【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
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
• Since symptoms may not occur until lung function is substantially reduced, early detection is enhanced by spirometric evaluation of FEV and FVC.
• The National Heart, Lung, and Blood Institute recommends spirometry for all smokers 45 years or older, particularly those who present with shortness of breath, coughing, wheezing, or– 26 million
• Underdiagnosed and Underrecognized
Some more Epidemiology
• More common in women • More fatal in Women
– Secondary to differences in lung size and mechanics, women’s airways are more hyperresponsive to exogenous irritants
• Continued airway irritation and inflammation causes scarring within the airways leading to airway obstruction and dyspnea
• Irritation, inflammation, mucus production, and scarring also predispose patients to respiratory infections which leads them to seek medical attention
What’s the Physiology?
• Related to chronic airway irritation, mucus production, and pulmonary scarring.
• Irritation from environmental pollutants (most commonly cigarette smoke) or a genetic predisposition leads to airway inflammation, which causes increased mucus production and decreased mucociliary function
• The combination of increased mucus and decreased mucociliary clearance leads to the hallmark COPD symptoms of coughing and sputum production
A Little More Physiology
• Without symptoms many patients will not seek medical attention and therefore disease can progress before diagnosis or treatment
Epidemiologically Speaking