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COPD

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ISOLDE enrolled patients with moderate to severe COPD ... ICS:ISOLDE trial. ICS:ISOLDE trial. Long-term inhaled corticosteroids ... – PowerPoint PPT presentation

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Title: COPD


1
COPD
  • ????? ???? MD. FCCP
  • ????????????
  • ??????????????????????

2
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3
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4
Fact about COPD
5
Burden of COPD
  • 2000 ????????????????? 2.74 ???????
  • 1990 COPD 12th ??????????????
  • 2020 5th(1999) 3rd (2001)

6
COPD in Thailand
  • ??????????????????????????????????????????????????
    ????????????? ??? ????????????
  • ?.?.2530 ????????????????? 8.6 ?????? ?.?.2536
    10.4 ??????
  • ?.?.2544 13 ??????
  • ???????????? 15 ??????????????????????????????????
    ???????????????????????????????
  • New case of COPD 500,000 ??/??

7
GOLD
8
Definition
  • Airflow limitation
  • not fully reversible
  • progressive
  • associated with abnormal inflammatory response
  • caused by noxious particles / gases

9
COPD vs Asthma
10
COPD vs Asthma
11
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12
Management
13
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14
COPD-smoking
15
????????????????????? COPD ??????????????????????
16
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17
FEV1lt30
FEV1 30-80
FEV1gt 80
COPD
????????????????
bronchodilator
Rehabilitation Inhaled corticosteroid
Long term O2 surgery
18
Classification(severity)
19
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20
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21
Bronchodilator
22
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23
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24
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25
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26
Long acting beta-2
  • 780 patients with COPD ,FEV1 45
  • 12 wk formoterol 12 or 24 µg BID
  • ipratropium bromide 40 µg QID
  • Placebo
  • multicenter, double-blind, parallel-group study
  • formoterol is more effective than ipratropium
    bromide

27
  • Am. J. Respir. Crit. Care Med., 164, 5, Sept
    2001, 778-784

28
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29
Quality of life
30
Methylxanthines
  • ??????????????????????????????????????????????
  • ????????????????????
  • ????????? cardiac output
  • ?????? pulmonary vascular resistance
  • ???????????????????????
  • severe Disease cor pulmonale
  • ??????? Compliance ?????

31
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32
Corticosteroids
  • Corticosteroids
  • ???????????????????? asthma
  • COPD ?????????????????????????
  • steroid ??? ??? ??? ???

33
Corticosteroids
  • COPD ???? acute exacerbation ?? steroid
    ???????????????????????????? ????????????????
    1-2 ??????? ?????????????????????????????????????
    ????????????????
  • ????????? stable COPD ????????????? 15-20
    ???????????????????? oral corticosteroid ?????
    FEV1 ????????????? 20

34
Long-term inhaled corticosteroids
  • Copenhagen City Lung Study randomized 290
    patients
  • EUROSCOP evaluated 912 current smokers with mild
    to moderate COPD
  • ISOLDE enrolled patients with moderate to severe
    COPD
  • The Lung Health Study enrolled 1116 patients

35
ICSISOLDE trial
36
ICSISOLDE trial
37
Long-term inhaled corticosteroids
  • not having a significant effect on the rate of
    decline in spirometric indices
  • decrease the number of exacerbations and the rate
    of decline in health status
  • reduce respiratory symptoms
  • decrease use of health care services
  • improve airway reactivity
  • These effects appear more marked in patients with
    moderate-to-severe disease
  • Med Health R I 2002 Feb85(2)52-5

38
inhaled corticosteroids
  • Ontario, Canada (n 22,620)
  • inhaled corticosteroid therapy postdischarge
  • 24 fewer repeat hospitalizations for COPD
  • 29 less likely to experience mortality during 1
    yr of follow-up
  • inhaled corticosteroid therapy is associated with
    reduced COPD-related morbidity and mortality in
    elderly patients
  • Am J Respir Crit Care Med 2001 Aug 15164(4)580-4

39
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40
Long-term O2 Rx
41
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42
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43
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44
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45
Lung reduction surgery
46
Objective of Rx
  • ?????progress ??????
  • ?????????????????
  • ????? exercise tolerance
  • ??????????????? exacerbation
  • ??????????????? complication
  • ???????????????????
  • ???????????????????????

47
FEV1lt30
FEV1 30-80
FEV1gt 80
COPD
????????????????
bronchodilator
Rehabilitation Inhaled corticosteroid
Long term O2 surgery
48
??????????
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