--英文精品课件ChronicObstructive Pulmonary Disease and Asthma
合集下载
英文精品课件ChronicObstructivepulmonaryDisease33p
Hypertrophy and hyperplasia of mucus secreting glands secretions
Chemoattractant, upregulation of adhesion molecules neutrophil sequestration in lungs
expression of pro-inflammatory mediators: IL-8, NF-B recruitment of N, B, E and T lymphocytes
hyperreactivity.
Def: Emphysema
Permanent abnormal distention of air spaces distal to the terminal bronchiole with destruction of alveolar septa (containing alveolar capillaries) and attachments to the bronchial walls.
the p53 gene locus epithelial dysplasia and lung cancer
ciliary function retained secretions; airway resistance vagal-mediated smooth muscle contraction
Effects of smoking -2
levels of myeloperoxidase and eosinophilic cationic
protein bronchoconstriction
levels of TGF- (transforming growth factor)
Chemoattractant, upregulation of adhesion molecules neutrophil sequestration in lungs
expression of pro-inflammatory mediators: IL-8, NF-B recruitment of N, B, E and T lymphocytes
hyperreactivity.
Def: Emphysema
Permanent abnormal distention of air spaces distal to the terminal bronchiole with destruction of alveolar septa (containing alveolar capillaries) and attachments to the bronchial walls.
the p53 gene locus epithelial dysplasia and lung cancer
ciliary function retained secretions; airway resistance vagal-mediated smooth muscle contraction
Effects of smoking -2
levels of myeloperoxidase and eosinophilic cationic
protein bronchoconstriction
levels of TGF- (transforming growth factor)
慢性阻塞性肺疾病ChronicObstructivePulmonaryDisease,COPDPPT课件
1．第一秒用力呼气容积占用力肺活量百分比（FEV1/FVC）是评价 气流受限的一项敏感指标。第一秒用力呼气容积占预计值百分比 （FEV1％预计值），是评估COPD严重程度的良好指标，其变 异性小，易于操作。吸入支气管舒张药后FEV1/FVC<70％及 FEV1<80％预计值者，可确定为持续的气流受限。
慢性阻塞性肺疾病
Chronic Obstructive Pulmonary Disease，COPD
1
❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖
内容提要
预治并鉴稳诊辅临病病发病现定 防疗发别定断助床理理病因状义
症诊期 检表生 机 断程 查现理 制 度 评 估
2
定义
❖ 慢性阻塞性肺疾病：简称慢阻肺，是一种常见的、 可以预防及治疗的疾病，其特征是持续存在的呼吸 系统症状和气流受限，通常与显著暴露于有害颗粒 或气体引起的气道和（或）肺泡异常有关。肺功能 检查对确定气流受限有重要意义，在吸入支气管扩 张剂后，第一秒用力呼气容积（FEV1）占用力肺活 量（FVC）之比值（FEV1/FVC）＜70%表明存在 持续性气流受限。
4
5
现状——认识情况
❖ 我国慢阻肺知晓率及肺功能检查普及率极低。研究 的受访者中，仅约 10% 知道慢阻肺这一疾病；不 足 10% 的受访者曾接受过肺功能检查。在所有慢 阻肺患者中，不足 3% 知道自己患有慢阻肺；近 90% 此前从未得到明确诊断。特别需要引起关注的 是，60% 的慢阻肺患者没有明显的咳嗽、咳痰、喘 息等症状，说明普及肺功能检查对实现慢阻肺早诊 早治的重要性。
6
病因
❖ 慢性阻塞性肺病的确切病因不清楚，一般认 为与慢支和阻塞性肺气肿发生有关的因素都 可能参与慢性阻塞性肺病的发病。已经发现 的危险因素大致可以分为外因（即环境因素） 与内因（即个体易患因素）两类。
慢性阻塞性肺疾病
Chronic Obstructive Pulmonary Disease，COPD
1
❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖
内容提要
预治并鉴稳诊辅临病病发病现定 防疗发别定断助床理理病因状义
症诊期 检表生 机 断程 查现理 制 度 评 估
2
定义
❖ 慢性阻塞性肺疾病：简称慢阻肺，是一种常见的、 可以预防及治疗的疾病，其特征是持续存在的呼吸 系统症状和气流受限，通常与显著暴露于有害颗粒 或气体引起的气道和（或）肺泡异常有关。肺功能 检查对确定气流受限有重要意义，在吸入支气管扩 张剂后，第一秒用力呼气容积（FEV1）占用力肺活 量（FVC）之比值（FEV1/FVC）＜70%表明存在 持续性气流受限。
4
5
现状——认识情况
❖ 我国慢阻肺知晓率及肺功能检查普及率极低。研究 的受访者中，仅约 10% 知道慢阻肺这一疾病；不 足 10% 的受访者曾接受过肺功能检查。在所有慢 阻肺患者中，不足 3% 知道自己患有慢阻肺；近 90% 此前从未得到明确诊断。特别需要引起关注的 是，60% 的慢阻肺患者没有明显的咳嗽、咳痰、喘 息等症状，说明普及肺功能检查对实现慢阻肺早诊 早治的重要性。
6
病因
❖ 慢性阻塞性肺病的确切病因不清楚，一般认 为与慢支和阻塞性肺气肿发生有关的因素都 可能参与慢性阻塞性肺病的发病。已经发现 的危险因素大致可以分为外因（即环境因素） 与内因（即个体易患因素）两类。
【COPD英文PPT课件】Chronic Obstructive Pulmonary Disease (32p)
More on Diagnosis
• Physical examination findings are not sensitive for the initial diagnosis of COPD
– Many patients have normal examination findings
• 10 million adults in the United States have been diagnosed with COPD
• National Health and Nutrition Examination Survey (NHANES) suggests that roughly 10 percent of the adult U.S. population has evidence of impaired lung function consistent with COPD
• Although the diagnosis of COPD is often overlooked in both populations, it is diagnosed even less in women than in men
How is it Diagnosed?
• Clinical suspicion in patients presenting with any of the hallmark symptoms which is then confirmed by spirometry. – Cough, ↑’ed sputum production, and dyspnea – Especially in patients with a smoking history
【COPD英文精品课件】CHRONIC OBSTRUCTIVE PULMONARY DISEASE (35p)_
Emphysema = Pink Puffer !
Gross Pathological Changes of Emphysema
Microscopic Changes of Emphysema
COPD I: DIAGNOSIS
ASTHMA: A chronic inflammatory disorder of the tracheobronchial tree, many cells and cellular elements play a role, leading to airway hyperreactivity and reversible airflow limitation. IMPLICATION: airway can return to normal between attacks or with treatment BUT in chronic asthma a condition similar to COPD can develop with irreversibility and progression of the airflow limitation.
EMPHYSEMA: Abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction (lack of uniformity in the pattern of airspace enlargement; the orderly appearance of the acinus and its components is disturbed and may be lost) of their walls and without obvious fibrosis.
【COPD英文精品课件】Patient Empowerment in Chronic Obstructive Pulmonary Disease (COPD)
COPD is currently the 4th leading cause of death
By 2020 expected to rank 5th as a world wide burden of disease
Local Impact
50 practices in North and West Belfast 6 practices involved in the project Total number of patients-19,524 patients Patients on the COPD register-598 patients 75% of patients not diagnosed
Aims
To initiate change in practice using evidence based guidelines and protocols
Implement a well researched and planned pilot study
Provide a seamless carepathway between primary and secondary care from diagnosis to palliation
management and optimal treatment
Education Package
Disease / Symptom and anxiety management Exacerbation management Self management plan Smoking cessation /energy conservation/breathing
management advice Importance of referrals for holistic management
By 2020 expected to rank 5th as a world wide burden of disease
Local Impact
50 practices in North and West Belfast 6 practices involved in the project Total number of patients-19,524 patients Patients on the COPD register-598 patients 75% of patients not diagnosed
Aims
To initiate change in practice using evidence based guidelines and protocols
Implement a well researched and planned pilot study
Provide a seamless carepathway between primary and secondary care from diagnosis to palliation
management and optimal treatment
Education Package
Disease / Symptom and anxiety management Exacerbation management Self management plan Smoking cessation /energy conservation/breathing
management advice Importance of referrals for holistic management
--英文PPT课件ChronicObstructive Pulmonary Disease and Asthma
capacity
(West: Textbook of Physiology)
Hypoxic Pulmonary Vasoconstriction
u The lung regulates blood flow
100
90
according to its oxygen content
Emphysema---a pathologic definition:
“abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of their walls”
• Since 1987, the prevalence of COPD among women has been significantly higher than that among men
*Age-adjusted to 2000 US population. †Represents a statistically significant difference from rate among males.
Prevalence of COPD in the US
Rate/1,000 Population*
90
80 70
†
† †††
†
† †
†
† †
†
†
†
†
60
50
male
10
Total
0
1980
1982
1984
1986
1988 1990
Year
1992
【COPD英文精品课件】Chronic Obstructive pulmonary Disease (33p)
Epidemiology of COPD
30% of smokers develop COPD 20% of adult males have COPD 15% of COPD patients are severely symptomatic 4 th leading cause of death (USA) Mortality rate still rising prevalence in low birth weight and low
COPD
SS Visser, Pulmonology Internal Medicine UP
Def: Emphysema
Permanent abnormal distention of air spaces distal to the terminal bronchiole with destruction of alveolar septa (containing alveolar capillaries) and attachments to the bronchial walls.
Hypertrophy and hyperplasia of mucus secreting glands secretions
Pathogenesis-3
Air pollution exacerbations of CB related to heavy pollution with SO2 and NO2
the p53 gene locus epithelial dysplasia and lung cancer
ciliary function retained secretions; airway resistance vagal-mediated smooth muscle coБайду номын сангаасtraction
英文PPT课件ChronicObstructivePulmonaryDisease32p
• The pathological hallmarks of chronic bronchitis are congestion of the bronchial mucosa and a prominent increase in the number and size of the bronchial mucus glands. Copious mucus may be seen within airway lumens. The terminal airways are most susceptible to obstruction by mucus.
MECHANISMS II
Increases in RBC, Blood viscosity, BP Ventilation / Perfusion imbalances Hypoxemia Carbon dioxide retention Bronchial hyperreactivity Hyperinflation
Bronchial glands / cells inflame Increased secretions
Inflammation spreads to smooth muscle (bronchiole) Airway obstruction, decreased ciliary action Air trapping / Collapse of small airways Further air trapping Hyperventilation Increased pressure in airways Weakened airway walls / wall destruction Alveolar destruction Overstressed right ventricle
MECHANISMS II
Increases in RBC, Blood viscosity, BP Ventilation / Perfusion imbalances Hypoxemia Carbon dioxide retention Bronchial hyperreactivity Hyperinflation
Bronchial glands / cells inflame Increased secretions
Inflammation spreads to smooth muscle (bronchiole) Airway obstruction, decreased ciliary action Air trapping / Collapse of small airways Further air trapping Hyperventilation Increased pressure in airways Weakened airway walls / wall destruction Alveolar destruction Overstressed right ventricle
--英文PPT课件ChronicObstructive Pulmonary Disease (32p)
• Without symptoms many patients will not seek medical attention and therefore disease can progress before diagnosis or treatment
Epidemiologically Speaking
Who else is at risk for getting COPD?
• People of advancing age • Those exposed to
secondhand smoke • Chronic exposure to
environmental or occupational pollutants • Alpha1-antitrypsin deficiency (typically early) • Childhood history of recurrent respiratory infections • Family history of COPD
Who gets COPD?
• Smokers • Smokers • Smokers • More than 80 percent of deaths from the disease
are directly attributable to smoking, and persons who smoke are 12 to 13 times more likely to die from COPD than nonsmokers. • The absolute risk of COPD among active, continuous smokers is at least 25 percent
– Emphysema: pathologic term used to describe destruction of the alveolar capillary membrane
Epidemiologically Speaking
Who else is at risk for getting COPD?
• People of advancing age • Those exposed to
secondhand smoke • Chronic exposure to
environmental or occupational pollutants • Alpha1-antitrypsin deficiency (typically early) • Childhood history of recurrent respiratory infections • Family history of COPD
Who gets COPD?
• Smokers • Smokers • Smokers • More than 80 percent of deaths from the disease
are directly attributable to smoking, and persons who smoke are 12 to 13 times more likely to die from COPD than nonsmokers. • The absolute risk of COPD among active, continuous smokers is at least 25 percent
– Emphysema: pathologic term used to describe destruction of the alveolar capillary membrane
【COPD英文PPT课件】Chronic obstructive pulmonary disease (COPD)_
Evidence guiding health care
Methodology:
• Fiscal year 2006/07 • Cohort = Ontarians (derived from the Registered Persons
Database [RPDB]) • EDC algorithm applied to Canadian Institute for Health
• Prevalence rates for other chronic conditions (diabetes, asthma, cancer, congestive heart failure and hypertension) not reported using the ACG System already being measured, or will be measured in the near future, using validated algorithms developed by ICES and Cancer Care Ontario.
• Exclusions: Persons less than 20 years of age (less than 35 years of age for calculation of COPD rates) Out-of-province residents Records with missing/invalid age, sex, and/or LHIN information Individuals who died or whose date of last contact with the health care system was greater than 5 years
Methodology:
• Fiscal year 2006/07 • Cohort = Ontarians (derived from the Registered Persons
Database [RPDB]) • EDC algorithm applied to Canadian Institute for Health
• Prevalence rates for other chronic conditions (diabetes, asthma, cancer, congestive heart failure and hypertension) not reported using the ACG System already being measured, or will be measured in the near future, using validated algorithms developed by ICES and Cancer Care Ontario.
• Exclusions: Persons less than 20 years of age (less than 35 years of age for calculation of COPD rates) Out-of-province residents Records with missing/invalid age, sex, and/or LHIN information Individuals who died or whose date of last contact with the health care system was greater than 5 years
【COPD英文精品课件】OBSTRUCTIVE PULMONARY DISEASE
The only two available treatment options that have been proven to achieve the aims of treatment are smoking cessation and long-term oxygen therapy in severe COPD
and expensive treatments are often needed. The indirect economic costs of COPD are also significant and include
lost years of life, disability, loss of working capacity, and reduction in
The main aim of COPD management is to achieve and maintain control of the disease. This includes improving
symptoms and quality of life and reducing COPD exacerbations; to improving lung
symptoms of chronic cough & sputum, and pulmonary emphysema with the specific symptoms of dyspnea. Asthma = acute obstructive pulmonary disease?
COPD can be defined as a chronic, irreversible, slowly progressive disorder characterized by airflow
【COPD英文精品课件】Furnace House Surgery Chronic Obstructive Pulmonary Disease
• emphysema permanent destruction of the alveoli, airspaces distal to the terminal bronchiole. On lung expansion, elastic recoil is reduced and pressure to drive expiration is lost. There is also a drop in intraluminal pressure needed to maintain airway patency during forced exhalation (demonstrated by lip pursing).
Causes
The underlying causes of COPD yet to be fully elucidated but include:
• cigarette smoking, with other types of tobacco smoking also being strong risk factors
Disease classification
severity of disease rather than presumed underlying causes. The objective measure used for this and monitoring progression of the disease is Forced Expiratory Volume in one second (FEV 1).
•Chronic bronchitis with increased and airway wall inflammation;
• small or peripheral airways disease increased mucus, airway wall thickening, scarring and narrowing
Causes
The underlying causes of COPD yet to be fully elucidated but include:
• cigarette smoking, with other types of tobacco smoking also being strong risk factors
Disease classification
severity of disease rather than presumed underlying causes. The objective measure used for this and monitoring progression of the disease is Forced Expiratory Volume in one second (FEV 1).
•Chronic bronchitis with increased and airway wall inflammation;
• small or peripheral airways disease increased mucus, airway wall thickening, scarring and narrowing
【COPD英文精品课件】Chronic Obstructive Pulmonary Disease (COPD)_
Number Deaths x 1000
70
60
50
Men
40 Women
30
20
10
0 1980
1985
1990
1995
2000
Source: US Centers for Disease Control and Prevention, 2002 – cited in GOLD 2007
Risk Factors for COPD
Disrupted alveolar attachments
Thickened wall with inflammatory cells - macrophages, CD8+ cells, fibroblasts
Peribronchial fibrosis
Changes in Lung Parenchyma in COPD
Obliteration
Death
Edema
Source: GOLD 2007
Diagnosis and Assessment of COPD
Patient LG
【COPD英文精品课件】 Chronic Obstructive Pulmonary
Disease (COPD)
Definition of COPD*
➢COPD is a preventable and treatable chronic lung disease characterized by airflow limitation that is not fully reversible.
➢The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung.
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
Prevalence of COPD in the US
Rate/1,000 Population*
90
80 70
†
† †††
†
† †
†
† †
†
†
†
†
60
50
40
30
Male
20
Female
10
Total
0
1980
1982
1984
1986
1988 1990
Year
1992
1994
1996
1998
2000
capacity
(West: Textbook of Physiology)
Hypoxic Pulmonary Vasoconstriction
u The lung regulates blood flow
100
90
according to its oxygen content
COPD: Outline
1. Epidemiology 2. Definitions 3. Medical management 4. Hypoxia 5. Infections 6. Vaccination
Universal Problem
COPD: epidemiology
14 million in the US with COPD
Emphysema---a pathologic definition:
“abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of their walls”
Chronic Obstructive Pulmonary Disease and Asthma Update
John L. Faul, MD FCCP
Assistant Professor, Division of Pulmonary/Critical Care Medicine
Stanford University
• Since 1987, the prevalence of COPD among women has been significantly higher than that among men
*Age-adjusted to 2000 US population. †Represents a statistically significant difference from rate among males.
12.5 million with chronic bronchitis 1.65 million with emphysema
4th leading cause of death in US
3rd most frequent diagnosis of patients receiving home care
when FEV1< 1.0 L (or < 50% predicted) an ABG should be done
Home O2 costs in the US/yr: $ 2,400,000,000
Oxygen Dissociation Curve
__ 100
__ 80
Hemoglobin
__
extends life in hypoxemic patients
NOTT trial, Ann Int Med 1980;93: 391-398 MRC trial, Lancet 1981; 1: 681-685
strengthens cardiac function, improves exercise performance and ADLs
Saturation % 60
__
40
__
20
__
0
At 80mmHg, 95% sat At 60mmHg, 90% sat At 40mHg)
Below PaO2 = 60mmHg, Hemoglobin rapidly loses oxygen carrying
occupational exposures to dusts and fumes
Lung function declines with age
Elastic tissue is lost in emphysema
COPD: definitions
Chronic bronchitis---a clinical definition:
Mannino et al. MMWR. 2002;51(SS-6):1-16.
COPD: The Usual Suspects
COPD: risk factors
tobacco smoking accounts for 80-90% of the risk of developing COPD
Pink puffers &
Blue bloaters
COPD: Hyperinflation
Increased retrosternal
airspace
Increased AP diameter
Flat diaphragms
COPD
COPD: Oxygen therapy
Oxygen therapy in COPD:
age of starting, total pack-years and current smoking status are predictive of mortality
only 15% of smokers develop clinically significant COPD
alpha1-antitrypsin deficiency (accounts for less than 1% of all COPD cases)
“the presence of chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of chronic cough have been excluded”