2011GOLD更新--办公室.pptVIP

* 与健康状况相关性良好及可预测未来死亡风险 * * * COPD管理包括不同药物联合治疗，药物治疗和非药物治疗的联合治疗 目前指南推荐，支气管扩张剂是COPD对症治疗的核心，添加ICS用于治疗未来有高风险患者 * Exacerbations or intermittent worsenings of the disease have a significant impact on patients. Frequent exacerbations are associated with impaired HRQL1 and a more rapid decline in lung function over time.2 Patients who are hospitalized with exacerbations of COPD have a poor prognosis.3 As well as the burden to the patient, the cost of additional medication and/or hospitalization for exacerbations of COPD add to the financial cost of treating COPD.4 Spencer S, Calverley PM, Burge PS, et al. Impact of preventing exacerbations on deterioration of health status in COPD. Eur Respir J. 2004;23(5):698-702. Donaldson GC, Seemungal TA, Bhowmik A, et al. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002;57(10):847-852. Gunen H, Hacievliyagil SS, Kosar F, et al. Factors affecting survival of hospitalised patients with COPD. Eur Respir J. 2005;26(2):234-241. Wouters EF. Economic analysis of the Confronting COPD survey: an overview of results. Respir Med. 2003;97 (Suppl C):S3-S14. Hypothesis: We reasoned that exacerbations affect the BODE index and its components, and that changes in the BODE index could be used to monitor the effect of exacerbations on the host. Study design: Prospective observational study in a Veterans Affairs medical center. Methods: We studied 205 patients with COPD (mean [ SD] FEV1, 43 15% predicted), and recorded the body mass index, FEV1 percent predicted, modified Medical Research Council dyspnea scale, 6-min walk distance, and the BODE index at baseline, during the exacerbation, and at 6, 12, and 24 months following the first episode, and documented all exacerbations for 2 years after the first acute exacerbation. Results: From the cohort, 130 patients (63%) experienced 352 exacerbations or (0.85 exacerbations per patient per year); 48 patients (23%), experienc