版copd全球策略教学幻灯 ppt课件.ppt
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1、 Global Initiative for Chronic Obstructive Lung Disease GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE (GOLD): TEACHING SLIDE SET 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 promotiona
2、l purposes requires approval from GOLD. lobal Initiative for Chronic bstructive ung isease G O L D Global Initiative for Chronic Obstructive Lung Disease GOLD Structure GOLD Board of Directors Roberto Rodriguez-Roisin, MD Chair Science Committee Jrgen Vestbo, MD - Chair Dissemination/Implementation
3、Committee Jean Bourbeau, MD - Chair GOLD Board of Directors: 2011 R. Rodriguez-Roisin, Chair, Spain A. Anzueto, U.S. ATS J. Bourbeau, Canada T. DeGuia, Philippines D. Hui, Hong Kong PRC F. Martinez, U.S. M. Mishima, Japan APSR D. Nugmanova, Kazakhstan WONCA A. Ramirez, Mexico ALAT R. Stockley, U.K.
4、J. Vestbo, Denmark, U.K. Observer: J. Wedzica, UK ERS GOLD Science Committee - 2011 Jrgen Vestbo, MD, Chair Alvar Agusti, MD Antonio Anzueto, MD Peter Barnes, MD Leonardo Fabbri, MD Paul Jones, MD Fernando Martinez, MD Masaharu Nishimura, MD Roberto Rodriguez-Roisin, MD Don Sin, MD Robert Stockley,
5、MD Claus Vogelmeier, MD Evidence Category Sources of Evidence A Randomized controlled trials (RCTs). Rich body of data B Randomized controlled trials (RCTs). Limited body of data C Nonrandomized trials Observational studies. D Panel consensus judgment Description of Levels of Evidence GOLD Structure
6、 GOLD Board of Directors Roberto Rodriguez-Roisin, MD Chair Science Committee Jrgen Vestbo, MD - Chair Dissemination/Implementation Task Group Jean Bourbeau, MD - Chair GOLD National Leaders - GNL United States United Kingdom Argentina Australia Brazil Austria Canada Chile Belgium China Denmark Colu
7、mbia Croatia Egypt Germany Greece Ireland Italy Syria Hong Kong ROC Japan Iceland India Korea Kyrgyzstan Uruguay Moldova Nepal Macedonia Malta Netherlands New Zealand Poland Norway Portugal Georgia Romania Russia Singapore Slovakia Slovenia Saudi Arabia South Africa Spain Sweden Thailand Switzerland
8、 Ukraine United Arab Emirates Taiwan ROC Venezuela Vietnam Peru Yugoslavia Albania Bangladesh France Mexico Turkey Czech Republic Pakistan Israel GOLD National Leaders Philippines Yeman Kazakhstan Mongolia GOLD Website Address http:/www.goldcopd.org lobal Initiative for Chronic bstructive ung isease
9、 G O L D Global Initiative for Chronic Obstructive Lung Disease GOLD Objectives nIncrease awareness of COPD among health professionals, health authorities, and the general public nImprove diagnosis, management and prevention nDecrease morbidity and mortality nStimulate research Global Strategy for D
10、iagnosis, Management and Prevention of COPD, 2011: Chapters nDefinition and Overview nDiagnosis and Assessment nTherapeutic Options nManage Stable COPD nManage Exacerbations nManage Comorbidities REVISED 2011 Global Strategy for Diagnosis, Management and Prevention of COPD, 2011: Chapters nDefinitio
11、n and Overview nDiagnosis and Assessment nTherapeutic Options nManage Stable COPD nManage Exacerbations nManage Comorbidities REVISED 2011 Global Strategy for Diagnosis, Management and Prevention of COPD Definition of COPD nCOPD, a common preventable and treatable disease, is characterized by persis
12、tent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. nExacerbations and comorbidities contribute to the overall severity in individual patients. Global Strategy for Diagnosis, Mana
13、gement and Prevention of COPD Mechanisms Underlying Airflow Limitation in COPD Small Airways Disease Airway inflammation Airway fibrosis, luminal plugs Increased airway resistance Parenchymal Destruction Loss of alveolar attachments Decrease of elastic recoil AIRFLOW LIMITATION Global Strategy for D
14、iagnosis, Management and Prevention of COPD Burden 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 to COPD risk factors and the aging of the worlds population. COPD is associated with signif
15、icant economic burden. Global Strategy for Diagnosis, Management and Prevention of COPD Risk Factors for COPD Lung growth and development Gender Age Respiratory infections Socioeconomic status Asthma/Bronchial hyperreactivity Chronic Bronchitis Genes Exposure to particles Tobacco smoke Occupational
16、dusts, organic and inorganic Indoor air pollution from heating and cooking with biomass in poorly ventilated dwellings Outdoor air pollution Global Strategy for Diagnosis, Management and Prevention of COPD Risk Factors for COPD GenesGenes InfectionsInfections Socio-economic Socio-economic statusstat
17、us Aging PopulationsAging Populations Global Strategy for Diagnosis, Management and Prevention of COPD, 2011: Chapters nDefinition and Overview nDiagnosis and Assessment nTherapeutic Options nManage Stable COPD nManage Exacerbations nManage Comorbidities REVISED 2011 Global Strategy for Diagnosis, M
18、anagement and Prevention of COPD Diagnosis and Assessment: Key Points A clinical diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease. Spirometry is required to make the diagnosis; the
19、presence of a post-bronchodilator FEV1/FVC 80% predicted GOLD 2: Moderate 50% 2 1 0 (C)(D) (A)(B) mMRC 0-1 CAT 2 CAT 10 Symptoms (mMRC or CAT score) Global Strategy for Diagnosis, Management and Prevention of COPD Combined Assessment of COPD (C)(D) (A)(B) mMRC 0-1 CAT 2 CAT 10 Symptoms (mMRC or CAT
20、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 COPD Combined Assessment of COPD Risk (GOLD Classification of Airflow Limitation) Risk (Exacerbation history) 2 1 0 (C)(D) (A)(B) mMRC 0-1 CAT 2 CAT 10 Symp
21、toms (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 Prevention of COPD Combined Assessment of COPD Ri
22、sk (GOLD Classification of Airflow Limitation) Risk (Exacerbation history) 2 1 0 (C)(D) (A)(B) mMRC 0-1 CAT 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 risk C: Less symptoms, high risk D: More Symtoms, high risk Use c
23、ombined assessment Global Strategy for Diagnosis, Management and Prevention of COPD Combined Assessment of COPD Risk (GOLD Classification of Airflow Limitation) Risk (Exacerbation history) 2 1 0 (C)(D) (A)(B) mMRC 0-1 CAT 2 CAT 10 Symptoms (mMRC or CAT score) PatientCharacteristicSpirometric Classif
24、ication Exacerbations per year mMRCCAT A Low Risk Less Symptoms GOLD 1-2 10-1 2 10 C High Risk Less Symptoms GOLD 3-4 20-1 2 2 10 Global Strategy for Diagnosis, Management and Prevention of COPD Combined Assessment of COPD When assessing risk, choose the highest risk according to GOLD grade or exace
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