2005 2005 1 IPAG International Primary Care Airways GroupIPAG
IPAG STAFF IPAG Coordinator: L Grouse, S Prete, A Wright Editors: L Grouse, S DeWeerdt IPAG EXPERT PANEL AND AUTHORS O van Schayck, Chair A M Korsten, Administrator Diagnosis: M Levy (Chair), E Dompeling, M Fletcher, T Hausen, D Price, R Spelman, B Yawn Asthma: T van der Molen (Chair), C Goncalves, M Stubbe Ostergaard, A Ostrem, R Singh, B Stallberg COPD: D Bellamy (Chair), J Bouchard, S Henrichsen, G Johansson, J Keenan, A Langhammer, J Reid Rhinitis: D Price (Chair), C Bond, J Bouchard, S Conn, R Costa, J Keenan, J Leder, M Levy, S Louw, M Orru, M Stubbe Ostergaard, D Ryan, S Walker, M Watson Dissemination: R Tomlins (Chair), R Beasley, S Henrichsen, N Khaltaev, K Lispers, I Smeele Corresponding Members: H Aizawa, F Chung, K Edwards, Y Fukuchi, R Halbert, M Ikusaka, S Isonaka, G Mikasa, K Ohta, S Ottmani, T Tsuda, C van Weel GINA Representative: T Clark GOLD Representative: S Buist ARIA Representative: J Bousquet Handbook concept developed and document edited by L Grouse and S DeWeerdt, from material developed by the IPAG Expert Panel. Materials from GINA, GOLD and ARIA initiatives are reproduced with permission. INTERNATIONAL PRIMARY CARE AIRWAYS GROUP Copyright 2005 MCR VISION, Inc. All Rights Reserved i
... iii... iv IPAG... v... vi IPAG... 1... 1... 1... 1... 1... 1 IPAG... 2... 2 ()... 2 1... 3... 4... 4... 5... 6...6 2... 7... 8... 8... 9 COPD... 12 COPD... 12 COPD... 13... 14 () IPAG... 16... 16 IPAG... 16... 16 3... 17... 18... 18... 19... 20... 21... 21... 22 :... 23 :... 24 :... 25... 26... 28 COPD... 29 COPD... 29 COPD... 30 COPD... 30 COPD... 31 :... 33... 10... 10... 11 4... 33 ii
(COPD) COPD GINAGOLD ARIA (: GINA http://www.ginasthma. org, GOLD http://www.goldcopd.orgaria http://www. whiar.org) COPD COPD Global Initiative for Asthma (GINA)Global Initiative for Chronic Obstructive Lung Disease (GOLD) Allergic Rhinitis and its Impact on Asthma (ARIA) () ( ) IPAG Altana AstraZeneca Boehringer Ingelheim EAMG GlaxoSmithKlineMerckSharp & Dohme NovartisUCB Pharma Zambon ARIAGINA GOLD Lawrence Grouse, MD, PhD IPAG Onno van Schayck, PhD IPAG () iii
IPAG (International Primary Care Airways Group) (World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians; WONCA) COPD () GINA ()GOLD (COPD) ARIA () WONCA IPAG 60 4 COPD 2006 3 1 iv
COPD COPD COPD COPD GOLD GINA COPD IPAG 2005 1 COPD QOL 2006 3 v
1 vi
EBM (COPD) () () 3 1 1 1 () 1 6 ( ) ( ) ( ) () HIV 1 () IPAG 1
6 : 3 6~14 : 15~39 : 40 : COPD ( ) () : 6 : () 6~14 : () 15~39 : () 40 : (): () : () : () IPAG 2
()/ () ~ ~ ( ) () () () () () () () ( ) ( ) ( ) () () ( ) ( ) 3
() ()() () () () 1 1 ( 1 1 ) ( ) : 2 1 (p.5) (p.5) / ( 4
() () (p.18) 5
6 () () () ( ) ( ) ( ) () (p.21) 6
~ ~ ( ) _ 7
6~14 _ 1 3 90% (p.9) / 8
6~14 () () () ( ) () () ( ) (p.21) 9
15 _ () _ () 1~6 1 2 (p.11) 7 10
15 () () () () () ( ) () () ( )() (p.21) ( COPD ) 11
40 COPD COPD COPD : COPD () COPD ( ) ( ) ~ ~ ~ ~ ~ ~ ()() () () ~ _( )_ () 12
17 : COPD () 16 : ( ; p.10 ) COPD 40 COPD () () ( )() COPD COPD (p.29) COPD ( ) 13
40 COPD COPD COPD ( ) ( ) ~ ~ ~ ~ ~ ~ () () ( ) ( ) ( ) () ( )_ () 14
18 : (p.11) 19 : COPD (p.13) : COPD 19 COPD COPD 15
() () COPD GINAGOLD ARIA ( GINA http://www.ginasthma.orggold http://www.goldcopd.orgaria http://www.whiar.org) : () : () COPD : () 16
COPD ~ ( ) ( ) ( ) 17
: () () () (p.19) () 18
p.20 ( p.33 ) ~ () () () ~ ~ () () () () ( ) ~ () (p.20) 19 ( )
( ) () ( ) ~ ( ) ( ) () () ( ) () ()( ) 20
1 () () () ~() ~ () () () ( _ () ( ) 5 : (p.23) 5~14 : (p.24) 15 : (p.25) 21
() ()( b 2 1 3 ) (b 2 PEF 60% ) 3 2~6 : Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention. 2004 (http://www.ginasthma.org) 22
()()5 p.26 http://www.ginasthma.org () () ( ~ ) b ( b ) () () () ( ) ( b ) b () () 3 (p.26) 23
()()5~14 p.26 http://www.ginasthma.org () () ( ~ ) b ( b ) () () () ( ) b ( b ) b b () () 3 (p.26) 24
()()(15 ) p.26 http://www.ginasthma.org () ( p.33 ) () ( ~ ) ~ b ( b ) () () () ( ) b ( b ) b b () () 3 (p.26) 25
() ~ ~ ~ ~ ( ) l ( ) ~ () ~ ~ ~ ~ () ~ ~ b b () () () () _ ( l) ( l) _ () ) () () (~ ) (~ ) (~ ) b () () (l) () (l) () () 26 ()
b b ( ~ ) () ~ ~ b b ~ l () () _()() ( ) 27
(l) (l) (l) _ ~ ~ ~ ~ _ ~ ~ ~ ~ _ ~ ~ ~ ~ _ ~ ~ ~ ~ _ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ () ()()() ( ) 28
COPD () COPD ( COPD ) () ( ) 1 () 2 () 3 () 4 () ( _ ) ( )() : COPD COPD (p.30) 29
COPD COPD ()() COPD COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) Global Strategy for Diagnosis, Management, and Prevention of COPD(http://www.goldcopd.org) COPD COPD p.31 Global Initiative for Chronic Obstructive Lung Disease Global Strategy for Diagnosis, Management, and Prevention of COPD(http://www. goldcopd.org) http://www.goldcopd.org ( ) 1 2 ( ) () 3 ( ) 4 () () COPD COPD FEV 1 QOL 30
COPD COPD COPD (l) () () () b ~() () ~ ~() () () () ~ () () ~ ~() ~() () ~ ~ () ~ () b () ~ () ~ () 31
~ () () ~ () () () ~ () ~ () () () () b () () () ~ () () ~ () ~ () () _()() ( ) 32
3 ( ) (/ buproprion ) 1 10 ( buproprion ) ( ) () () ( ) 33
3 1 1 _ ( ) ~ ~ ~ ( ) ~ ~ ~
~ )(~ ) ( ) () ~ ~ ( )