《copd英文课》ppt课件.ppt
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1、Chronic Obstructive Pulmonary Disease (COPD),Guohua Zhen Tongji Hospital,Percent Change in Age-Adjusted Death Rates, U.S., 1965-1998,0,0.5,1.0,1.5,2.0,2.5,3.0,Proportion of 1965 Rate,1965 - 1998,1965 - 1998,1965 - 1998,1965 - 1998,1965 - 1998,59%,64%,35%,+163%,7%,Coronary Heart Disease,Stroke,Other
2、CVD,COPD,All Other Causes,Why COPD is Important ?,COPD is the only chronic disease that is showing progressive upward trend in both mortality and morbidity It is expected to be the third leading cause of death by 2020 Approximately 3% Chinese above 15 are currently suffering from COPD,Definition,COP
3、D is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.,R
4、elationship of COPD and Chronic bronchitis, Asthma or Emphysema,Chronic Bronchitis,Chronic Bronchitis,Definition: Chronic and unspecific inflammation of bronchi and the surrounding tissue. Feature: chronic mucus hypersecretion and cough. Morbidity: 3.2% in population over 15 y,up to 15% in elderly o
5、ver 50 y.,Etiology and mechanism,Environment Factors Cigarette smoking Occupational dusts and chemicals Infections Host Factors Genes Lung growth and defense mechanism,Chronic Bronchitis,Clinical manifestation,Character: chronic onset, recurrent attack and long course of disease Main symptoms: cough
6、: chronic, long term, repeatedly expectoration: mucoid sputum, purulent sputum when infection wheezing: seen in some patients,Clinical manifestation,Sign: 1. no obvious sign in early stage 2. sometimes moist rales and rhonchi,Examination,Chest x-ray imaging,Examination,Pulmonary function test: maybe
7、 normal in early stage. Gradually obstructive airway function appeared. Blood routine: elevated neutrophil or eosinophil Sputum examination: bacterial culture guide antibiotic treatment,Diagnosis,Chronic cough and sputum production for 3 consecutive months in at least 2 successive years(3m/y2y), exc
8、luding other chronic lung diseases (TB, Bronchiectasis ) Definite chest imaging or lung function,Typing,Typing : 1、simple:cough, sputum 2、wheezing:with wheezing (actually Chronic bronchitis plus asthma),Emphysema,Definition,Emphysema is characterized by enlargement and destruction of respiratory bro
9、nchioles and /or alveoli in the lungs.,Etiology,Environment Factors Cigarette smoking Occupational dusts and chemicals Infections Host Factors Genes: Alpha1-antitrypsin deficiency,Contributing factor,Airway obstruction due to chronic inflammation Damaged bronchial cartilage and lead to the loss of s
10、upporting function Increased activity of proteinase due to chronic airway inflammation or smoking Alpha1-antitrypsin deficiency Others: Poor nutrition of alveoli or respiratory bronchiole due to decreased blood supply because of oppression of high airway pressure,Cigarette smoke,Alveolar macrophage,
11、Neutrophil,PROTEASES,Alveolar wall destruction,(Emphysema),Mucus hypersecretion,(Chronic bronchitis),PROTEASE INHIBITORS,Neutrophil chemotactic factors,CELLULAR MECHANISMS OF COPD,Neutrophil elastase,Cathepsins,Matrix metalloproteinases,Cytokines (IL-8),Mediators (LTB4),?,CD8+,lymphocyte,-,MCP-1,1-A
12、ntitrypsin TIMPs SLPI Elafin,Neutrophil elastase Cathepsins MMP-1, MMP-9, MMP12 Granzymes, perforins Others,PROTEASE-ANTIPROTEASE IMBALANCE IN COPD,Pathology feature,Alveolar walls become thinner Alveolar sacs enlargement Rupture of alveoli and formation of bleb,Pathological Category,In panlobular e
13、mphysema, the enlargement and destruction of air space involve the acinus more or less uniformly.,In centrilobular emphysema, respiratory bronchioles are selectively and dominantly involved.,COPD - chronic bronchitis - emphysema,COPD Pathophysiology,Hypoventialtion- PaO2 , PaCO2 Airflow obstruction
14、/ airway narrowing mucus plugging airway inflammation, edema, fibrosis airway collapse due to alveolar wall destruction Hyperinflation: air trapping Gas exchange defects- PaO2 Destruction of alveolar wall/alveolar-capillary membrane V/Q mismatch (shunt),Clinical manifestation,Symptom 1. cough, sputu
15、m and/or wheezing 2. gradually progressive dyspnea, shortness of breath, chest tightness,Clinical manifestation,Sign: 1. not obvious in early stage 2. typical sign: barrel chest, decreased chest movement, diminished tactile fremitus, hyperresonance, decreased vesicular breath sound and prolong expir
16、ation or wheeze,Examination,Pulmonary function test Diagnosis Assessing severity Assessing prognosis Monitoring progression,Examination: pulmonary function test,Dynamic lung function airflow obstruction FEV1, FEV1/FVC Static lung function hyperinflation TLC, FRC air trapping RV,FEV1/FVC, FEV1 % pred
17、icted to estimate obstruction and severity。 Bronchodilator Reversibility Testing: to detect the reversibility, after bronchodilator, FEV1/FVC 40%,Examination: pulmonary function test,Chest X-ray: ECG: Blood gas:to detect respiratory failure. Blood routine and sputum examination:,Examination,Chest X-
18、ray,Intercostal space widening Diaphragm are low and flat Vascular marking deficiency Shadow of the heart narrowing,low, flat diaphragms, hyperlucency, vascular marking deficiency,Diagnosis,1、Smoking history 2、Symptom: cough, sputum production, gradually progressive dyspnea 3、Sign:emphysema 4、PFT: a
19、irway flow limitation,COPD classification based on pulmonary function test,Clinical Features of COPD Patients of different severity,Mild COPD: no abnormal signs, smokers cough, little or no breathlessness Moderate COPD: breathlessness with/without wheezing, cough with/without sputum Severe COPD: bre
20、athlessness on any exertion/at rest, wheeze and cough prominent, lung inflation usual, cyanosis, peripheral edema, and polycythemia in advanced disease,Stage of disease,Acute Exacerbations Stable,Acute exacerbation of COPD AE-COPD,“Exacerbation” of COPD Respiratory dyspnea / chest tightness cough /
21、sputum, purulent Systematic decreased activity, fatigue, headache, poor appetite, somnolence,Differential diagnosis,Bronchial asthma: reversibility of the airflow Bronchiectasis: especially mild patients, chronic cough and mucus sputum Pulmonary TB:positive anti-fast smear Bronchogenic carcinoma: Em
22、physema due to other cause: for compensation,Complications of COPD,Chronic respiratory failure Spontanous pneumothorax Cor pulmonale hypoxia, pedal edema, passive hepatic congestion.,Management of COPD,Prevent decline in FEV1 Reduce mortality Improve quality of life symptoms exercise tolerance exace
23、rbations Minimal side-effects,Goals,Non-pharmacologic Therapies,Adjustment Therapy & Education,Avoidance of Tobacco & Pollution,Vaccination,Nutrition,Lung Volume Reduction or Transplant,Exercise & Rehabilitation,COPD,Smoking cessation Physician intervention critical Multidisciplinary approach Withdr
24、awal anxiety, irritability, difficult concentrating, sleep disruption, fatigue, drowsiness, depression Nicotine replacement withdrawal symptoms nicotine gum (2 mg = cigarette) transdermal nicotine patches x 8 wks 20-40% / 6 mos vs 5-20% / 6 mos with placebo,Effects of Smoking and Smoking Cessation o
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