COPD慢性阻塞性肺病課件

此ppt下載后可自行編輯慢性阻塞性肺病AnatomyandphysiologyTrachea,bronchi,bronchioles,respiratorybronchioles,alveolardusts,sacsandalveoliPulmonaryarteries,veins,capillaries;bronchialarteries,veins,capillariesVentilationandgasesexchangeAnatomyandphysiologyTrachea,bronchi,bronchioles,respiratorybronchioles,alveolardusts,sacsandalveoliPulmonaryarteries,veins,capillaries;bronchialarteries,veins,capillariesVentilationandgasesexchangeGasesExchangeTrachea,bronchi,bronchioles,respiratorybronchioles,alveolardusts,sacsandalveoliPulmonaryarteries,veins,capillaries;bronchialarteries,veins,capillariesVentilationandgasesexchangeLungFunctionTest

&BloodAnalysisFVCFEV1FEV1/FVCDlcoPHHCO3PaO2PaCO2PaO2/FiO2RadiologyChestXrayCTscanPET–CTV/Qradionuclideimaging…Getthewhole,ratherthangetawall“Onsite”disorders:asthma,pneumonia,...Systemdisorders:COPD,“pneumonia”...Lookslike“pneumonia”AnatomyandphysiologyFiberbronchoscopyinterventionaltherapy

Befor&afterinterventionaltherapyR.mainbronchusL.Mainbronchusbefore&afterangio-interventionaltherapy

Before

after

Swan-GanzCatheterization

ChronicBronchitisDefinitionChronicbronchitisisanon-specificinflammationoftrachea,bronchiandperibronchialstructure.Clinicalfeaturesarecough,sputumwithorwithoutwheezing.Thesesymptomsrepeatyearsandgraduallyprogress.EtiologyandpathogenesisCigaretteSmokingOccupationalDustsandChemicalsIndoororOutdoorAirPollutionInfectionClimateIntrinsicfactorsAllergicfactorsDisfunctionofautonomicnervesAirwayhyperresponsivenessDeficiencyofvitaminC,AAgedGeneticfactorsSmoking&

OccupationalDustsandChemicalsIrritantfumeSulfurdioxideNitrogendioxideChlorinegasOzoneBronchispasmWeakenedciliarymovementIncreasedmucussecretionDecreasedphagocytes’functionActivesmokingPassivesmokingSusceptibletoCOPD(10-15%smoker)Infection（virus,mycoplasma,bacteria）VirusRhinovirus（鼻病毒）Influenzavirus（流感病毒）parainfluenzavirus（副流感病毒）Adenovirus（腺病毒）Respiratorysyncytialvirus（呼吸道合胞病毒）BacteriaPneumococcus

（肺炎鏈球菌）Hemophilusinfuenzae

（流感嗜血桿菌）

Neisseria

（奈瑟球菌）－streptococcus

（甲型鏈球菌）MucociliarydysfunctionMucushypersecretionCiliarymovementdysfunctionCilialossmucousmembranedamageNormalCOPDMucociliaryClearanceDisruptedHaemophilusInfluenzaeNormalCOPDBronchocons-trictionBronchialhyperrespons-ivenessElasiticitydecreasedAlveolarattachmentdecreasedAlveolarattachmentAlveolarattachmentdecreasedAirwaynarrowingorcollapse

IncreasedresistanceinairwaysPathologyCiliafalloff,fadingHyperplasiaofmucousglandsinairwayInfiltrationofinflammatorycellsinproximalairways,peripheralairways,lungparenchyma,pulmonaryvasculatureHypertrophyinthetissuesaroundairwaysStiffandcollapseofthewallsofairwaysDestructionoflungtissuesFibrosisoflungtissuesSymptomsCough:indispensableChronicproductivecough,noticeablyoccurringinthemorning,usuallyrecurrentinwinter.ExpectorationWhitemucoidorforthysputum(occasionallywithblood);pusormucopussputumininfectionepisode.

WheezingExpiratorydyspneaorwheezing,exertionalshortnessofbreathSigns

NoanyabnormalsignsintheearlystageMoistralesandrhonchimaybeheardintheacuteepisodeRhonchiandprolongedexpirationmaybeheardinasthmaticbronchitisClassificationandstagingClassificationSimpletype:

WithoutwheezingAsthmatictype:

WithwheezingStagingAcuteexacerbation

Becomeseverefor1weekClinicalprolongedstage

Prolongedfor1mo.

Clinicalremission

Disappearedordiminishedfor2mo.LaboratoryfindingsSputumsmearandculture

Qualifiedspecimen:WBC>25/LP,epithelium<10/LPPulmonaryfunctiontest

NoabnormalityorobstructiveimpairmentChestradiographyNoabnormality.Toexcludeotherpulmonarydiseases.Bloodroutine

※Diagnosis※

Cough,sputumwithorwithoutwheezingonmostdaysduringatleast3consecutivemonthsformorethan2successiveyears.Othercauses,suchaspulmonaryTB,pneumoconiosis,asthma,bronchiectasis,lungcancer,lungabscess,heartdiseases,orheartfailuremustbeexcluded.Iftheonsetislessthan3monthsineveryyear,thedefiniteevidencesoftheaccessoryexamination(pulmonaryfunctiontest)ishelpfulforthediagnosis.DifferentialdiagnosisAsthmaBronchiectasisPulmonarytuberculosisinterstitiallungdiseaseLungcancerTreatment:StopSmokingNon-smoking/non-sensitivetosmokingSmokingasusualandsensitiveStopatage45Stopatage65Treatment

ReductionofexposuretoriskfactorsThetherapyofexacerbationandremission

ChronicobstructiveemphysemaDefinition

HyperinflationofterminalbronchiolesRespiratorybronchiolesalveolardusts,sacsalveoliDestructionofthestructureNon-obstructiveemphysemaSenileemphysemaInterstitialemphysemaCompensatoryemphysemaCicatricleemphysemaEtiologyThecausesaresimilartothoseofchronicbronchitis.Deficiencyof1antitrypsinDeficiencyof1antitrypsin

emphysema1-antitrypsininhibitorElastasebreakdownelasticfibersThemechanismsofemphysemaObstructionofLumenduetoChronicinflammationinBronchioleBronchialcollapseduetodestructionofcartilageIncreasedElastasebyinflammatorycellsreleasingCompressionofcap.BedsAir–trappingduetodestructionofalveoliPathology

___Thesiteofdilatation

CentriacinaremphysemaSacculardilatationinthe2ndorderofrespiratorybronchiolesresultedfromincompleteobstructioninterminalbronchiolesand1storderofrespiratorybronchioles.Panacinaremphysema

Thedilatationinthealveolardusts,sacsandalveoliresultedfromrespiratorybronchioles.TerminalacinaremphysemaThedilatationofterminalbronchioles,alveolardustsandsacsinsub-pleura.

PathophysiologyFEV1andFVCRVDiffusioncapacityTLCV/QdisturbanceSymptomsSimilartochronicbronchitis(cough,sputum,wheezing)InsidiousandprogressivedyspneaSymptomsofrespiratoryfailureSignsInspection:barrelchest,decreasedrespir.movementPalpation:decreasedvocalfremitusPercussion:hyperresonance,narrowedareaofcardiacdullnessAuscultation:diminishedbreathingsounds,prolongedexpiration;moistralesandrhonchiinpulmonaryinfectionPulmonaryfunctiontest

___obstructiveimpairmentFEV1/FVC(forcedvitalcapacity)<70%AfterInhalationofbronchodilater(2-agonist)IncreasedRV/TLC(40%)DecreasedDLco/VA(diffusioncapacityforCO)LaboratoryfindingsChestradiographyCTscanBloodgasesanalysisComplications

SpontaneouspneumothoraxCorpulmonaleRespiratoryfailureDiagnosis

MedicalhistoryPhysicalfindingsPulmonaryfunctionstestChestCTDifferentialdiagnosisAsthmaBronchiectasisPulmonarytuberculosisLungcancerOthertypesofemphysemaSenileemphysemaInterstitialemphysemaCompensatoryemphysemaCicatricleemphysemaCardiacdiseasesTreatment(exacerbation)Bronchodilators:

2-agonists,anticholinergicagents(ipratropin,Tiotropin),aminophylline,corticosteroidsOxygentherapy(1-2L/min)AntibioticsEliminatingphlegmRespiratorystimulantTreatment(remission)StopsmokingReductionofexposuretoriskfactorsBronchodilatorsLongtermoxygentherapy(LTOT)>15hrs/dRehabilitationLungvolumereductionsurgery

ChronicObstructivePulmonaryDisease

(COPD)GOLDGlobalinitiativeforchronicObstructiveLungDiseaseDefinitionChronicObstructivePulmonaryDisease(COPD),acommonpreventableandtreatabledisease,ischaracterizedbypersistentairflowlimitationthatisusuallyprogressiveandassociatedwithanenhancedchronicinflammatoryresponseintheairwaysandthelungtonoxiousparticlesorgases.Exacerbationsandcomorbiditiescontributetotheoverallseverityinindividualpatients.COPD

(chronicobstructivepulmonarydisease)persistentlimitationofairflowProgressivecourse

ChronicbronchitisemphysemaasthmaLimitationofairflowCOPDDiagnosisSymptomsRiskfactorsSpirometryAfterInhalationofshort-actingbronchodilater(2-agonist),FEV1/FVC<70%

Modifiedmedicalresearchcouncil(mMRC)

QuestionnaireforAssessingtheSeverityofBreathlessnessGrade0Grade1Grade2Grade3Grade4Modifiedmedicalresearchcouncil(mMRC)

QuestionnaireforAssessingtheSeverityofBreathlessnessIonlygetbreathlesswithstrenuousexercise.Grade0Igetshortofbreathwhenhurryingonthelevelorwalkingupaslighthill.Grade1Iwalkslowerthanpeopleofthesameageonthelevelbecauseofbreathlessness,orIhavetostopforbreathwhenwalkingonmyownpaceonthelevel.Grade2Istopforbreathafterwalkingabout100metersorafterafewminutesonthelevel.Grade3IamtoobreathlesstoleavethehouseorIambreathlesswhendressingorundressing.Grade48)Energy7)Sleep6)Confidence5)Activities4)Breathlessness3)Chesttightness2)Phlegm1)CoughScaleofeveryitem0~5maximalscore40COPDAssessmentTest(CAT)itemClassifyofseverityofairflowlimitationInpatientswithFEV1/FVC0.7GOLD1MildFEV1

80%Pred.GOLD2Moderate50%FEV180%Pred.GOLD3Severe30%FEV150%Pred.GOLD4VerysevereFEV130%Pred.COPDgroupsCDABGOLD4GOLD3GOLD2GOLD12+10mMRC0-1CAT<10mMRC2CAT≥10symptomsRiskAirflowlimitationRiskExacerbationhistoryGroupsunderstandingGroupA:lowrisk,lesssymptomsGOLD1or2and/or0-1exacerbationperyearandmMRCgrade0-1orCATscore10GroupB:lowrisk,moresymptomsGOLD1or2and/or0-1exacerbationperyearandmMRCgrad