflammation and co-morbidity--a common inflammatory phenotype? Respir Res. 2006;7:70-78. Luppi F, Franco F, Beghé B, Fabbri LM. Treatment of chronic obstructive pulmonary disease and its comorbidities. Proc Am Thorac Soc. 2008;5:848-856. Chatila WM, Thomashow BM, Minai OA, Criner GJ, Make BJ. Comorbidities in chronic obstructive pulmonary disease.