常见的《慢阻肺诊断、治疗与预防全球倡议(GOLD)》2018版.ppt

《慢阻肺诊断、治疗与预防全球倡议（GOLD）》2018版解读 要点概述 1. GOLD 2018沿用了GOLD 2017对慢阻肺和AECOPD的定义，维持了慢阻肺综合评估以及稳定期药物治疗推荐，主要对各章节的循证证据进行了更新。 2. 支气管扩张剂仍是慢阻肺稳定期治疗的基石用药：唯有LAMA是所有分组患者的首选单药治疗药物；LAMA预防急性加重优于LABA；LAMA/LABA联用是B-D组患者的推荐用药。 3. 适合以ICS/LABA作为起始治疗药物的患者限于某些特定亚型的患者人群。 第一章：定义和概述 GOLD 2018维持了GOLD 2017对慢阻肺的定义：“慢阻肺是可防可治的常见病，以持续性呼吸道症状和气流受限为特点，常与有毒颗粒或气体的显著暴露引起的气道和/或肺泡异常有关”。 慢阻肺的病理生理学 1、医学研究委员会国家卫生与发展调查发现，在43岁时，肺功能受吸烟和婴幼儿呼吸道感染以及童年家庭过度拥挤的协同交互作用影响。 The Medical Research Council National Survey of Health and Development recently documented a synergistic interaction between smoking and infant respiratory infection as well as early life home overcrowding with lung function at age 43. (Allinson et al., 2017) 2、来自我国的一项横断面研究显示，周围环境的PM 2.5/10 水平与慢阻肺患病率相关。 A recent cross-sectional analysis from China showed an association between ambient levels of particulate matter (PM2.5/10) and COPD prevalence. (Liu et al., 2017). 3、局部 IgA 缺乏与细菌移位、小气道炎症以及气道重塑相关。 A recent study suggests that local IgA deficiency is associated with bacterial translocation, small airway inflammation and airway remodeling. (Polosukhin et al., 2017) 4、即使在轻度慢阻肺，或易发生肺气肿的吸烟人群，其肺部微血管血流存在显著异常，并随疾病进展而恶化。 Even in mild COPD, or in smokers susceptible to emphysema, (Alford, van Beek, McLennan, Hoffman, 2010; Iyer et al., 2016) there are significant abnormalities in pulmonary microvascular blood flow that worsen with disease progression. (Peinado, Pizarro, Barbera, 2008). 第二章：诊断和起始评估慢阻肺的诊断 在利用肺功能检查评价气流受限时，考虑到某些患者在下一次测量时FEV1/FVC会随生理性变化而改变，若使用支扩剂后FEV1/FVC介于0.6-0.8，应在另一场合再次测量以确诊。 Assessment of the presence or absence of airflow obstruction based on a single measurement of the post-bronchodilator FEV1/FVC ratio should be confirmed by repeat spirometry on a separate occasion if the value is between 0.6 and 0.8, as in some cases the ratio may change as a result of biological variation when measured at a later interval (Aaron et al., 2017; Schermer et al., 2016) If the initial post-bronchodilator FEV1/FVC ratio is less than 0.6 it is very unlikely t