\P AII@NmSÊgB@B@Nm\ªSÊnWj

AII@NSÊ

B@B@N\ªSÊiÍC¬ÂÃW\´iC¬áºCá_fA.

«S¾³A.

«S¾³ÇÈÇÉæè®¬d»ðiW³¹CSÇC]

B.

]ÇáQB.

]ÇáQÇCl½ÈÇÌÇáQðN±·DÄzíC.
D.

ºÄzí´õÇº«¾³C.
D.

«ÂÇ«x¾³ºÄzí´õÇÁCC¹ßq«´iCStAáºð«½µC

E.
F.

ªØÉº¤Q«ÂÇ«x¾³

E.
F.

ÄzíàðÊÌíXÌÄzí¾³Ì´öâ«öqÆÈéDG.

jG.

H.
I.

 ]
ðÊÌ

H.
I.

Ý àãV«ÆusSA@.

ÄzíàA@.

© EnÉ¨¢ÄÍCC¹ÇÌäNÆC¹ªå¨Ì{eÅÍiªÄzínÉyÚ·e¿ÉÂ¢Ä
q × C  « Â Ç « x ¾ ³ i chronic obstructive
pulmonary disease: COPDjCÄzí´õÇCxji¶£ 2 æèøpjàÉÎ·éiÌe¿ðl¦ÄÝéD³çÉó®
iÆÄzí¾³ÌÖAÉÂ¢ÄàGêÄÝ½¢D400l`500lÉB·éÆª³êÄ¢éD««V¶¨CSÇ¾³C]Ç¾³ÉCiªövJ~^iÖA¾³ÅåÌë¯öqÆÈÁÄ¢é COPD ðÁ¦½±

ú¶J­È­\Ì2004Nlû®ÔvÉæéÆCíªÌSÒÍNÔñ103lÅèC«

êç 4 ÂÌ¾³ÍCpêÌª¶©çuiÖ
AÌ 4CvÆÄÎêÄ¢éD«V¶¨icancer) 33lCSÇ¾³icardio­

ÉC¢EÛ@ÖiWHOjª­\µ½¢Evascular disease) 16lC]Ç¾³icerebro­

É¨¯é1990NÌSÊÆ2020NÌ\ªSvascular disease) 13lªOåöÆÈÁÄ¢ÊÅÍC1 ÊÌ«S¾³C2 ÊÌ]ÇáéD««V¶¨ÌÅÍiÆÌÖAªæ­mçQ É Ï í è Í È ¢ ª C COPD ª 6 Ê © ç 3 ÊêÄ¢éxàÉæéSÒªàÁÆà½­Cñ 6ÖCÄzíàixàjª10Ê©ç 5 ÊÉÈèCé1)Dú{ÅÍNÔñ10lªiÉæiÖA¾³ÉæéSÒÌÁª\z³êÄlÅéßèÆl¦çêCS¢EÅÍ»ÌÍNÔ
mKey words n¢é2)i\PjD

i#x@\#COPD#xà#ÖøÊ
ú{zÂíwïêåãzÂíêåãæACªæQ B@@ENXCCI}Pigx@\iAbÊjmÏ»Þ25ÎÌ 1 bÊð100Æµ½ä¦i¶£ 3 æèøp)igx@\mÏ»ig COPD

x@\i1 bÊjÍ25Îðs[NÉCÁîÆCÇ©çxEÉ¢½éC¹nÉ¨¢ÄC×CÇÆàÉXÉáº·éªCñiÒ¨æÑ^oRxÌæªiÌe¿ðàÁÆàó¯â·¢D]´ó«ÌÈ¢iÒÅÍ 1 bÊÌáºÍ­ÈCxCîÆ«CÇxÉC¬§Àðº¤Æl­C^oR´ó«Ìéi^oRÌQªoâ·¢j¦çêÄ¢½ COPD ÍC^oRÌâåCõiÒÅÍÁîÆÆàÉåÉáº·éDµ©

ª´öÅCàa 2 mm ¢Ì¬CÇxâ×CÇxéiÒÅàÖµ½_ÈÇÌ½C¹ÌáQªN±èCC¹ÌSt

©çx@\ÌáºÍÉâ©ÉÈèCÖNîªµC^oR´ó«ÌBÌìåªN±éC¹aÏDÊ^ÆxEÇÌjó¢ÙÇÖÉæéøÊÍå«¢3) i}PjD·×ªN±éCîDÊ^ÉiW·é4,5)i}QjDíªÄÌiÒÉ¨¢ÄiÉæéåÈ 1 bÊÌÉ¨¯é COPD Ì³ÒÍ Fukuchi çÌñáºªÝçêéÆÍÀçÈ¢ªC»_ÅÍèúÅÍCñ530lÆè³êÄ¨èC¡ãÜ·ÜIÈx@\ÈOÉ^oR´ó«ÌL³ðÞ·é·Á·é±ÆªO³êÄ¢é6)DCOPD ÌÇèiÍÈ­C³çÉñiÒÅÍÁîÉº¤x@É¨¢ÄÍC·×ÄÌ³ÒÉ¨¢ÄÖªK{\áºÌÝÅé±Æðl¶·éÆ^oRðzíÈ¢±ÆªÌvÅéDx@\Ìáºð­È­·é½ßÉÍC^oR´ó«ÌéiÒÅÍÈéÅèCÖðåOñÉò¨Ã@CxwÃ@Cx¸Êk¬pâxÚAÈÇÌOÈ¡Ãªsíêé7)D×­úÌÖª]ÜêéD

igÄzí´õÇiÉæèCCÇxâxÈÇÌÄzí´õCD@ú{zÂíwïêåãzÂíêåãæACªæQ B@@ENX}Q

COPD mÕ°jÖXTO}i¶£ 5 æèøp)ÇÌXNàã¸·éD±êÍiªC¹ÇðÍáºµÈ¢±ÆCÜ½Cá^[^oRÉ¨¢äNµCC¹ªå¨ÌÁâStAÌáºð«ÄàÖÌNîªá¢ÙÇxàÌXNÍá­½µ½½ßÆl¦çêéDÜ½CiÉæéá_ÈéÆñ³êÄ¢é12)DfªgDÌCðxç¹C´õÇªJ·é´öÅÍCiðªffãÌ¡ÃøÊÉàe¿ðyÚ·DRçÍéÆ»ÌXNÍñiÒÌ2,220áÌxàØáð¢µC«Ì¶¶¦ª1.7{ÉÈéÆÌñªé8) DÜ½CxÌNÛÆµÄàÁÆàpxª¢xÄCdÇÌxiÍxàÌXNðßéÎ©èÅÍÈ­CésxÆàÈéDã\IÈÄzí´õÇÅÛÉ¨¢Û´õÇÍiÒÅÍñiÒ

Ì4.1{ÉCÜ½ó®iÅà2.5{ÅÁ½Æñj«æèàÇDÅ

Á½ÆñµÄ¢éDiÒÆñiÒÌärÅÍCñiÒÉ¨¢Ä\ãªLÓÉÇDÅ

Á½Dµ©µCiwi1 úÌi{~iNjª 1`399, 400`799, 800
ÈãÌ 3 QÔÅÍCpãÌ¶¶¦ÉÍLÓ·ÍÝ³êÄ¢é9)DçêÈ©Á½13)i}RjDi©Ìª\ãsÇöqÆª³êCxàØãÌ¶¶¦Ì«·ÉÍjigxàÌi¦Ì·ªå«­e¿µÄ¢éDñèpáiÉæèxàðÍ¶ßCôAªàCÁ»íÉ¨¢ÄàC»iÒÍñiÒâùiÒÉäé14) D³çÉÀÇ^Ì¬×ExàCXàCÌàCAHnàÈÇÙÆñÇ·××\ãsÇÅÄÌíÌ­àXNªã¸·é10) DíªÌàÉ¨¢ÄÍCúËüÃ@Æ»wÃ@Ì¯¡ÃñÅÍCxàSÌÅÌÎë¯xÍ4.5{ÅÌÛÉC¡ÃÌióµª¶¶¦Ée¿·éÆéªCxåÉ­¶µâ·¢G½ãçàâ¬×Eñ³êÄ¢é15) DiÒÅÍ COPD ÈÇÌÄàÅÍiÌe¿ª³çÉå«¢DÜ½CiJ

zí¾³â«S¾³C³ÈÇÌzÂí¾nNîª¢ÙÇCÜ½ 1 úÌi{ª½¢³Ì¹ÉæèCèpKª§À³êéÎ©èÅÙÇxàÌë¯xª­Èé11) DßNCiÉÈ­CúËü¡ÃÉ¨¢ÄÍÆËìÌk¬âÆËæéNáQðy¸³¹½¢ÆÌÓ}ÅC¢íäüÊÌ¸­ð]VÈ­³êC³çÉ»wÃ@É¨éá^[^oRðz¤iÒªÁµÄ¢éD¢ÄàâtÊâÔ¿«xÌOÈÇ©çCRàµ©µCá^[^oRÉÏ¦ÄàxàÌXNòÌÊâíÞª§À³êéD±ÌÊCiÒÅú{zÂíwïêåãzÂíêåãæACªæQ B@@ENX

CDAÈ­CxàffãÌ¡ÃûjCòÜ½«Éà«e¿ðyÚ·Dó®igÄzí¾³ó®iÍ«S¾³â]ÇáQÌXNðã¸³¹éªCÄzínÉ¨¢ÄÍxàÌ­¶CCÇxb§â COPD Ì«CÄzí´õÉÖA·é17) DÜ½CÙÉÎµÄÍ¬YCáÌ}RimL³gxàØãm¶¶¦do¶Cï`ÌXNðC¬ÉÎµÄÍûci¶£13æèøp)ËRÇóQC¬·âm\áQÌXNðã¸³¹é18) DxàÉÂ¢ÄÍñiÒÉ¨¢ÄCzÍxàÉÎ·é¡Ãªå«­§ñ³êCñiÒôÒÌi{ÆêÉéçµ½úÔÉ¶ÄCÆÌÎë¯xª·19)i}SjDÜ½C¬úÌó¢¾Å¡ÃøÊÉ·ª¶¶éÆl¦çê®ià¬lãÌxàÌXNÉÈè¤é20) DéDßNCxàÉÎ·éÍ¶ßÄÌªqWI¡ÃòiÒÍ\®iÉæé©ª©gÌNíQ¾¯ÆµÄCãçBöqóeÌ`VLi[[ðÅÈ­Có®iÉæéüÍÖÌe¿ÉÂ¢ÄàjQ·é gefitinib ª­³êCêÌÇáÉ¨¢F¯·×«ÅéDÄÍIÈRîøÊª¾çêÄ¢éDgefitinibÌøÊªúÒÅ«éöqÆµÄ«CBàCñiÒªé16) DÜ½CiÍdÄÈìpÅ\®iÈçÑÉó®iªÄzí¾³Î©

éÔ¿«xÌë¯öqÉàÈÁÄ¢éDÈãCiÍxàÌë¯öqÅéÎ©èÅÍ}SIjèÅÍÈ­C³Ü´ÜÈ¾³ÌXNðßé±zôÒmigxàmÎë¯xi¶£19æèøp)CDB

ú{zÂíwïêåãzÂíêåãæACªæQ B@@ENXÆÍ¾ç©ÅéDAJ¾a\hZ^[ÌÖÌX[KðÐî·éDuÖÍCNîE«Êðâí¸C·×ÄÌlÌNÉ½å©Âv¬

ing and invasive pneumococcal disease. N Engl J Med
2000; 342: 681_68910) ÜYêY (Ä)FÚÅ©éiÌXNÆÖw±@D©úz[hN^[ÐC1993ÈLv«ðà½ç·vi´¶FSmoking cessation

11) Vineis P, Alavanja M, Buer P et al: Tobacco and can­has major and immediate health benets for men

cer: recent epidemiological evidence. J Natl Cancer
Inst 2004; 96(2): 99_106

and women of all agesjDãÃ]ÒÍiÌQÆÖøÊðF¯µCi
h~ÆÖ[ÖÉÏÉIÉæègÞ×«Å12) Harris JE, Thun MJ, Mondul AM et al: Cigarette tar
yields in relation to mortality from lung cancer in thecancer prevention study II prospective cohort, 1982_8.

éDBMJ 2004; 328(7431): 7213) R²C²¡ëüC÷c¶q£q1) ú¶J­ÈF½¬15Nxlû®ÔvD
qhttp: //www.mhlw.go.jp /toukei/saikin /hw/jinkou/
geppo/nengai04/toukei5.htmlr
2) Murray CJL, Lopez AD: Alternative projections ofmortality and disability by cause 1990_2020: Global
Burden of Disease Study. Lancet 1997; 349: 1498_1504
3) Fletcher C, Peto R: The natural history of chronic air­
ow obstruction. BMJ 1977; 1: 1645_1648
4) Global initiative for chronic obstructive lung disease.
GOLD Workshop updated 2003. Global strategy for thediagnosis, management, and prevention of chronic
obstructive pulmonary disease.
qhttp://www.goldcopd.
com.r5) COPDi«ÂÇ«x¾³) ffÆ¡ÃÌ½ßÌKChCCæ 2 ÅCú{ÄzíwïC20046) Fukuchi Y, Nishimura M, Ichinose M et al: COPD in
Japan:

theNippon

COPD

epidemiology

study.

Respirology 2004; 9: 458_465
7) Sutherland ER, Cherniack RM: Management of chron­ic obstructive pulmonary disease. N Engl J Med 2004;
350: 2689_2697
8) Almirall J, Gonzalez CA, Balanzo X et al: Proportion ofcommunity­acquired pneumonia cases attributable totobacco smoking. Chest 1999; 116: 375_379
9) Nuolti JP, Butler JC, Farley MM et al: Cigarette smok­

ú{zÂíwïêåãWÙ©Fiª\ãÉyÚ·e¿Ì«·F´­«xà2220ØÇáÉ¨¯é¢Dxà 2004; 44: 83_8914) Tammemagi CR, Neslund_Dudas C, Simo M et al:
Smoking and lung cancer survival: the role of comor­
bidity and treatment. Chest 2004; 125: 27_3715) Videtic GMM, Stitt LW, Dar AR et al: Continued
cigarette smoking by patients receiving concurrent
chemoradiotherapy for limited­stage small­cell lungcancer is associated with decreased survival. J Clin On­
col 2003; 21: 1544_1549
16) Kosaka T, Yatabe Y, Endoh H et al: Mutation of theepidermal growth factor receptor gene in lung cancer:
biological and clinical implications. Cancer Res 2004;
64: 8919_892317) ¼è¹KFó®iDúÄzï 2004; 42: 592_596
18) Carpenter RG, Irgens LM, Blair PS et al: Sudden unex­
plained infant death in 20 regions in Europe: case con­trol study. Lancet 2004; 363: 185_191
19) Hackshaw AK, Law MR, Wald NJ: The accumulated
evidence on lung cancer and environmental tobaccosmoke. BMJ 1997; 315: 980_988
20) Vineis P, Airoldi L, Veglia F et al: Environmental
tobacco smoke and risk of respiratory cancer andchronic obstructive pulmonary disease in former smok­
ers and never smokers in the EPIC prospective study.
BMJ 2005; 330(7486): 277

zÂíêåãæACªæQ B@@ENXCDC