COPD

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COPD

• ????? ???? MD. FCCP
• ????????????
• ??????????????????????

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Fact about COPD
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Burden of COPD

• 2000 ????????????????? 2.74 ???????
• 1990 COPD 12th ??????????????
• 2020 5th(1999) 3rd (2001)

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COPD in Thailand

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

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GOLD
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Definition

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

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COPD vs Asthma
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COPD vs Asthma
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Management
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COPD-smoking
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????????????????????? COPD ??????????????????????
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FEV1lt30
FEV1 30-80
FEV1gt 80
COPD
????????????????
bronchodilator
Rehabilitation Inhaled corticosteroid
Long term O2 surgery
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Classification(severity)
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Bronchodilator
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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

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

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Quality of life
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Methylxanthines

• ??????????????????????????????????????????????
• ????????????????????
• ????????? cardiac output
• ?????? pulmonary vascular resistance
• ???????????????????????
• severe Disease cor pulmonale
• ??????? Compliance ?????

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Corticosteroids

• Corticosteroids
• ???????????????????? asthma
• COPD ?????????????????????????
• steroid ??? ??? ??? ???

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Corticosteroids

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

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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

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ICSISOLDE trial
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ICSISOLDE trial
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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

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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

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Long-term O2 Rx
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Lung reduction surgery
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Objective of Rx

• ?????progress ??????
• ?????????????????
• ????? exercise tolerance
• ??????????????? exacerbation
• ??????????????? complication
• ???????????????????
• ???????????????????????

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