1. © 2013 Global Initiative for Chronic Obstructive Lung Disease
WORLD COPD DAY
November 20, 2013
Raising COPD Awareness Worldwide
© 2013 Global Initiative for Chronic Obstructive Lung Disease

2. Chronic Obstructive Pulmonary Disease (COPD): Improving Fiscal and Health Impact through Accountable Care
Guy W. Soo Hoo, MD, MPH
Pulmonary and Critical Care Section
West Los Angeles VA Healthcare Center
Los Angeles, CA

3. WORLD COPD DAY 2013: It’s not too late
How many people have COPD?
Worldwide, one in 10 adults over age 40 may have COPD.
COPD is most common in countries where cigarette smoking has been, or still is, very widespread.
How many lives are lost to COPD?
Worldwide, nearly 3 million people die from COPD every year.
According to a report commissioned by the World Bank, COPD is the third leading cause of death worldwide, surpassed only by heart attack and stroke.
In the United States in 2005, the direct costs of COPD were $21.8 billion and the indirect costs totaled $17 billion.
World COPD Day 2013 is organized by the Global Initiative for Chronic Obstructive Lung Disease (

4. COPD: perceptions of disease
COPD is a disease of smokers
COPD is a disease of men
COPD is a disease of elderly adults
COPD only affects the lungs
COPD is diagnosed too late for any treatment
COPD results an progressive decline
COPD results in permanent disability
COPD is unmanageable
COPD is untreatable

5. Death rates of major cardiopulmonary diseases
Pauwels R, Rabe K:. Lancet 2004; 304:

7. © 2013 Global Initiative for Chronic Obstructive Lung Disease
Global Strategy for Diagnosis, Management and Prevention of COPD
Definition of COPD
COPD, a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.
Exacerbations and comorbidities contribute to the overall severity in individual patients.
© 2013 Global Initiative for Chronic Obstructive Lung Disease

8. Petty T. Chest 2002: 1219(S):116S

9. Prevalence of COPD in the US 2007-2009
Most people with COPD are < 75 years of age
Most undiagnosed patients with COPD are < 65 years of age
Akinbami L , Liu X. NCHS Data brief; 2011 (6): 1-8

10. Prevalence of COPD in the US 2007-2009
There are more women with COPD than men
COPD in more common among women than men
Akinbami L , Liu X. NCHS Data brief; 2011 (6): 1-8

11. © 2013 Global Initiative for Chronic Obstructive Lung Disease
Global Strategy for Diagnosis, Management and Prevention of COPD
Risk Factors for COPD
Genes
Infections
Socio-economic status
Aging Populations
© 2013 Global Initiative for Chronic Obstructive Lung Disease

12. © 2013 Global Initiative for Chronic Obstructive Lung Disease
Global Strategy for Diagnosis, Management and Prevention of COPD Diagnosis and Assessment: Key Points
A clinical diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum production, and a history of exposure to risk factors for the disease.
Spirometry is required to make the diagnosis; the presence of a post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD.
© 2013 Global Initiative for Chronic Obstructive Lung Disease

13. © 2013 Global Initiative for Chronic Obstructive Lung Disease
Global Strategy for Diagnosis, Management and Prevention of COPD Combined Assessment of COPD
Assess symptoms
Assess degree of airflow limitation using spirometry
Assess risk of exacerbations
Combine these assessments for the purpose of improving management of COPD
© 2013 Global Initiative for Chronic Obstructive Lung Disease

14. In patients with FEV1/FVC < 0.70:
Global Strategy for Diagnosis, Management and Prevention of COPD Classification of Severity of Airflow Limitation in COPD*
In patients with FEV1/FVC < 0.70:
GOLD 1: Mild FEV1 > 80% predicted
GOLD 2: Moderate % < FEV1 < 80% predicted
GOLD 3: Severe % < FEV1 < 50% predicted
GOLD 4: Very Severe FEV1 < 30% predicted
*Based on Post-Bronchodilator FEV1
© 2013 Global Initiative for Chronic Obstructive Lung Disease

15. Modified Medical Research Council (mMRC) Dyspnea Scale
Grade
Description
Not troubled with breathlessness except with strenuous exercise 1
Troubled by shortness of breath when hurrying on the level or walking up a slight hill 2
Walks slower than people of the same age on the level because of breathlessness or has to stop for breath when walking at own pace on the level 3
Stops for breath after walking about 100 yards or after a few minutes on the level 4
Too breathless to leave the house or breathless when dressing or undressing
Mahler D et al. Chest 1988; 93: 580

16. Spirometric Classification Exacerbations per year
Global Strategy for Diagnosis, Management and Prevention of COPD Combined Assessment of COPD
When assessing risk, choose the highest risk according to GOLD grade or exacerbation history. One or more hospitalizations for COPD exacerbations should be considered high risk.)
Patient
Characteristic
Spirometric Classification
Exacerbations per year
mMRC
CAT A
Low Risk
Less Symptoms
GOLD 1-2
≤ 1
0-1
< 10 B
More Symptoms
> 2
≥ 10 C
High Risk
GOLD 3-4 D
© 2013 Global Initiative for Chronic Obstructive Lung Disease

17. © 2013 Global Initiative for Chronic Obstructive Lung Disease
Global Strategy for Diagnosis, Management and Prevention of COPD Manage Stable COPD: Goals of Therapy
Relieve symptoms
Improve exercise tolerance
Improve health status
Prevent disease progression
Prevent and treat exacerbations
Reduce mortality
Reduce
symptoms
risk
© 2013 Global Initiative for Chronic Obstructive Lung Disease

18. © 2013 Global Initiative for Chronic Obstructive Lung Disease
Global Strategy for Diagnosis, Management and Prevention of COPD Manage Stable COPD: Key Points
Identification and reduction of exposure to risk factors are important steps in prevention and treatment.
Individualized assessment of symptoms, airflow limitation, and future risk of exacerbations should be incorporated into the management strategy.
All COPD patients benefit from rehabilitation and maintenance of physical activity.
Pharmacologic therapy is used to reduce symptoms, reduce frequency and severity of exacerbations, and improve health status and exercise tolerance.
© 2013 Global Initiative for Chronic Obstructive Lung Disease

19. The natural history of lung function: smoker and non-smokers
Smoking cessation decreases the decline in lung function
Fletcher C, Peto R. BMJ 1997; 1:

20. © 2013 Global Initiative for Chronic Obstructive Lung Disease
Global Strategy for Diagnosis, Management and Prevention of COPD Manage Stable COPD: All COPD Patients
Avoidance of risk factors
- smoking cessation
- reduction of indoor pollution
- reduction of occupational exposure
Influenza vaccination
© 2013 Global Initiative for Chronic Obstructive Lung Disease

21. Options in COPD management
Increasing options for treatment
Medications
Oxygen therapy
Preventive vaccinations
Pulmonary rehabilitation
Surgical options
Lung transplantation
Biomarkers and genes (ECLIPSE, COPD Gene, SPIROMICS)
Targeted therapy

22. COPD: World COPD Day 2013 COPD is a disease of inhaled irritants
COPD is a disease of men and women
COPD is a disease of working adults
COPD is a systemic disease
COPD diagnosis important for treatment
COPD progression is variable
COPD patients are functional
COPD is manageable
COPD is treatable

23. Patient Protection and Affordable Care Act (PPACA); Affordable Care Act Enacted 2010; Upheld 2012
Most significant overhaul of US healthcare system since Medicare and Medicaide (1965)
Goals of legislation
Increase quality and affordability of health insurance
Lower uninsured rate, expanding insurance coverage
Minimum standards, eliminate exclusion from pre-existing conditions
Reforms by shifting system towards quality over quantitiy
Expanding Medicaid and establishing state based health insurance exchanges

24. Accountable care organizations
Health care providers
Heath care plans
Accountable care organizations
What is the impact on COPD?

25. It’s not too late

29. The changing face of COPD

30. Under-diagnosis and unfamiliarity with COPD
Public not aware of “COPD”, ~ 15% aware
Diagnosis on query
COPD 23%
Emphysema 26%
Chronic bronchitis 36%
Only about half of patients with COPD diagnosed
Mannino, D et al MMWR 2002: 51: 1-16; Rennard S, et al. Eur Resp J 2002;20:

31. How do you know you have COPD?