Global Initiative for Chronic Obstructiv课件.ppt

CHAPTER 3 RISK FACTORS Genes (e.g., alpha-1 antitrypsin deficiency) Airway Hyperresponsiveness Lung Growth Tobacco Smoke Occupational Dusts and Chemicals Indoor and Outdoor Air Pollution Infections Socioeconomic Status Characteristics of Inflammation in COPD and Asthma Indications for Hospital Assessment or Admission for Acute Exacerbations of COPD Marked increase in intensity of symptoms, such as sudden development of resting dyspnea Severe background COPD Onset of new physical signs(e.g., cyanosis, peripheral edema) Failure of exacerbation to respond to initial medical management Significant comorbidities Newly occurring arrhythmias Diagnostic uncertainty Older age Insufficient home support Indications for ICU Admission of Patients with Acute Exacerbations of COPD Severe dyspnea that responds inadequately to initial emergency therapy Confusion, lethargy, coma Persistent or worsening hypoxemia (PaO26.7kPa), and/or severe/worsening hypercapnia (PaCO29.3kPa,), and/or severe worsening respiratory acidosis (pH7.30) despite supplemental oxygen and NIPPV A Chest X-ray is seldom diagnostic in COPD unless obvious bullous disease is present, but it is valuable in excluding alternative diagnoses. Chest X-ray This test should be performed in patients with FEV140% predicted or with clinical signs suggestive of respiratory failure or right heart failure. Arterial blood gas measurement Any patient who has cough, sputum production, or dyspnea, and/or a history of exposure to risk factors for the disease. Whose postbronchodilator FEV180% with FEV1/FVC70% confirms the diagsis. Diagnosis of COPD Onset all ages Chest X-ray shows lung infiltrate Microbiological confirmation High local prevalence of tuberculosis Tuberculosis Large volumes of purulent sputum Commonly associated with bacterial infection Coarse crackles/clubbing on auscultation Chest X-ray/CT shows bronchial dilation, bronchial wall thickening Bronchiectasis ? Fine basilar crackles on auscultation Chest X-ray show