1、Grazie per aver scelto di utilizzare a scopo didattico questo materiale delle Guidelines 2011 libra.Le ricordiamo che questo materiale di propriet dellautore e fornito come supporto didattico per uso personale.PHARMACOLOGICAL MANAGEMENT OF COPD IN PATIENTS WITH CHRONIC CO-MORBIDITIESProfessor Peter
2、CalverleyUniversity Hospital AintreeLiverpoolUKA RUMSFELD MOMENT!u Does having COPD influence the choice of therapy for a co-morbidity?u Does taking a treatment for a co-morbidity improve the outcome in COPD?u Does taking a treatment for COPD affect the co-morbidity?BETA BLOCKERS AND COPDu Good data
3、 for the benefits of selective beta-blockade in congestive heart failure, rate control of AFu Longstanding worry that beta-blockade might precipitate bronchospasmu So most people avoided beta-blockers in COPDu Now we have evidence for safety and a reason why this is the caseBETA-BLOCKERS, COPD AND V
4、ASCULAR SURGERYu 1205 COPD patients, 462 receiving therapy with BB pre-surgeryVan Gestel et al AJRCCM 2008Why COPD is not asthma bronchodilator testing is not helpfulChange in FEV1 (L), Post-bronchodilatorSubject GroupPercentSmoker ControlsPercentNon-smoker ContrPercentCOPD Subjects35302520151050353
5、02520151050353025201510500.150.05-0.65 -0.55 -0.25 -0.05 0.25 0.35 0.45 0.55 0.65 0.75 0.85 0.95 1.05 1.15 1.25 1.35-0.45 -0.35 -0.15THE STATIN STORYSTATINS AND COPD OUTCOMES IN LOW RISK PATIENTSMancini et al JACC 2006STATINS AND EXACERBATIONSMortenson E et al Respir Res 2009Systemic Effects of COPD:Target Organs Lung Infections Lung CancerWeight lossMuscle weaknessOsteoporosisAngina Acute coronary syndromesDepressionDiabetesMetabolic syndromeSystemic InflammationOxidatitive Stress DepressionPeptic ulceration/refluxFrom W MacNee
