1) A 55-year-old homeless man presented with shortness of breath and cough. He has a history of COPD, hypertension, diabetes, seizures and substance abuse.
2) On examination, he had wheezes in both lungs. Labs showed mild leukocytosis. Chest x-ray revealed right lower lobe infiltrate.
3) He was diagnosed with COPD exacerbation and started on antibiotics, steroids, and bronchodilators. His other conditions including hypertension, diabetes, seizures, and dyslipidemia were also addressed.
This document provides guidance on diagnosing and treating patients with asthma, COPD, or asthma-COPD overlap syndrome (ACOS). It outlines a step-wise approach including 1) determining if a patient has chronic airways disease, 2) making a syndromic diagnosis of asthma, COPD, or ACOS, 3) confirming with spirometry, 4) initiating initial treatment, and 5) referring for further testing if needed. Key points include distinguishing features of asthma and COPD, the overlapping characteristics of ACOS, and ensuring appropriate controller therapy is used depending on the diagnosis. The goal is to accurately diagnose this common problem to optimize treatment outcomes.
- A 70 year old male presented with 10 years of dyspnea and white productive sputum without fever or other URI symptoms. Skin tests were positive for allergens.
- He has been prescribed several inhalers but was referred to determine if he has COPD or asthma.
- The document discusses the differences and similarities between the inflammation seen in COPD versus asthma. COPD typically involves neutrophilic inflammation in small airways and parenchyma while asthma usually shows eosinophilic inflammation, but there can be overlap between the conditions.
The ILLUMINATE and SPARK trials evaluated the efficacy and safety of QVA149 compared to other COPD medications. ILLUMINATE found that in moderate to severe COPD, QVA149 provided significant lung function improvements over 26 weeks compared to salmeterol-fluticasone. SPARK found in severe and very severe COPD, QVA149 reduced exacerbations more than glycopyrronium or tiotropium over 64 weeks and improved lung function and health status. Both trials showed QVA149 to be well tolerated.
COPD exacerbation case presentation and disease overview farah al souheil
management of a simulated case scenario: patient presenting with COPD exacerbation: what's the best next step? summary of the guideline is then described
Napcon 2014 presentation abstract Page 14 - Presentation28
High Dose Rate Endobronchial Brachytherapy for Palliative Treatment of Lung Cancer – A Case Report Muhammed Aslam N K , Rajeev Ram , Achuthan V , Manoj D K ,Rajani M Pariyaram medical colleg , kannur
This document discusses pre-operative lung function testing for patients undergoing lung resection surgery. It recommends evaluating patients' pulmonary function via spirometry, DLCO, VO2 max testing, and predicting post-operative lung function to assess surgical risk. High-risk factors include COPD, smoking history, obesity, and poor nutrition status. Pre-operative optimization of lung function can help reduce post-operative complications.
Practical approach to Idiopathic Pulmonary Fibrosis.Hiba Ashibany
This document provides information on idiopathic pulmonary fibrosis (IPF), including its causes, diagnosis, clinical features, prognosis, and treatment approaches. It summarizes that IPF is a progressive lung disease of unknown cause where scarring develops in the lungs. Diagnosis involves ruling out other conditions, imaging, and sometimes biopsies. Prognosis is generally poor with median survival of 3 years. Treatment includes drugs like pirfenidone and nintedanib that can slow disease progression in mild to moderate IPF.
1) A 55-year-old homeless man presented with shortness of breath and cough. He has a history of COPD, hypertension, diabetes, seizures and substance abuse.
2) On examination, he had wheezes in both lungs. Labs showed mild leukocytosis. Chest x-ray revealed right lower lobe infiltrate.
3) He was diagnosed with COPD exacerbation and started on antibiotics, steroids, and bronchodilators. His other conditions including hypertension, diabetes, seizures, and dyslipidemia were also addressed.
This document provides guidance on diagnosing and treating patients with asthma, COPD, or asthma-COPD overlap syndrome (ACOS). It outlines a step-wise approach including 1) determining if a patient has chronic airways disease, 2) making a syndromic diagnosis of asthma, COPD, or ACOS, 3) confirming with spirometry, 4) initiating initial treatment, and 5) referring for further testing if needed. Key points include distinguishing features of asthma and COPD, the overlapping characteristics of ACOS, and ensuring appropriate controller therapy is used depending on the diagnosis. The goal is to accurately diagnose this common problem to optimize treatment outcomes.
- A 70 year old male presented with 10 years of dyspnea and white productive sputum without fever or other URI symptoms. Skin tests were positive for allergens.
- He has been prescribed several inhalers but was referred to determine if he has COPD or asthma.
- The document discusses the differences and similarities between the inflammation seen in COPD versus asthma. COPD typically involves neutrophilic inflammation in small airways and parenchyma while asthma usually shows eosinophilic inflammation, but there can be overlap between the conditions.
The ILLUMINATE and SPARK trials evaluated the efficacy and safety of QVA149 compared to other COPD medications. ILLUMINATE found that in moderate to severe COPD, QVA149 provided significant lung function improvements over 26 weeks compared to salmeterol-fluticasone. SPARK found in severe and very severe COPD, QVA149 reduced exacerbations more than glycopyrronium or tiotropium over 64 weeks and improved lung function and health status. Both trials showed QVA149 to be well tolerated.
COPD exacerbation case presentation and disease overview farah al souheil
management of a simulated case scenario: patient presenting with COPD exacerbation: what's the best next step? summary of the guideline is then described
Napcon 2014 presentation abstract Page 14 - Presentation28
High Dose Rate Endobronchial Brachytherapy for Palliative Treatment of Lung Cancer – A Case Report Muhammed Aslam N K , Rajeev Ram , Achuthan V , Manoj D K ,Rajani M Pariyaram medical colleg , kannur
This document discusses pre-operative lung function testing for patients undergoing lung resection surgery. It recommends evaluating patients' pulmonary function via spirometry, DLCO, VO2 max testing, and predicting post-operative lung function to assess surgical risk. High-risk factors include COPD, smoking history, obesity, and poor nutrition status. Pre-operative optimization of lung function can help reduce post-operative complications.
Practical approach to Idiopathic Pulmonary Fibrosis.Hiba Ashibany
This document provides information on idiopathic pulmonary fibrosis (IPF), including its causes, diagnosis, clinical features, prognosis, and treatment approaches. It summarizes that IPF is a progressive lung disease of unknown cause where scarring develops in the lungs. Diagnosis involves ruling out other conditions, imaging, and sometimes biopsies. Prognosis is generally poor with median survival of 3 years. Treatment includes drugs like pirfenidone and nintedanib that can slow disease progression in mild to moderate IPF.
This document discusses asthma and COPD, including key differences and updates. It provides an overview of asthma, describing it as a chronic inflammatory airway disorder characterized by recurrent wheezing, breathlessness, and coughing. It also provides an overview of COPD, describing it as a common lung disease associated with exposure to noxious particles or gases. The document reviews epidemiology, pathophysiology, diagnosis, management, and updates from the GINA and GOLD guidelines for both conditions.
This document provides an overview of asthma-COPD overlap syndrome (ACOS). It discusses how asthma and COPD were traditionally viewed as distinct conditions but some patients exhibit features of both. Patients with ACOS have worse health outcomes than those with asthma or COPD alone. The document reviews clinical features of ACOS and provides guidance on diagnosing patients based on their symptoms, lung function tests, and other features. It also discusses treatment approaches for ACOS.
This document contains information about bronchodilators used in the treatment of chronic obstructive pulmonary disease (COPD). It discusses the mechanisms of action of different bronchodilators and their effects on lung volumes, airflow limitation, hyperinflation, and exercise tolerance. It also provides treatment algorithms and guidelines for COPD pharmacotherapy. The document compares short-acting and long-acting bronchodilators and summarizes the evidence for their impact on outcomes like exacerbations, quality of life, and lung function in COPD patients.
1) Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic airflow obstruction that interferes with normal breathing and is not fully reversible. It includes chronic bronchitis and emphysema.
2) A 48-year old female patient was admitted to the hospital with a chief complaint of fever, cough with expectoration, and right-sided chest pain. She was diagnosed with COPD based on her history and examination.
3) Over three days in the hospital, she was treated with medications like antibiotics, bronchodilators, and corticosteroids. Her symptoms improved and she was discharged on medications and lifestyle recommendations to manage her COPD.
COPD: Management of Acute Exacerbationmustaqadnan1
This document discusses the management of COPD exacerbations. It begins by defining a COPD exacerbation and classifying exacerbations by severity. It then outlines the goals of exacerbation treatment and recommends short-acting bronchodilators as the initial treatment. It advocates for systemic corticosteroids to improve outcomes and antibiotics when indicated. The document also recommends non-invasive ventilation for acute respiratory failure. Finally, it stresses implementing prevention strategies after an exacerbation.
This document provides an overview of chronic obstructive pulmonary disease (COPD). It defines COPD as a progressive lung disease characterized by limited airflow. The two major types are chronic bronchitis and emphysema. Risk factors include smoking, air pollution, and genetics. Symptoms include chronic cough, shortness of breath, and limited activity. Treatment focuses on bronchodilators, steroids, oxygen therapy, and smoking cessation. Proper diagnosis and use of evidence-based guidelines can help control symptoms and reduce exacerbations.
1) Transbronchial cryobiopsy is a bronchoscopic technique that uses extreme cold to obtain biopsy samples and has potential as a safer alternative to surgical lung biopsy for diagnosing interstitial lung diseases.
2) Results from studies show the diagnostic yield of cryobiopsy is around 73% with an overall complication rate of 23%, including pneumothorax in 9.4% of patients and significant bleeding in 14.2%.
3) Guidelines now recommend considering cryobiopsy for suspected idiopathic pulmonary fibrosis when a multidisciplinary team reviews clinical, radiological, and pathological findings.
An update on the management of Idiopathic Pulmonary Fibrosis (IPF)Sarfraz Saleemi
This document provides a historical overview and update on the management of idiopathic pulmonary fibrosis (IPF). It discusses the evolution of IPF diagnosis and classification over time based on clinical and pathological criteria. Key risk factors for IPF like older age, family history, smoking and genetics are summarized. The document also reviews prognostic indicators, comorbidities, current pharmacological therapies including pirfenidone and nintedanib, and the multidisciplinary approach to diagnosis and management of IPF.
This document summarizes COPD (chronic obstructive pulmonary disease). It defines COPD as a disease characterized by irreversible airflow limitation. COPD includes emphysema, chronic bronchitis, and small airways disease. The major risk factor is cigarette smoking. The pathology involves changes in the large airways, small airways (<2mm), and lung parenchyma. Emphysema is classified as centriacinar or panacinar. Treatment focuses on smoking cessation, bronchodilators, inhaled corticosteroids, lung volume reduction surgery, lung transplantation, and managing exacerbations.
EBUS is a bronchoscopic technique that uses ultrasound to visualize structures within the airway wall, lung, and mediastinum. It uses radial or convex probes. Radial probes provide 360-degree images of the airway wall and surrounding structures at high definition but do not allow for real-time biopsy. Convex probes have a 90-degree angle of view and allow for real-time EBUS-guided biopsy. EBUS is used to diagnose and stage lung cancers and mediastinal masses and can guide procedures like airway stenting. It has advantages of being minimally invasive and having a high diagnostic yield.
This document discusses restrictive lung diseases including interstitial lung fibrosis and asbestosis. It defines interstitial pulmonary fibrosis as a chronic, fibrosing interstitial pneumonia of unknown cause typically affecting adults over 50. Usual interstitial pneumonia is the most common form and has a median survival of 3 years. Asbestosis is an occupational lung disease caused by inhalation of asbestos fibers, which can lead to pleural thickening, effusions, rounded atelectasis or fibrosis. Prevention focuses on never disturbing asbestos materials and smoking cessation.
Biologic therapies target specific inflammatory pathways involved in asthma. Omalizumab targets IgE and is approved for severe allergic asthma. It reduces exacerbations and lowers corticosteroid needs. Mepolizumab targets IL-5 and reduces exacerbations in severe eosinophilic asthma. Anti-IL-4/IL-13 and anti-IL-17 therapies are also under investigation. While biologics show promise for uncontrolled asthma, their high cost, parenteral administration, and potential adverse effects limit broader use. Accurate patient phenotyping is key to matching the right therapy.
This document discusses the approach to interstitial lung diseases (ILD) and diffuse parenchymal lung diseases (DPLD). It begins by reviewing the spectrum of ILD and DPLD, identifying clues from clinical presentation to make a diagnosis, and reviewing common radiographic findings. Key points include that ILD involves the pulmonary interstitium located between the epithelial and endothelial basement membranes. Clinical presentation of DPLD/ILD often involves dyspnea, cough, and abnormal chest imaging. Diagnosis involves considering history, physical exam, pulmonary function tests, imaging like chest radiographs and CT, and tissue sampling. Management depends on the specific diagnosis but may include treatments like corticosteroids, immunosuppressants, anti
Asthma is a heterogeneous disease with different phenotypes and endotypes. Severe asthma is a subset of difficult-to-treat asthma that remains uncontrolled despite maximal optimized treatment. Cluster analysis has identified several asthma phenotypes including eosinophilic phenotypes characterized by type 2 inflammation as well as non-type 2 phenotypes. Biomarkers can help identify patients with type 2 inflammation who may benefit from targeted biologic therapies.
This document contains multiple choice questions about chronic obstructive pulmonary disease (COPD) and its treatment. It asks questions about the types of emphysema most severe in upper lobes, risk factors for mortality, most significant COPD symptom, best test for exacerbation severity, and accurate treatment statements. It also provides clinical information about COPD pathogenesis, airflow limitation, symptoms by disease severity, rationale for dual bronchodilation, and studies on withdrawing inhaled corticosteroids.
DLCO/TLCO measures the ability of the lungs to transfer carbon monoxide from the alveoli to the blood. It estimates the surface area and thickness of the alveolar-capillary membrane. CO is used instead of oxygen because its transfer is diffusion limited and it binds readily to hemoglobin. A single-breath hold method is most common where the patient inhales a gas mixture and holds their breath for 10 seconds while CO uptake is measured. DLCO can help identify interstitial lung diseases, emphysema, pulmonary hypertension and assess treatment response. Reduced DLCO may be due to decreased surface area from conditions like emphysema, or increased membrane thickness from fibrosis. Adjustments are made
This document discusses bronchial hyperresponsiveness and bronchial provocation tests. It begins by defining asthma as a chronic inflammatory airway disease characterized by variable airflow obstruction and hyperresponsiveness to triggers. Bronchial hyperresponsiveness is an abnormal increase in airflow limitation following exposure to a stimulus and can be quantified using bronchial provocation tests. Several types of direct and indirect stimuli are described for use in bronchial provocation tests, with methacholine challenge being the most commonly used direct stimulus test due to its safety and sensitivity. The document outlines the procedures, interpretations, and indications for various bronchial provocation tests.
Chronic Obstructive Pulmonary Disease (COPD) by Dr Kemi DeleKemi Dele-Ijagbulu
Presentation on definition and general overview of COPD, how to differentiate COPD from Asthma, how to make diagnosis of COPD, simple tools for assessment of COPD; available therapeutic options; as well as management of stable COPD, COPD exacerbations and comorbidities
This lecture covers diffusing capacity testing, specifically the single-breath carbon monoxide diffusing capacity (DLCO) test. DLCO measures the transfer of carbon monoxide across the alveolar-capillary membrane and is used to evaluate gas exchange ability. The single-breath method involves rapid inhalation of a test gas mixture containing carbon monoxide to total lung capacity, a 10 second breath hold, and analysis of exhaled gases. DLCO may be reduced in conditions involving decreased alveolar surface area or pulmonary capillary blood volume such as emphysema. Physiologic factors like hemoglobin, carboxyhemoglobin, and pulmonary blood volume also impact DLCO values.
This document discusses asthma and COPD, including key differences and updates. It provides an overview of asthma, describing it as a chronic inflammatory airway disorder characterized by recurrent wheezing, breathlessness, and coughing. It also provides an overview of COPD, describing it as a common lung disease associated with exposure to noxious particles or gases. The document reviews epidemiology, pathophysiology, diagnosis, management, and updates from the GINA and GOLD guidelines for both conditions.
This document provides an overview of asthma-COPD overlap syndrome (ACOS). It discusses how asthma and COPD were traditionally viewed as distinct conditions but some patients exhibit features of both. Patients with ACOS have worse health outcomes than those with asthma or COPD alone. The document reviews clinical features of ACOS and provides guidance on diagnosing patients based on their symptoms, lung function tests, and other features. It also discusses treatment approaches for ACOS.
This document contains information about bronchodilators used in the treatment of chronic obstructive pulmonary disease (COPD). It discusses the mechanisms of action of different bronchodilators and their effects on lung volumes, airflow limitation, hyperinflation, and exercise tolerance. It also provides treatment algorithms and guidelines for COPD pharmacotherapy. The document compares short-acting and long-acting bronchodilators and summarizes the evidence for their impact on outcomes like exacerbations, quality of life, and lung function in COPD patients.
1) Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic airflow obstruction that interferes with normal breathing and is not fully reversible. It includes chronic bronchitis and emphysema.
2) A 48-year old female patient was admitted to the hospital with a chief complaint of fever, cough with expectoration, and right-sided chest pain. She was diagnosed with COPD based on her history and examination.
3) Over three days in the hospital, she was treated with medications like antibiotics, bronchodilators, and corticosteroids. Her symptoms improved and she was discharged on medications and lifestyle recommendations to manage her COPD.
COPD: Management of Acute Exacerbationmustaqadnan1
This document discusses the management of COPD exacerbations. It begins by defining a COPD exacerbation and classifying exacerbations by severity. It then outlines the goals of exacerbation treatment and recommends short-acting bronchodilators as the initial treatment. It advocates for systemic corticosteroids to improve outcomes and antibiotics when indicated. The document also recommends non-invasive ventilation for acute respiratory failure. Finally, it stresses implementing prevention strategies after an exacerbation.
This document provides an overview of chronic obstructive pulmonary disease (COPD). It defines COPD as a progressive lung disease characterized by limited airflow. The two major types are chronic bronchitis and emphysema. Risk factors include smoking, air pollution, and genetics. Symptoms include chronic cough, shortness of breath, and limited activity. Treatment focuses on bronchodilators, steroids, oxygen therapy, and smoking cessation. Proper diagnosis and use of evidence-based guidelines can help control symptoms and reduce exacerbations.
1) Transbronchial cryobiopsy is a bronchoscopic technique that uses extreme cold to obtain biopsy samples and has potential as a safer alternative to surgical lung biopsy for diagnosing interstitial lung diseases.
2) Results from studies show the diagnostic yield of cryobiopsy is around 73% with an overall complication rate of 23%, including pneumothorax in 9.4% of patients and significant bleeding in 14.2%.
3) Guidelines now recommend considering cryobiopsy for suspected idiopathic pulmonary fibrosis when a multidisciplinary team reviews clinical, radiological, and pathological findings.
An update on the management of Idiopathic Pulmonary Fibrosis (IPF)Sarfraz Saleemi
This document provides a historical overview and update on the management of idiopathic pulmonary fibrosis (IPF). It discusses the evolution of IPF diagnosis and classification over time based on clinical and pathological criteria. Key risk factors for IPF like older age, family history, smoking and genetics are summarized. The document also reviews prognostic indicators, comorbidities, current pharmacological therapies including pirfenidone and nintedanib, and the multidisciplinary approach to diagnosis and management of IPF.
This document summarizes COPD (chronic obstructive pulmonary disease). It defines COPD as a disease characterized by irreversible airflow limitation. COPD includes emphysema, chronic bronchitis, and small airways disease. The major risk factor is cigarette smoking. The pathology involves changes in the large airways, small airways (<2mm), and lung parenchyma. Emphysema is classified as centriacinar or panacinar. Treatment focuses on smoking cessation, bronchodilators, inhaled corticosteroids, lung volume reduction surgery, lung transplantation, and managing exacerbations.
EBUS is a bronchoscopic technique that uses ultrasound to visualize structures within the airway wall, lung, and mediastinum. It uses radial or convex probes. Radial probes provide 360-degree images of the airway wall and surrounding structures at high definition but do not allow for real-time biopsy. Convex probes have a 90-degree angle of view and allow for real-time EBUS-guided biopsy. EBUS is used to diagnose and stage lung cancers and mediastinal masses and can guide procedures like airway stenting. It has advantages of being minimally invasive and having a high diagnostic yield.
This document discusses restrictive lung diseases including interstitial lung fibrosis and asbestosis. It defines interstitial pulmonary fibrosis as a chronic, fibrosing interstitial pneumonia of unknown cause typically affecting adults over 50. Usual interstitial pneumonia is the most common form and has a median survival of 3 years. Asbestosis is an occupational lung disease caused by inhalation of asbestos fibers, which can lead to pleural thickening, effusions, rounded atelectasis or fibrosis. Prevention focuses on never disturbing asbestos materials and smoking cessation.
Biologic therapies target specific inflammatory pathways involved in asthma. Omalizumab targets IgE and is approved for severe allergic asthma. It reduces exacerbations and lowers corticosteroid needs. Mepolizumab targets IL-5 and reduces exacerbations in severe eosinophilic asthma. Anti-IL-4/IL-13 and anti-IL-17 therapies are also under investigation. While biologics show promise for uncontrolled asthma, their high cost, parenteral administration, and potential adverse effects limit broader use. Accurate patient phenotyping is key to matching the right therapy.
This document discusses the approach to interstitial lung diseases (ILD) and diffuse parenchymal lung diseases (DPLD). It begins by reviewing the spectrum of ILD and DPLD, identifying clues from clinical presentation to make a diagnosis, and reviewing common radiographic findings. Key points include that ILD involves the pulmonary interstitium located between the epithelial and endothelial basement membranes. Clinical presentation of DPLD/ILD often involves dyspnea, cough, and abnormal chest imaging. Diagnosis involves considering history, physical exam, pulmonary function tests, imaging like chest radiographs and CT, and tissue sampling. Management depends on the specific diagnosis but may include treatments like corticosteroids, immunosuppressants, anti
Asthma is a heterogeneous disease with different phenotypes and endotypes. Severe asthma is a subset of difficult-to-treat asthma that remains uncontrolled despite maximal optimized treatment. Cluster analysis has identified several asthma phenotypes including eosinophilic phenotypes characterized by type 2 inflammation as well as non-type 2 phenotypes. Biomarkers can help identify patients with type 2 inflammation who may benefit from targeted biologic therapies.
This document contains multiple choice questions about chronic obstructive pulmonary disease (COPD) and its treatment. It asks questions about the types of emphysema most severe in upper lobes, risk factors for mortality, most significant COPD symptom, best test for exacerbation severity, and accurate treatment statements. It also provides clinical information about COPD pathogenesis, airflow limitation, symptoms by disease severity, rationale for dual bronchodilation, and studies on withdrawing inhaled corticosteroids.
DLCO/TLCO measures the ability of the lungs to transfer carbon monoxide from the alveoli to the blood. It estimates the surface area and thickness of the alveolar-capillary membrane. CO is used instead of oxygen because its transfer is diffusion limited and it binds readily to hemoglobin. A single-breath hold method is most common where the patient inhales a gas mixture and holds their breath for 10 seconds while CO uptake is measured. DLCO can help identify interstitial lung diseases, emphysema, pulmonary hypertension and assess treatment response. Reduced DLCO may be due to decreased surface area from conditions like emphysema, or increased membrane thickness from fibrosis. Adjustments are made
This document discusses bronchial hyperresponsiveness and bronchial provocation tests. It begins by defining asthma as a chronic inflammatory airway disease characterized by variable airflow obstruction and hyperresponsiveness to triggers. Bronchial hyperresponsiveness is an abnormal increase in airflow limitation following exposure to a stimulus and can be quantified using bronchial provocation tests. Several types of direct and indirect stimuli are described for use in bronchial provocation tests, with methacholine challenge being the most commonly used direct stimulus test due to its safety and sensitivity. The document outlines the procedures, interpretations, and indications for various bronchial provocation tests.
Chronic Obstructive Pulmonary Disease (COPD) by Dr Kemi DeleKemi Dele-Ijagbulu
Presentation on definition and general overview of COPD, how to differentiate COPD from Asthma, how to make diagnosis of COPD, simple tools for assessment of COPD; available therapeutic options; as well as management of stable COPD, COPD exacerbations and comorbidities
This lecture covers diffusing capacity testing, specifically the single-breath carbon monoxide diffusing capacity (DLCO) test. DLCO measures the transfer of carbon monoxide across the alveolar-capillary membrane and is used to evaluate gas exchange ability. The single-breath method involves rapid inhalation of a test gas mixture containing carbon monoxide to total lung capacity, a 10 second breath hold, and analysis of exhaled gases. DLCO may be reduced in conditions involving decreased alveolar surface area or pulmonary capillary blood volume such as emphysema. Physiologic factors like hemoglobin, carboxyhemoglobin, and pulmonary blood volume also impact DLCO values.
8. 美國死亡率曲線圖, 1965-1998
Reference: GOLD Teaching Slide Kit. Updated 2006. (National Institute of Health).
3.0
2.5
2.0
1.5
1.0
0.5
0
Coronary
heart
disease
Stroke Other
CVD
COPD All other
causes
-59% -64% -35% +163% -7%
Percentage change in age-adjusted death rates in USA, from 1965 to 19981
Proportionof1965rate
因COPD造成死亡的比率有逐年增加的趨勢
11. FEV1(%ofvalueatage25)
100
75
50
25
0
25 50 75
Never smoked
or not susceptible
to smoke
Stopped at 65
Stopped at 45
Disability
Smoked regularly
and susceptible
to its effects
Death
Age (years)
Reference: Fletcher & Peto. Br Med J 1977; 1: 1649-1648.
抽菸對肺功能的影響
20. COPD急性惡化發生死亡風險高於心肌梗塞
20
Mortality after first severe
COPD exacerbation
Mortality after first
myocardial infarction
at 1 year1* NSTEMI at 1 year2† STEMI at 1 year2†
1. Suissa S, et al. Thorax 2012;67:957–963.
2. McManus DD, et al. Am J Med 2011;124:40–47.
預防急性惡化 是對於肺阻塞病人非常重要的治療指標!!!
25. Group C
A long-acting bronchodilator
( LABA or LAMA)
Persistent
symptoms
LAMA+LABA
Group B
Preferred Treatment =
Further
Exacerbation(s) LAMA+LABA+ICS
Consider roflumilast
if FEV1 < 50% pred. & patients
has chronic bronchitis
Consider macrolide
(in former smoker)
A bronchodilator
Evaluate effect
Continue, stop or try
alternative class of
bronchodilator
Group A
Group D
LAMA
LAMA+LABA LABA + ICS
LAM
A
LAMA+LABA LABA + ICS
Further
Exacerbation(s)
Further
Exacerbation(s)
GOLD 2019治療新準則