醫(yī)學交流課件：GOLD 2017 and individual therapyfrom bench to bedside

1、GOLD 2017 and individual therapy:from bench to bedside Disclosures Research grants/clinical trials:AstraZeneca, GSK, Menarini, MSD Lector for:AstraZeneca, Boheringer-Ingelheim, Chiesi, Menarini, Teva, Novartis, GSK, Kyorin Member of scientific (advisory) board: AstraZeneca, Boheringer-Ingelheim,Chie

2、si, GSK, Novartis Consultant:None Employer (including part-time):None Tobacco Industry relationship:None Summary of new recommendations GOLD 2017 1. Definition Impact of respiratory symptoms Lung tissue and airway abnormalities. 2. Risk factors Environmental exposures Host factors (early-life events

3、) 3. Spirometry YES: Diagnosis, Prognosis, Follow-up 13: S466-S70. Summary of new recommendations GOLD 2017 1. Definition Impact of respiratory symptoms Lung tissue and airway abnormalities. 2. Risk factors Environmental exposures Host factors (early-life events) 3. Spirometry YES: Diagnosis, Progno

4、sis, Follow-up & Non- pharmacological tx. NO: Pharmacological tx. 4. ABCD assessment tool Symptoms + Exacerbations Escalation/de-escalation 5. Others Non-pharmacological treatment Exacerbations Comorbidities 6. References Updated and checked for accuracy. Spirometry: Its role in COP

5、D 1.Diagnosis: essential in the appropriate clinical context FEV1/FVC 1 leading to hospital admission 1 (not leading to hospital admission) 0 Symptoms CD AB CAT 10 Breathlessness mMRC 01mMRC 2 Diagnosis CD AB mMRC 0-1 CAT 2 or 1 leading to hospitalization 0 or 1 (not leading to hospital admission) G

6、radeFEV1 (% pred.) 180 250-79 330-49 430 FEV1/FVC0.7 Assessment of airflow limitation Assessment of symptoms/risk of exacerbations + = The refined ABCD assessment tool GOLD 2017 Example: Consider Two Patients Both with FEV1 30% and CAT scores of 18 One no AECOPD / the other 3 AECOPD

7、 Both labelled GOLD D in prior classification scheme CD AB GradeFEV1 (% pred.) 180 250-79 330-49 430 AB CD 3 AECOPDs - GOLD 4, Category D No AECOPDs- GOLD 4, Category B (GOLD 2011)(GOLD 2017) Summary of new recommendations GOLD 2017 1. Definition Impact of respiratory symptoms Lung tissue and airway

8、 abnormalities. 2. Risk factors Environmental exposures Host factors (early-life events) 3. Spirometry YES: Diagnosis, Prognosis, Follow-up & Non- pharmacological tx. NO: Pharmacological tx. 4. ABCD assessment tool Symptoms + Exacerbations Escalation/de-escalation 5. Others Non-pharmacological treat

9、ment Exacerbations Comorbidities 6. References Updated and checked for accuracy. Group AGroup B Group CGroup D A bronchodilator Continue, stop or try alternative class of bronchodilator Evaluate effect A long-acting bronchodilator (LABA or LAMA) LAMA + LABA Persistent symptoms LAMA LAMA + LABA Further Exacerbation(s) LABA + ICS LAMA + LABA Consider rolumilast if FEV1 50% pred and patient has chronic bronchitis Further Exacerbation(s) Consider macrolide LAMALABA + ICS LAMA + LABA + ICS Further Exacerbation(s) Persistent symptoms/further exacerbations mMRC 0-1 C