【文章內(nèi)容簡(jiǎn)介】 污染, 廚房通風(fēng)不佳等。這些因素在女性COPD 患者的發(fā)病中尤為重要。,第三十四頁(yè)，共九十二頁(yè)。,COPD 的治療(zh236。li225。o)——藥物,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第三十五頁(yè)，共九十二頁(yè)。,支氣管擴(kuò)張劑是用來(lái)改善肺功能FEV1 或改善 其他(q237。tā)肺功能參數(shù)的藥物, 其主要是通過(guò)改變氣道平滑肌的張力以擴(kuò)張支氣管, 而不能改善肺彈性回縮力, 因而這類藥物稱為“支氣管擴(kuò)張劑” 主要的支氣管擴(kuò)張劑：beta2agonists, anticholinergics, theophylline or combination therapy.,支氣管擴(kuò)張劑,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第三十六頁(yè)，共九十二頁(yè)。,支氣管擴(kuò)張劑在COPD 穩(wěn)定期中的應(yīng)用(y236。ngy242。ng),支氣管擴(kuò)張劑是控制COPD 癥狀的主要治療措施 首選吸入療法 如何選擇β2 激動(dòng)劑、抗膽堿能藥、茶堿類或聯(lián)合使用, 取決于藥物是否可以獲得以及不同(b249。 t243。nɡ)個(gè)體的反應(yīng)( 包括癥狀是否能控制、不良反應(yīng)等) 短期按需使用支氣管擴(kuò)張劑可緩解癥狀, 長(zhǎng)期規(guī)律使用可預(yù)防和減輕癥狀 吸入長(zhǎng)效支氣管擴(kuò)張劑更為方便, 而且效果更好 與應(yīng)用一種支氣管擴(kuò)張劑的劑量相比, 聯(lián)合應(yīng)用多種支氣管擴(kuò)張劑可以增加療效, 減少不良反應(yīng),第三十七頁(yè)，共九十二頁(yè)。,磷酸二酯酶4 抑制劑 In patients with severe and very severe COPD (GOLD 3 and 4) and a history of exacerbations and chronic bronchitis, the phospodiesterase4 inhibitor (PDE4), roflumilast, reduces exacerbations treated with oral glucocorticosteroids.,Global Strategy for Diagnosis, Management and Prevention of COPD Therapeutic Options: Phosphodiesterase4 Inhibitors,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第三十八頁(yè)，共九十二頁(yè)。,茶 堿,目前, 關(guān)于甲基黃嘌呤類藥物的具體作用還存在爭(zhēng)議。甲基黃嘌呤是非選擇性的磷酸二酯酶抑制劑, 除支氣管擴(kuò)張作用外, 還有其他(q237。tā)一些非支氣管擴(kuò)張劑的作用, 但仍有爭(zhēng)議。 低劑量茶堿能減少COPD 患者急性加重發(fā)作, 但不能增加應(yīng)用支氣管擴(kuò)張劑后的肺功能。 不良反應(yīng): 不良反應(yīng)與劑量相關(guān)。,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第三十九頁(yè)，共九十二頁(yè)。,吸入糖皮質(zhì)激素(ICS) 可以改善癥狀，肺功能(gōngn233。ng)，生活質(zhì)量，減少急性加重的次數(shù)。,吸入糖皮質(zhì)激素,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第四十頁(yè)，共九十二頁(yè)。,在重度COPD患者中推薦(tuīji224。n)聯(lián)合ICS和LABA/LAMA . 可以減少肺炎的風(fēng)險(xiǎn),聯(lián)合(li225。nh233。)治療,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第四十一頁(yè)，共九十二頁(yè)。,避免長(zhǎng)期(ch225。ngqī)使用全身糖皮質(zhì)激素,Therapeutic Options: Systemic Corticosteroids,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第四十二頁(yè)，共九十二頁(yè)。,Influenza vaccines can reduce serious illness. Pneumococcal polysaccharide vaccine is recommended for COPD patients 65 years and older and for COPD patients younger than age 65 with an FEV1 40% predicted. The use of antibiotics, other than for treating infectious exacerbations of COPD and other bacterial infections, is currently not indicated.,Global Strategy for Diagnosis, Management and Prevention of COPD Therapeutic Options: Other Pharmacologic Treatments,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第四十三頁(yè)，共九十二頁(yè)。,Oxygen Therapy: The longterm administration of oxygen ( 15 hours per day) to patients with chronic respiratory failure has been shown to increase survival in patients with severe, resting hypoxemia. Ventilatory Support: Combination of noninvasive ventilation (NIV) with longterm oxygen therapy may be of some use in a selected subset of patients, particularly in those with pronounced daytime hypercapnia.,Global Strategy for Diagnosis, Management and Prevention of COPD Therapeutic Options: Other Treatments,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第四十四頁(yè)，共九十二頁(yè)。,Lung volume reduction surgery (LVRS) is more efficacious than medical therapy among patients with upperlobe predominant emphysema and low exercise capacity. LVRS is costly relative to healthcare programs not including surgery. In appropriately selected patients with very severe COPD, lung transplantation has been shown to improve quality of life and functional capacity.,Global Strategy for Diagnosis, Management and Prevention of COPD Therapeutic Options: Surgical Treatments,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第四十五頁(yè)，共九十二頁(yè)。,Global Strategy for Diagnosis, Management and Prevention of COPD, 2014: Major Chapters,Definition and Overview Diagnosis and Assessment Therapeutic Options Manage Stable COPD Manage Exacerbations Manage Comorbidities,UPDATED 2013,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第四十六頁(yè)，共九十二頁(yè)。,Relieve symptoms Improve exercise tolerance Improve health status Prevent disease progression Prevent and treat exacerbations Reduce mortality,Manage Stable COPD: Goals of Therapy,169。 2013 Global Initiative for Chronic Obstructive Lung Disease,第四十七頁(yè)，共九十二頁(yè)。,Avoidance of risk factors smoking cessation reduction of indoor pollution reduction of occup