《COPD　素材》PPT课件

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1、NewadvancesinCOPDbetween2007and2008(startingfrom2006)PaulJonesMD,PhDProfessorofRespiratoryMedicineStGeorge’s,UniversityofLondonCOPDstaging(FEV1/FVC<0.70)Stage1MildFEV1≥80%predictedStage2ModerateFEV150–79%Stage3SevereFEV130–49%Stage4VerySevereFEV1<30%orwithrespiratoryfailurewww.gold

2、copd.comGOLDtreatmentguidelines2007www.goldcopd.comGOLD2006treatmentaimsRelievesymptomsImproveexercisetoleranceImprovehealthstatusPreventandtreatexacerbationsPreventdiseaseprogressionReducemortalityMinimizeside-effectswww.goldcopd.comInflammationinCOPDCD8+T-Lymphocytes*Adjustedform

3、ultiplicity(p=0.004unadjusted)Placebo(n=68)Seretide(n=55)04080120160200240280320Mediancells/mm2BaselineWeek12BaselineWeek12p=0.02*BarnesetalAJRCCM2006;173:736SFCreducesarangeofinflammatorycellsandmarkersBarnesetalAJRCCM2006;173:736Comparisonofeffectof3monthstreatmentwithSFC,FPorpla

4、ceboonairwaycellularityinCOPD(totaln=60)DifferenceincellcountsBourbeauetalThorax2007;62:938TORCH:StudyDesignSFC500/50bdFP500bdSalmeterol50bdPlaceboDuration=3years1,5331,5341,5241,5216112patients2weekrun-inITTpopulation(anyPRNorregularshort-actingbronchodliatorand/ortheophyline)Regi

5、ons*Australia,NewZealand,Argentina,Brazil,Chile,Mexico,SouthAfrica&CanadaRandomisedN=6184USA1401(23%)AsiaPacific(12%)(China244patients)EasternEurope1179(19%)WesternEurope1911(31%)Other*935(15%)FEV1DistributionofSeveritybyPost-bronchodilatorFEV10102030405060Severe≥5030to<50VerySeve

6、re<30%ofSubjects%PredictedModeratePostBronchodilatorFEV1(mL)Adj.MeanChangeFEV1024487296120156Time(Weeks)-150-100-50050100PlcSALFPSFCVerticalbarsrepresentstandarderrorsCalverleyetalNEJM2007;356:775GOLD2006COPDtreatmentaimsRelievesymptomsImproveexercisetoleranceImprovehealthstatusPre

7、ventandtreatexacerbationsPreventdiseaseprogressionReducemortalityMinimizeside-effectswww.goldcopd.comRateofdeclineofFEV1-60-50-40-30-20-100Placebop<0.01vsplacebop<0.001vsplacebo***SalmeterolFPSFC****Cellietal(ATSAbstractMay07)ChangeinFEV1(ml/yr)Neversmokers00.51.01.52.02.53.0Years0

8、24681012ChangeinSGRQScore(