1130712-肺阻塞照護新趨勢-講師：鄭孟軒社主任-社團法人高雄市醫師公會.pdf

日期：113年7月12日
主題：肺阻塞照護新趨勢
講師：高雄醫學大學附設醫院胸腔內科 鄭孟軒主任

1. This slide set is restricted for academic and educational purposes only. Use of the slide set, or of individual slides, for commercial or promotional purposes requires approval from GOLD.
肺阻塞照護新趨勢
高雄醫學大學附設醫院
胸腔內科
鄭孟軒
2024/7/12
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2. •Contents:
•病因
•診斷
•治療
•藥物
•非藥物
•疫苗注射
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診斷標準:
FEV1/FVC<0.7
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10. （preserved ratio impaired spirometry，PRISm）
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14. 評估症狀嚴重度的工具 (mMRCand CAT
score)
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https://www.cmuh.cmu.edu.tw/NewsInfo/NewsArticle?no=4231 14

15. GOLD 整合性評估
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16. 穩定期肺阻塞病人使用 CT
•雖然CT 尚未被認為是肺阻塞疾病診斷之必要工具，但是隨著使用的增
加，在肺阻塞病人可以用來評估肺結節以及其他合併的肺疾病
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LABA/LAMA, 肺復原
ICS

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22. 台灣目前常用吸入藥物
2021第一次使用吸入器就上手 (修訂版)
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24. 肺阻塞醫療處置循環
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33. 選用吸入器的建議
2021第一次使用吸入器就上手 (修訂版) 33

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35. 肺復原
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40. COPD 患者疫苗建議
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COPD或Asthma提升帶狀疱疹及其併發症之風險
1,2
1. Marra F et al. Open Forum Infect Dis 2020 7 :ofaa005 ; 2. Forbes HJ et al. Neurology 2016 87:94 102; 3. Kawai K et al. BMJ Open 2014 4 :e 004833.
帶狀疱疹 風險 疱疹後神經痛 (PHN)風險
†Data from a prospective study involving HZ cases with a median age of 61 years, including patients with COPD (N=5060) and asthma (N=8267); data shows risk of PHN (defined as pain 90 days after HZ, based on diagnostic or prescription
codes) compared with controls without COPD or asthma. Adjusted for age, sex, socioeconomic status, immune deficiencies, comorbidities, smoking, BMI, site of HZ, antivirals and immunosuppressive therapies.
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U.S. CDC/ACIP 帶狀疱疹疫苗接種建議
可用於≥50 歲的成年人 :無論以前是否接種
過水痘疫苗或 ZVL，且不需篩檢水痘病史
即使具帶狀疱疹病史或過去曾接種過 ZVL，
皆需接種兩劑RZV疫苗
接種ZVL後2個月內不應接種 RZV
有帶狀疱疹病史 之成年人應接種 RZV；
且須待帶狀疱疹 急性期過後且症狀減輕始
能接種RZV
https://www.cdc.gov/mmwr/volumes/67/wr/mm6703a5.htm (Accessed August 2022)
HZ:Herpes zoster; CDC:Centers for Disease Control and Prevention
2006 年，美國免疫實踐諮詢委員會 (ACIP) 建議對60 歲
以上的成人常規注射 ZVL，以預防帶狀 疱疹及其併發症，
特別是PHN。然而， RZV 的卓越療效使其在 2018 年被
ACIP 優先推薦用於免疫功能健全的 50 歲以上成年人

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44. 肺氣腫的各種介入治療和手術選擇
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48. Take home message
•FEV1/FVC< 0.7
•決定治療是否有急性惡化扮演關鍵角色 (≧1 住院，≧2 急性惡化 )
•LABA+LAMA常用起始治療
•Triple therapy(ICS?)➔AEHXwith eosinophil count>100
•Single inhaler
•Keep SpO2> 88 %
•Vaccination
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Thanks !
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