305 Ch 304. Chronic Obstructive Pulmonary Disease (COPD)

COPD = 慢性、進行性、可治療但不可逆 airflow limitation；emphysema (肺氣腫 + alveolar destruction) + chronic bronchitis (慢性支氣管炎 + mucus hypersecretion) 兩大病理；smoking 是 #1 cause（global 90%+），but air pollution + occupational + genetic (α1-antitrypsin deficiency, AAT) 也重要；diagnosis：post-bronchodilator FEV1/FVC < 0.7；GOLD 2024-2025 stratification: ABE (A/B/E based on symptoms + exacerbation history)；treatment：(1) bronchodilator (LABA + LAMA combo first-line for symptomatic)；(2) ICS 用於 eosinophilic phenotype + frequent exacerbations；(3) triple therapy (ICS + LABA + LAMA) in ETHOS, IMPACT, KRONOS, TRINITY；(4) biologics emerging: dupilumab (BOREAS, NOTUS 2024) for eosinophilic COPD — game-changer；(5) mepolizumab (MATINEE 2024) also positive in eosinophilic COPD；(6) azithromycin chronic for frequent exacerbations；(7) roflumilast for severe with chronic bronchitis phenotype；(8) smoking cessation is single best intervention；acute exacerbation：SABA-SAMA + steroids + antibiotics + NIV；lung transplant for end-stage；lung volume reduction (surgical or endobronchial valves) for emphysema-dominant。