2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1 1 ( 2011 ) ( 100730) 2001 1 ( COPD), 10, 10 COPD 2011 Global :, E-mail: caibq2009 @ hotmail. com strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease ( Revised 2011) [ 1] ( ), COPD COPD COPD, : GOLD: GOLD Global Initiative for Chronic Obstructive Lung Disease, GOLD, 1998, COPD ; COPD, Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, GOLD, GOLD COPD, GOLD 2001 COPD COPD COPD,, COPD COPD, COPD, ( Executive Summary), 2001 COPD, GOLD, COPD, COPD, GOLD COPD 2001 1 2002 12, 2003 7 COPD 2004 7, 2005 7 2005 1 GOLD COPD, 2006, COPD 2006, COPD 2009 GOLD COPD, COPD, COPD 2011 11 16 ( APSR) COPD ( 2011 ) COPD 2011 COPD COPD COPD : COPD,, COPD, COPD : COPD,,,, COPD ( ), ( ), COPD COPD
2 2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1 COPD : ;, COPD ( AECOPD) COPD COPD, COPD, FEV 1 COPD, COPD COPD, COPD FEV 1,, COPD, FEV 1 2011 COPD, ( Stage ), ( Grade) COPD,,,, ( ),,, COPD, COPD, COPD, COPD 1. COPD :,, COPD ( 1) COPD, FEV 1 / FVC < 0. 70, COPD, FEV 1 /FVC < 0. 70 ( FEV 1 / FVC),, COPD,, <45 COPD 1 COPD 40,, COPD, COPD,, COPD ( ) COPD ( ) ( ) 2. COPD :, COPD ( 2), COPD COPD, COPD 2 COPD ; ; ( ) ; ; ; / ; X ; ( ) ; ; ; CT ; ; ;, ;, CT, ; ; X HRCT 3. COPD : 2011, COPD COPD
2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1 3 COPD,, ( ), COPD 4, ( 1) : MRC ( modified british medical research council, mmrc ) COPD ( COPD assessment test, CAT) COPD mmrc( 3) CAT 3 MRC ( mmrc) mmrc mmrc mmrc 0 mmrc 1 ( 3) :, 2 FEV 1 % pred <50%, ( 4) : COPD,,, ( 5) COPD : COPD,, COPD, ( 1) ( 5) mmrc 2 mmrc 3 mmrc 4, 100, COPD ( CAT) 8, COPD 0 40, CAT ( SGRQ), ( http: / / www. catestonline. org) ( 2) :, FEV 1 80% 50% 30% COPD 4 ( Grades), : GOLD 1, GOLD 2, GOLD 3, GOLD 4 COPD ( Stage), FEV 1 COPD,, COPD GOLD 4 ( 4) 4 COPD ( FEV 1 ) GOLD FEV 1 /FVC < 0. 70 GOLD 1: FEV 1 % pred 80 % GOLD 2: 50% FEV 1 % pred < 80 % GOLD 3: 30% FEV 1 % pred < 50% GOLD 4: FEV 1 % pred < 30 % 1 COPD, mmrc CAT, mmrc 2 CAT 10 CAT, CAT, CAT, mmrc, AECOPD GOLD, : GOLD 3 4, 1 2 2,,
4 2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1 1 COPD, mmrc CAT ( mmrc 0 1 CAT <10: A C) ; ( mmrc 2 CAT 10: B D), ; : ( GOLD 1 GOLD 2, GOLD 3 GOLD 4 ) ; 12 ( 0 1, 2 2 ) : CAT 18, FEV 1 45% ; 12 3 CAT ( CAT 10), B D GOLD 3 ( ), 12 3, D, COPD ( 5) : A :, GOLD 1 GOLD 2( ) / 0 1 mmrc 0 1 CAT < 10 B :, GOLD 1 GOLD 2( ) / 0 1 mmrc 2 CAT 10 C :, GOLD 3 GOLD 4( ) / 2 mmrc 0 1 CAT < 10 D :, GOLD 3 GOLD 4( ) / 2 mmrc 2 CAT 10 5 COPD mmrc CAT A, GOLD 1 2 1 0 1 < 10 B, GOLD 1 2 1 2 10 C, GOLD 3 4 2 0 1 < 10 D, GOLD 3 4 2 2 10 :, GOLD 3 4, FEV 1, CAT 10, GOLD 3 4, COPD COPD,, 1. : COPD ( 3 ) COPD, COPD : COPD ( 4 ), COPD ( 5 ), COPD ( 6 ) COPD, COPD COPD, COPD COPD,,, COPD, : 5 ( 6),,, 6 1. ( ASK) :, 2. ( ADVISE) :, 3. ( ASSESS) : ( 30 d ) 4. ( ASSIST) : ; ; ; ; ; 5. ( ARRANGE) :,
2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1 5 2. COPD : COPD, COPD, FEV 1 COPD, ( ),, COPD,, COPD 7 ( 1) FEV 1,,,, FEV l, COPD 7 2011 COPD COPD ( g) ( mg /ml) ( mg) ( h) 2 2 ( Fenoterol) 100 200 ( MDI) 1 0. 05% 4 6 ( Levalbuterol) 45 90( MDI) 0. 21, 0. 42 6 8 ( Salbutamol) 100, 200( MDI & DPI) 5 5 mg( ) 0. 024% 0. 1, 0. 5 4 6 ( Terbutaline) 400, 500( DPI) 2. 5, 5 mg( ) 4 6 2 ( Fomoterol) 4. 5 12( MDI & DPI) 0. 01 12 ( Arformoterol) 0. 0075 12 ( Indacaterol) 75 300( DPI) 24 ( Salmeterol) 25 50( MDI & DPI) 12 ( Tulobuterol) 2 mg( ) 24 ( Ipratropium bromide) 20, 40( MDI) 0. 25 0. 5 6 8 ( Oxitropium bromide) 100 ( MDI) 1. 5 7 9 ( Tiotropium) 18( DPI), 5( SMI) 24 2 / ( Fenoterol/ Ipratropium) ( Salbutamol/ Ipratropium) ( Methylxanthines) 200 /80( MDI) 1. 25 /0. 5 6 8 75 /15( MDI) 0. 75 /0. 5 6 8 ( Aminophylline) 200 600 mg( ) 240, 24 h Theophylline( SR) 100 600 mg( ), 24 h ( Beclomethasone) 50 400( MDI & DPI) 0. 2 0. 4 ( Budesonide) 100, 200, 400( DPI) 0. 20, 0. 25, 0. 5 ( Fluticasone) 2 / / ( Fomoterol / Budesonide) / ( Salmeterol / Fluticasone) ( Prednisone) ( Methylprednisolone) -4( PDE-4 ) ( Roflumilast) 50 500( MDI & DPI) 4. 5 /160( DPI), 9 /320 ( DPI) 50 /100, 250, 500 ( DPI), 25 /50, 125, 250( MDI) : MDI = ; DPI = ; SMI = 5 60 mg( ) 4, 8, 16 mg( ) 500 g( ) 24
6 2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1 COPD,, ( 8) FEV 1, -, 2,, M3 M1,,,,, :,,,, 8 COPD COPD 2, ( ),,,, 2 : 2 4 6 h 2 FEV 1, 2, COPD, 2 FEV 1,,,, 2, 24 h, FEV 1, : 2 2, 2,,, 18 g,,, COPD, Respimat Handihaler, :,,,, COPD,,,,,,,, COPD,,,, 2 ( ),, COPD,, 2, COPD 2 : 2, 8 h, 24 h :, : ( ) ( ),
2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1 7, :, :,, 2 FEV 1 2 /, FEV 1 ( 2) : - -, COPD, COPD, COPD, FEV 1 % pred < 60% COPD,,, FEV 1, COPD :, ( triamcinolone),, COPD, 500 g, 2, / : COPD, 2,, 2, 2 /,, ( 3) -4 : -4 camp -4 1,, FEV 1, COPD, 15% 20%, ( 4) : COPD, COPD 65 < 65 FEV 1 % pred < 40% COPD, COPD 1 : 1,, 1, 1 COPD, : COPD 1,,,,, COPD, COPD (, ) :,,, COPD N-,, N-, : COPD,
8 2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1, :,, COPD, : COPD,,, ( NO), COPD, -, ( ), NO -,, COPD NO, COPD ( ) : COPD, ( opioids),, : COPD,, 3. COPD ( 1) COPD : COPD, FEV 1, COPD,,, COPD, COPD 2,, COPD, FEV 1 % pred < 50%, COPD, ( ) COPD,, COPD, AECOPD COPD,,, ( 2) : COPD,,,,, 3, 3 ( FEV 1 % pred), FEV 1, COPD COPD :, COPD : ( 9),, COPD, 9 COPD A ( ) B C D ( ) COPD :, 4 COPD ( 10) A :, FEV 1 % pred > 80% ( GOLD 1), A,, B :,,,
2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1 9 10 COPD ( First choice) ( Second Choice) ( Alternative Choice) A SAMA LAMA LABA SAMA SABA SABA B LAMA LABA LAMA LABA SABA / SAMA; C ICS /LABA LAMA LAMA LABA PDE-4 ; SABA / SAMA; D ICS /LABA LAMA ICS LAMA; ICS/LABA LAMA; ICS/LABA PDE-4 ; LAMA LABA; LAMA PDE-4 ; SABA / SAMA; 1 : SABA: 2 ; SAMA: ; LABA: 2 ; LAMA: ; ICS: ; PDE-4 : 2:, 3:,,, C : 2,, 2,,, D : C, ( + 2 + ),,,, : 2, 2 2,, COPD,,,, COPD, 4. AECOPD COPD AECOPD : AECOPD,,, AECOPD ( ), AECOPD AECOPD ( 1) AECOPD : ( 11) AECOPD 11 AECOPD AECOPD COPD ( 2) AECOPD : :
10 2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1 2, 2, FEV 1, MDI,,, ( FEV 1 ) ( PaO 2 ),, 30 40 mg/d, 10 14 d, AECOPD,, 5 7 d COPD COPD, 88% 92%,,,, AECOPD,,,, : 12 :, 88% 92%, 30 60 min Venturi ( ),, :,,,,,, ( NIV) 13 12 AECOPD( ) / 2, (, ) : ( ) : 13 ( ph 7. 35 / PaCO 2 > 45 mm Hg, ;, ; : 1 mm Hg = 0. 133 kpa :, PaO 2 PaCO 2 ph,,, 14 14 NIV NIV ( NIV), < 50 /min, ; ;, NIV NIV NIV ( NIV) AECOPD :, COPD COPD, COPD, COPD COPD,,, COPD, AECOPD
2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1 11 1. : ( CVD) COPD, COPD CVD : ( 1) ( IHD) : COPD IHD, COPD, IHD COPD COPD IHD : IHD COPD IHD IHD, IHD 1, 1,, COPD IHD COPD : COPD, IHD COPD, 2 ( 2) ( HF) : HF COPD 30% COPD HF, HF AECOPD, 30% HF COPDCOPD HF HF COPD, COPD HF : HF HF, COPD HF 1 HF, COPD, COPD, HF, 1, ( bisoprolol) COPD HF, FEV 1, 1 1 HF, COPD HF COPD : COPD, HF COPD, HF 2, HF COPD ( 3) ( AF) : AF, COPD AF COPD AF, COPD AF : AF AF, COPD AF, 1 ( ) AF COPD : COPD, AF COPD, 2, ( 4) : COPD,, COPD :, COPD, COPD, 1 COPD : COPD, COPD 2. : COPD,, COPD, COPD, COPD, COPD, COPD, ( triamcinolone),, ( budesonide) ( fluticasone),, COPD, AECOPD 3. : COPD, FEV 1 SGRQ COPD, COPD, COPD
12 2012 1 11 1 Chin J Respir Crit Care Med, January 2012, Vol. 11, No. 1, 4. : COPD COPD, COPD, COPD, COPD,, 5. : COPD, COPD,, COPD,, COPD, COPD,,, 6. :, COPD,, COPD, 21 kg/ m 2 COPD, COPD, COPD 2011 COPD, COPD, FEV 1 / FVC < 0. 70 COPD, COPD COPD COPD COPD, 2011 COPD, COPD COPD, AECOPD 2 / AECOPD,,,,, COPD, COPD 1 GOLD Executive Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease ( Revised 2011 ). www. goldcopd. com ( : 2012-01 -05) ( : ) : : Stephen T Holgate( ) Peter Barners( ) : : : : ( ) ( ) ( ) ( ) Peter Calverley( ) Micheal A Matthay( ) Stephen Rennard( ) :