复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）呼吸系统_COPD

复旦大学附属中山医院 呼吸科暨呼吸病研究所 上海市重点学 Chronic obstructive Pulmonary Disease Jing ZHANG(张静),MD,PhD zhang jing@zs-hospitalshcn Department of Pulmonary Medicine Zhongshan Hospital Fudan University MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital Chronic Obstructive Pulmonary Disease Jing ZHANG (张静), MD, PhD zhang.jing@zs-hospital.sh.cn Department of Pulmonary Medicine Zhongshan Hospital Fudan University

OUTLINE Definition of coPd ° Epidemiology Etiology and risk factors Pathophysiology mechanisms Clinical manifestation How to make the diagnosis and assess the severity of disease Management of stable copd and AEcoPD Prevention MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital OUTLINE • Definition of COPD • Epidemiology • Etiology and risk factors • Pathophysiology mechanisms • Clinical manifestation • How to make the diagnosis and assess the severity of disease • Management of stable COPD and AECOPD • Prevention

GOLD Global Initiative for chronic Obstructive Lung NITIA Disease Global strategy for Diagnosis, Management and Prevention of copd CTIVE MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital GOLD • Global Initiative for Chronic Obstructive Lung Disease • Global Strategy for Diagnosis, Management and Prevention of COPD

Definition COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients Its pulmonary component is characterized by airflow limitation that is not fully reversible The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital Definition • COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. • Its pulmonary component is characterized by airflow limitation that is not fully reversible. • The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases

Epidemiology COPD is a leading cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and Increasing 1990 2020 Ischemic heart disease Cerebrovascular disease 一 COPD 263 Lower respiratory infection Lung cancer 10 Road traffic accidents Tuberculosis 2345678 Stomach cancer 14

Epidemiology • COPD is a leading cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. 1990 1 2 6 3 10 9 7 14 Ischemic heart disease Cerebrovascular disease COPD Lower respiratory infection Lung cancer Road traffic accidents Tuberculosis Stomach cancer 2020 1 2 3 4 5 6 7 8

The mortality of coPD is increasing! Proportion of 1965 Rate 3.0 Coronary Stroke Other CVD COPD All Other 25 Heart Causes Disease 20 15 1.0 05 59% 64% 35% +163% 0 1965-19981965-19981965-19981965-19981965-1998 Source: NHLBI/NIH/DHHS MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital The mortality of COPD is increasing! 0 0.5 1.0 1.5 2.0 2.5 3.0 Proportion of 1965 Rate 0.0 0.5 1.0 1.5 2.0 2.5 3.0 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 –59% –64% –35% +163% –7% Coronary Heart Disease Stroke Other CVD COPD All Other Causes Source: NHLBI/NIH/DHHS

Prevalence of copd in china BOLD Study Overall prevalence: 8.2% ·>43 milion Urban Rural口 Total 14 121127124 12 oo 10 8.8 7.8 8.2 4.95.45.1 2 Male Female Total Nanshan Zhong et al. Am J Respir Crit Care Med 2007, 176: 753-760 MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital Prevalence of COPD in China --BOLD study • Overall prevalence: 8.2% • > 43 million Nanshan Zhong et al. Am J Respir Crit Care Med 2007, 176: 753-760 12.1 4.9 7.8 12.7 5.4 8.8 12.4 5.1 8.2 0 2 4 6 8 10 12 14 Male Female Total prevalence of COPD(%) Urban Rural Total * #

In china COPD the third leading cause of death in rural and the fourth in urban in 2008 the second leading cause of DALYs lost in2001 Incidence and mortality is increasing MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital In China • COPD —the third leading cause of death in rural and the fourth in urban in 2008 —the second leading cause of DALYs lost in 2001 • Incidence and mortality is increasing

WORLD COPD DAY November 14.2007 CHRONIC OBSTR 四PF=<m GOLD Raising COPD Awareness Worldwide

WORLD COPD DAY November 14, 2007 Raising COPD Awareness Worldwide

Risk factors for coPd Nutrition Cigarette smoke Occupational dust and chemicals Infections Environmental tobacco smoke(ETs) Socio-economic status Indoor and outdoor air pollution N Aging Populations Genetic Susceptibility MBBS project, Zhongshan Hospital

MBBS project, Zhongshan Hospital Risk factors for COPD Nutrition Infections Socio-economic status Aging Populations Genetic Susceptibility