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10-15% 45 .

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FEV1/FVC < 0.70

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FVC

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5
4

FEV1 = 4L

FVC = 5L

FEV1/FVC = 0.8

()
2015 Global Initiative for Chronic Obstructive Lung Disease

()

()

5
4
3

FEV1 = 1.8L

FVC = 3.2L

FEV1/FVC = 0.56

()
2015 Global Initiative for Chronic Obstructive Lung Disease


GOLD
FEV1/FVC < 0.70:

GOLD 1:

FEV1 > 80% .

GOLD 2: 50% < FEV1 < 80% .


GOLD 3:

30% < FEV1 < 50% .

GOLD 4:

FEV1 < 30% .


...
()
.

...

:



(mMRC) (CAT, CCQ)

GOLD 4
GOLD 3

GOLD 2

GOLD 1
CAT < 10
mMRC 0-1

CAT 10
mMRC 2

...


90%
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3

5-10% .
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>65
<65 FEV1 < 40% .


2-
2-
2-



2- +


2- +

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2-,
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FEV1 < 60%

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(ICS)
2- (LABA)
,

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LABA/ICS
()
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-4
(GOLD 3 & 4)
,
( -4)

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(LABA)
FEV1 , ,
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lpha-1



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(> 15 /.)

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(NIV)

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(LVRS)

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,

.

( )

GOLD 4 C
ICS + LABA

GOLD 3
LAMA

D 2
ICS + LABA
/
LAMA
1

SAMA prn

SABA prn
GOLD 1 A
GOLD 2

CAT < 10
mMRC 0-1

LABA

LAMA

B
CAT 10
mMRC 2

GOLD 4 C
GOLD 3
GOLD 2

D 2

ICS + LABA LAMA


LAMA LABA

ICS + LABA PDE4


LAMA PDE4-inh.

LAMA LABA

LABA PDE4-inh
LAMA PDE4-inh.

LAMA

LABA

SABA SAMA

LAMA LABA

CAT < 10
mMRC 0-1

CAT 10
mMRC 2

GOLD 1 A

( )

GOLD 4 C
SABA / SAMA

GOLD 3

D 2

-
SABA / SAMA

GOLD 2

SABA / SAMA

GOLD 1 A

B
CAT < 10
mMRC 0-1

CAT 10
mMRC 2

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: PaO2 < 60 mmHg PaCO2 > 50
mmHg
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:
88-92%.
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2-
.

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,
FEV1
(PaO2)


.
40 mg
5 .

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(NIV) :



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ASTHMA COPD OVERLAP SYNDROME (ACOS)


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.(GINA 2014)

ACOS


ACOS


.

.
.(GOLD 2015)

3
.

ACOS

LABA / LAMA