COPD治疗-从指南到临床实践精选.pptVIP

药物安全性 * * The loss of elasticity and alveolar attachments has significant consequences in COPD patients. In normal expiration, the small airways narrow, but are prevented from closing due to the tethering provided from alveolar attachments. In COPD, a progressive loss of elastic recoil results in greater airway collapse and hence narrowing of the small airways during expiration. Air trapping and hyperinflation are exhibited in spirometry by increases in total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC), and decreases in inspiratory capacity (IC), and inspiratory reserve volume (IRV). Dyspnea results and physical activity can become limited. * * Realize the importance of hyperinflation. Barrel-shaped chest. EILV: 吸气末肺容积，EELV（FRC,平静呼气末肺内残留的气体量）：呼气末肺容积 RIV，inspiratory reserve volum：补吸气容积,从平静吸气末开始进行最大吸气所能吸入的最大气体容量。 Slide illustrates static hyperinflation Represents increase in EELV (FRC), RV or air trapping and TLC During a variety of maneuvers, e.g. exercise, IC can be used to assess EELV and quantitate the degree of hyperinflation * 1Cooper CB. The connection between chronic obstructive pulmonary disease symptoms and hyperinflation and its impact on exercise and function. Am J Med 2006; 119:S21-S31 2Casanova C, Cote C, de Torres J, et al. Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171:591-597. 3Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease Report. Updated 2006. Available at: . Accessed November 15, 2006. COPD Cycle of Decline We have just worked through how patients experience air trapping and hyperinflation with exertion. As we can see, these events are part of a cycle that produces a downward spiral that can ultimately decrease the quality of life for COPD patients. Air-trapping sits in the core of the whole