医学常见的临床药师如何在呼吸内科做好用药监护及用药教育.ppt

首先我们还是来看看权威的GOLD是怎么说的， * 皮肤挫伤发生率增加 * * * Other Treatment Options for AECB More as a preventative measure, local irritants such as dust, pollutants, or cigarette smoke should be removed. Symptomatic therapy for exacerbations in chronic bronchitis include bronchodilator therapy which may slow the decline of lung function in those COPD patients who are bronchodilator responsive. Inhaled anticholinergic agents appear to produce greater bronchodilatation than inhaled ?-agonists. The role of long-acting inhaled ?-agonists is unclear but preliminary reports suggest that mild symptomatic improvement and small increases in pulmonary function are associated with their use (Balter and Grossman, 1997). Low-flow oxygen therapy should be administered if hypoxemia is present. It is important not to administer excess oxygen which may lead to progressive hypercapnia. The use of oral or IV corticosteroids is recommended for most patients with chronic bronchitis and demonstrable airflow obstruction during exacerbations. Although the optimal dose of corticosteroids is unknown, most clinicians prescribe prednisone in a daily dose of 30 to 40 mg, decreasing the dose to zero over the next 7 to 10 days. Theophylline products have less bronchodilator effect than ?2-agonists or anticholinergic agents (Balter and Grossman, 1997). (C) (D) (A) (B) mMRC 0-1 CAT 10 mMRC 2 CAT 10 症状 如果mMRC 0-1 或 CAT 10: 症状较少(A or C) 如果mMRC 2 或CAT 10: 症状较多(B or D) 首先评估症状（根据mMRC或CAT评分） COPD全面评估 COPD的全面评估：患者症状 GOLD推荐mMRC(改良英国医学研究理事会)问卷，评估呼吸困难程度 COPD的全面评估：患者症状 COPD评估测试（CAT）：针对COPD健康状态损害、包含8个小项、一维的可靠检测方法，全球总分0-40分，与SGRQ关联度很高 COPD全面评估 风险 (气流受限GOLD 分级) 风险 (急性加重病史) 2 1 0 (C) (D) (A) (B) mMRC 0-1 CAT 10 4 3 2 1 mMRC 2 CAT 10 症状(mMRC or CAT评分)) 如果 GOLD 1 或 2 和每年 仅0 或1次急性加重: 低危 (A 或 B) 如果GOLD 3 或 4 或 每年 2次或以上急性加重:高危 (C 或 D) 其次评估风险（气流受限GOLD分级和急性加重病史） 分组 特征 肺功能分级 每年急性加重次数 CAT A 低风险，症状少 GOLD 1-2 ≤1 10 B 低风险，症状多 GOLD 1-2 ≤1 ≥10 C