英文ppt课件chronicobstructive pulmonary disease （32p）

Chronic Obstructive Pulmonary Disease,Chiefs Conference: Kevin L. Gilliam II, M.D. April 16, 2009 Emory Family Medicine,What is COPD?,It is a syndrome of progressive airflow limitation caused by chronic inflammation of the airways and lung parenchyma. The terms chronic bronchitis and emphysema are no longer included in the formal definition of COPD, although they are still used clinically Emphysema: pathologic term used to describe destruction of the alveolar capillary membrane Chronic Bronchitis: clinical term used to describe the presence of cough or sputum production for at least a three month duration during two consecutive years,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,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,Whats 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,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 Without symptoms many patients will not seek medical attention and therefore disease can progress before diagnosis or treatment,Epidemiologically Speaking,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 26 million Underdiagnosed and Underrecognized,Some more Epidemiology,More common in women More fatal in Women Secondary to differences in lung size and mechanics, womens airways are more hyper-responsive to exogenous irritants 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 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 persistent sputum production,More on Diagnosis,Physical examination findings are not sensitive for the initial diagnosis of COPD Many patients have normal examination findings Features of lung hyperinflation include a widened anteroposterior chest diameter, hyperresonance on percussion, and diminished breath sounds,Some More on Diagnosis,Persistent pulmonary damage can lead to increased right-sided heart pressure causing right sided heart failure (cor pulmonale) Which can give an accentuated second heart sound, peripheral edema, jugular venous distension, and hepatomegaly. Signs of increased work of breathing include the use of accessory respiratory muscles, paradoxical abdominal movement, increased expiratory time, and pursed lip breathing; auscultatory wheezing is variable. Other physical findings are occasionally cyanosis and cachexia Weight loss is an independent predictor of mortality therefore BMI should be followed,A Little More on Diagnosis,The stage of the disease suggests the prognosis, and follow-up data from longitudinal studies indicate that moderate and severe stages of the disease are associated with higher mortality Joint guidelines from the American Thoracic Society (ATS) and the European Respiratory Society (ERS) recommend screening for alpha1-antitrypsin deficiency in symptomatic adults with persistent obstruction on pfts and asymptomatic adults with history of smoking or occupational exposure,Just a Smidge More Diagnosis,Then What?,Evidence suggests that dyspnea is a better predictor of mortality than spirometry