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<title>喘息・COPD・ACO増悪マネジメント | 株式会社文光堂</title>


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<meta name="description" content="喘息とCOPD（慢性閉塞性肺疾患），そして両者のオーバーラップ（ACO）は，呼吸器が専門でない医師でも外来での遭遇頻度が非常に高い．その中でも重要な「増悪」に主眼を置き，各疾患の定義と診断基準といった基本事項，増悪の原因，診断と治療の実際，そして増悪の予防をわかりやすく解説．特に治療関連の章では「CHECK LIST」を提示し，STEPに沿って実際の症例で行った治療を「Case」として掲載した．非">

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		<h1 class="title">喘息・COPD・ACO増悪マネジメント<span class="version"></span></h1>
		

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					著：松瀬厚人（東邦大学医療センター大橋病院呼吸器内科教授）
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				<ul class="property"><li class="disc">B5判・100頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1737-9</li><li class="disc">2021年4月5日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">喘息とCOPD（慢性閉塞性肺疾患），そして両者のオーバーラップ（ACO）は，呼吸器が専門でない医師でも外来での遭遇頻度が非常に高い．その中でも重要な「増悪」に主眼を置き，各疾患の定義と診断基準といった基本事項，増悪の原因，診断と治療の実際，そして増悪の予防をわかりやすく解説．特に治療関連の章では「CHECK LIST」を提示し，STEPに沿って実際の症例で行った治療を「Case」として掲載した．非専門医はもちろん，呼吸器専門医にもぜひ手にとっていただきたい一冊．</section><section class="preface">序　文<br><br>　気管支喘息と慢性閉塞性肺疾患chronic obstructive pulmonary disease（COPD）そして両者の合併病態である喘息とCOPDのオーバーラップasthma and COPD overlap（ACO）は，非常に頻度の高い呼吸器疾患であり，呼吸器が専門でない先生方にとっても外来で遭遇される機会が非常に高い疾患です．これらの疾患では，患者さんが日常生活の中で経験される慢性的な症状を改善することはもちろんですが，生命に直結する増悪の治療と予防はそれにもまして重要です．医療経済的に見ても，喘息やCOPDに費やされる医療費の過半数が増悪に関連することも知られています．<br>　本書を執筆中だった2019年12月に中国の武漢で始まったSARS-CoV-2感染症であるCOVID-19のパンデミックにより，わが国においても，一時緊急事態宣言が発出され，不要不急の外出が制限される事態となりました．われわれの病院においても，症状が安定していた患者さんの受診期間はできるだけ長くしていたのですが，喘息，COPD，ACOの患者さんの中には，増悪のため予定外受診せざるを得ない方々がおられました．さらに，増悪による予定外受診をされた際にも，飛沫を発生するネブライザー吸入やNPPVの使用ができないなど，これまで以上に増悪予防の重要性を認識させられる日々でした．<br>　本書「CHECK LIST とCase でわかる！ 喘息・COPD・ACO増悪マネジメント」は，喘息，COPD，ACOの診療の中でも，私が特に重要と考えている増悪に主眼をおいて，各疾患の診断基準に始まり，増悪の原因，増悪の診断と治療，増悪の予防について記載しています．特に治療関連の章では，診療ガイドラインにそったCHECK LISTを提示し，CHESK LISTのSTEPにそって実際の症例の治療を提示しています．ほかの章でも，理解を容易にするためにできるだけ多くの実際の症例を提示することを試みました．<br>　本書が，診療にあたられる医療従事者の方々のお役に立ち，わが国から喘息，COPD，ACOの増悪で苦しまれる患者さんが一人でも多く減ることを願っています．<br><br>2021年4月<br>東邦大学医療センター大橋病院呼吸器内科教授<br>松瀬　厚人</section><section class="indexes">Ⅰ章　定義と診断基準<br>　喘息・COPD・ACOの定義と診断基準<br>　　1．定　義<br>　　2．診断基準<br>　　3．ACOの増悪<br>　　4．ACOが臨床的に重要視される理由<br>　　［COLUMN］呼気NO（FeNO）<br><br>Ⅱ章　増悪の原因<br>　1―喘息増悪の原因<br>　　1．呼吸器感染症<br>　　2．食物（貯蔵ダニ）<br>　　　Case 1　20代男性　アレルギー疾患の既往はない<br>　　3．薬　剤<br>　　　Case 2　58歳女性　昼食後に皮膚の発赤と呼吸困難で受診した喘息症例<br>　　4．アルコール<br>　　5．その他の誘因<br>　2―COPD増悪の原因<br>　　1．COPD増悪とは<br>　　2．COPD増悪の影響<br>　　3．COPD増悪のリスクファクター<br>　　4．COPD増悪の原因<br>　　［COLUMN］COVID-19と喘息・COPD<br><br>Ⅲ章　増悪の診断と治療<br>　1―喘息増悪の診断と治療<br>　　STEP 1：喘息増悪時の問診と身体所見<br>　　STEP 2：喘息増悪の重症度の評価<br>　　STEP 3：喘息増悪時の検査所見<br>　　　Case 3 　57歳女性　胸部CTが診断の一助となった喘息増悪症例<br>　　STEP 4：喘息増悪時の薬物療法<br>　　　Case 4　24歳男性　喘息増悪との鑑別を要した声帯機能不全の症例<br>　　　Case 5　32歳女性　ステロイド点滴後に増悪した喘息症例<br>　　　Case 6　32歳女性　出産時に喘息大発作を生じた症例<br>　2―STEPで考える喘息増悪Case<br>　　　Case 7　62歳男性　人工呼吸器を必要とした喘息重篤発作症例<br>　　　Case 8　25歳女性　環境整備が必要だった喘息小発作症例<br>　3―COPD増悪の診断と治療<br>　　STEP 1：COPD増悪時の問診と身体所見<br>　　STEP 2：COPD増悪時の検査所見<br>　　　Case 9　69歳男性　肺癌による肺葉切除の既往があるCOPD症例<br>　　　Case 10　75歳男性　COPDのため外来で長時間作用性抗コリン薬の吸入を行っている症例<br>　　　Case 11　73歳男性　近医でCOPDによる慢性呼吸不全のため長期酸素療法を施行されている症例<br>　　　Case 12　56歳男性　右心不全を合併したCOPD症例<br>　　　Case 13　70歳男性　肺血栓塞栓症を合併したCOPD症例<br>　　STEP 3：COPD増悪の重症度の評価<br>　　STEP 4：COPD増悪時の薬物療法<br>　　STEP 5：COPD増悪時の酸素療法<br>　4―STEPで考えるCOPD増悪Case<br>　　　Case 14　67歳男性　気道感染による増悪に対しABCアプローチを行った症例<br>　　　Case 15　74歳男性　外来での増悪step治療<br>　5―ACO増悪の診断と治療<br>　　1．ACO増悪の定義<br>　　2．ACO増悪の治療<br>　6―STEPで考えるACO増悪Case<br>　　　Case 16　73歳男性　全身性ステロイドに対する反応が特徴的であった症例<br>　　　Case 17　84歳男性　気道感染により増悪をきたした症例<br><br>Ⅳ章　増悪の予防<br>　1―喘息増悪の予防<br>　　1．喘息増悪の誘因<br>　　2．喘息増悪予防のための非薬物療法<br>　　3．喘息増悪予防のための薬物療法<br>　　　Case 18　72歳女性　重症アトピー型喘息でマクロライドが著効した症例<br>　　　Case 19　80歳女性　メポリズマブが著効した重症好酸球性喘息症例<br>　　　Case 20　32歳男性　オマリズマブ（抗IgE抗体）により感冒の頻度が減少した喘息症例<br>　　　Case 21　70代男性　デュピルマブにより特に喀痰症状が改善した重症好酸球性喘息症例<br>　2―COPD増悪の予防<br>　　1．COPD治療の目標<br>　　2．COPD増悪予防の非薬物療法<br>　　3．COPD増悪予防の薬物療法<br>　　　Case 22　70代男性　現在も喫煙を続けている重症COPD患者<br>　　　Case 23　82歳男性　COPD増悪を契機に入院が長期に及んだ症例<br>　　　Case 24　67歳男性　末梢血好酸球が高く，ICSが有効であった症例<br><br>索　引</section></article>
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