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World COPD Day Chronic Obstructive Pulmonary Disease Press Conference Kyoto, Japan November 19, 2006.

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Presentation on theme: "World COPD Day Chronic Obstructive Pulmonary Disease Press Conference Kyoto, Japan November 19, 2006."— Presentation transcript:

1 World COPD Day Chronic Obstructive Pulmonary Disease Press Conference Kyoto, Japan November 19, 2006

2 Opening Remarks Yoshinosuke Fukuchi, MD, PhD Introduction of GOLD Sonia Buist, MD New GOLD Guidelines Suzanne Hurd, PhDKlaus F. Rabe, MD, PhD Additional Comments Peter Calverley, MD Comments from WONCA Chris van Weel, MD Closing Remarks Claude Lenfant, MD World COPD Day Press Conference

3 Definition of COPD n Chronic Obstructive Pulmonary Disease is a preventable and treatable disease with some significant extrapulmonary effects. n The pulmonary component is characterized by airflow limitation that is not fully reversible. n Chronic Obstructive Pulmonary Disease is a preventable and treatable disease with some significant extrapulmonary effects. n The pulmonary component is characterized by airflow limitation that is not fully reversible. Healthy Alveolus COPD

4 Chronic Obstructive Pulmonary Disease (COPD) n The airflow limitation in COPD is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles and gases n Severe COPD leads to respiratory failure, hospitalization and eventually death from suffocation n The airflow limitation in COPD is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles and gases n Severe COPD leads to respiratory failure, hospitalization and eventually death from suffocation

5 Risk Factors for COPD Nutrition Infections Socio-economic status Aging Populations

6 Dr. A. Sonia Buist Introduction of GOLD Chair, GOLD Executive Committee Portland, Oregon USA Chair, GOLD Executive Committee Portland, Oregon USA

7 lobal Initiative for Chronic bstructive ung isease GOLDGOLD GOLDGOLD November 19, 2006 World COPD Day, Kyoto Japan

8 Why was GOLD Started? The social and economic burden of COPD is increasing rapidly in countries at all levels of economic development COPD is under-appreciated, under- diagnosed and under-treated Important questions about COPD are still unanswered The social and economic burden of COPD is increasing rapidly in countries at all levels of economic development COPD is under-appreciated, under- diagnosed and under-treated Important questions about COPD are still unanswered

9 COPD is Under-appreciated and Under-diagnosed Example from Japan: NICE Survey of COPD prevalence Carried out in several regions of Japan using standardized methods Example from Japan: NICE Survey of COPD prevalence Carried out in several regions of Japan using standardized methods

10 COPD Prevalence Rate (adjusted)* in Population 40 years *Adjusted for age, sex, cluster ** % depending on criteria Study Fukuchi et al. Respirology 2004;9: % 8.5%** 5.3 vs 0.2M COPD patients in Japan 40 years MHW Survey

11 COPD Prevalence Survey (NICE) in Japan Had prior diagnosis Did not have prior diagnosis: Fukuchi et al. Respirology 2004;9:458-65

12 Prevalence of GOLD Stage 1 + COPD 1, Guangzhou, China 1 FEV 1 /FVC<0.70, post BD MEN 15.3% WOMEN 7.6%

13 Of the six leading causes of death in the United States, only COPD has been increasing steadily since Source: Jemal A. et al. JAMA 2005

14 COPD Mortality by Gender, U.S., Number Deaths x 1000

15 Ischaemic heart disease Cerebrovascular disease Lower resp infection Diarrhoeal disease Perinatal disorders COPD Tuberculosis Measles Road Traffic Accidents Lung Cancer Stomach Cancer HIVSuicide 6th 3rd COPD Mortality Worldwide Source: Murray & Lopez. Lancet 1997

16 Why is COPD Increasing Worldwide? Increase in exposure to risk factors (especially tobacco) in developing countries & in women Changing demographics globally with more of the population, especially in the developing countries living into the COPD age range Increase in exposure to risk factors (especially tobacco) in developing countries & in women Changing demographics globally with more of the population, especially in the developing countries living into the COPD age range

17 Dr. Suzanne S. Hurd New GOLD Guidelines GOLD Scientific Director Gaithersburg, Maryland, USA GOLD Scientific Director Gaithersburg, Maryland, USA

18 GOLD Objectives n Increase awareness of COPD among health professionals, health authorities, and the general public n Improve diagnosis, management and prevention of COPD n Stimulate research in COPD n Increase awareness of COPD among health professionals, health authorities, and the general public n Improve diagnosis, management and prevention of COPD n Stimulate research in COPD

19 Global Strategy for Diagnosis, Management and Prevention of COPD n Definition, Classification n Burden of COPD n Risk factors n Pathogenesis, pathology, pathophysiology n Management n Practical Considerations n Definition, Classification n Burden of COPD n Risk factors n Pathogenesis, pathology, pathophysiology n Management n Practical Considerations Revised 2006

20 MAJOR CHANGES Global Strategy for Diagnosis, Management and Prevention of COPD Revised 2006

21 Dr. Klaus Rabe New GOLD Guidelines Chair, GOLD Science Committee Leiden, The Netherlands Chair, GOLD Science Committee Leiden, The Netherlands

22 Global Strategy for Diagnosis, Management and Prevention of COPD n Definition, Classification n Burden of COPD n Risk factors n Pathogenesis, pathology, pathophysiology n Management n Practical Considerations n Definition, Classification n Burden of COPD n Risk factors n Pathogenesis, pathology, pathophysiology n Management n Practical Considerations Revised 2006

23 Definition of COPD Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.

24 SYMPTOMS cough sputum shortness of breath EXPOSURE TO RISK FACTORS tobacco occupation indoor/outdoor pollution SPIROMETRY Diagnosis of COPD è è

25 Spirometry for COPD Diagnosis and Classification of Severity

26 Classification of COPD Severity by Spirometry Stage I: Mild FEV 1 /FVC < 0.70 FEV 1 > 80% predicted Stage II: Moderate FEV 1 /FVC < % < FEV 1 < 80% predicted Stage III: Severe FEV 1 /FVC < % < FEV 1 < 50% predicted Stage IV: Very Severe FEV 1 /FVC < 0.70 FEV 1 < 30% predicted or FEV 1 < 50% predicted plus chronic respiratory failure

27 COPD and Co-Morbidities n COPD has significant extrapulmonary (systemic) effects n Weight loss, nutritional abnormalities n Skeletal muscle dysfunction n COPD has significant extrapulmonary (systemic) effects n Weight loss, nutritional abnormalities n Skeletal muscle dysfunction

28 COPD and Co-Morbidities n COPD patients are at increased risk: Myocardial infarction, angina Osteoporosis Respiratory infection Depression Diabetes COPD and lung cancer n COPD patients are at increased risk: Myocardial infarction, angina Osteoporosis Respiratory infection Depression Diabetes COPD and lung cancer

29 Dr. Peter Calverley New GOLD Guidelines GOLD Executive/Science Committee Liverpool, England GOLD Executive/Science Committee Liverpool, England

30 Global Strategy for Diagnosis, Management and Prevention of COPD n Definition, Classification n Burden of COPD n Risk factors n Pathogenesis, pathology, pathophysiology n Management n Practical Considerations n Definition, Classification n Burden of COPD n Risk factors n Pathogenesis, pathology, pathophysiology n Management n Practical Considerations Revised 2006

31 Four Components of Care Assess and Monitor Disease Reduce Risk Factors Manage Stable COPD Manage Exacerbations

32 Relieve symptoms Prevent disease progression Improve exercise tolerance Improve health status Prevent and treat complications Prevent and treat exacerbations Reduce mortality GOALS of COPD MANAGEMENT VARYING EMPHASIS WITH DIFFERING SEVERITY

33 DIAGNOSIS AND RISK FACTORS n Bronchodilator testing no longer mandatory n Post-bd FEV 1 still the preferred outcome n Symptom assessment, e.g., MRC dyspnoea n Co-morbid pathology to be documented n New therapy for smoking cessation n More emphasis on indoor pollution n Bronchodilator testing no longer mandatory n Post-bd FEV 1 still the preferred outcome n Symptom assessment, e.g., MRC dyspnoea n Co-morbid pathology to be documented n New therapy for smoking cessation n More emphasis on indoor pollution

34 IV: Very Severe III: Severe II: Moderate I: Mild Therapy at Each Stage of COPD FEV 1 /FVC < 70% FEV 1 > 80% predicted FEV 1 /FVC < 70% 50% < FEV 1 < 80% predicted FEV 1 /FVC < 70% 30% < FEV 1 < 50% predicted FEV 1 /FVC < 70% FEV 1 < 30% predicted or FEV 1 < 50% predicted plus chronic respiratory failure Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation Add inhaled glucocorticosteroids if repeated exacerbations Active reduction of risk factor(s); influenza vaccination Add short-acting bronchodilator (when needed) Add long term oxygen if chronic respiratory failure. Consider surgical treatments

35 OTHER TREATMENT OPTIONS n Less support for mucolytic and antioxidant therapy n Pneumococcal vaccination n Rehabilitation remains a key intervention n Oxygen therapy reviewed n Surgery and COPD guidance n Less support for mucolytic and antioxidant therapy n Pneumococcal vaccination n Rehabilitation remains a key intervention n Oxygen therapy reviewed n Surgery and COPD guidance

36 COPD EXACERBATIONS n COPD exacerbations defined: An event in the natural course of the disease characterized by a change in the patients baseline dyspnea, cough, and/or sputum that is beyond normal day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD. n Antibiotics with specific advice n NIV explained and prioritised n Care at home/follow up n COPD exacerbations defined: An event in the natural course of the disease characterized by a change in the patients baseline dyspnea, cough, and/or sputum that is beyond normal day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD. n Antibiotics with specific advice n NIV explained and prioritised n Care at home/follow up

37 Dr. Chris van Weel Comments from WONCA GOLD Executive Committee President, World Organization of Family Physicians Nijmegen, The Netherlands GOLD Executive Committee President, World Organization of Family Physicians Nijmegen, The Netherlands

38 Global Strategy for Diagnosis, Management and Prevention of COPD n Definition, Classification n Burden of COPD n Risk factors n Pathogenesis, pathology, pathophysiology n Management n Practical Considerations n Definition, Classification n Burden of COPD n Risk factors n Pathogenesis, pathology, pathophysiology n Management n Practical Considerations Revised 2006

39 COPD Comorbidities Comorbid heterogeneity Common cause Heart failure Lung cancer Complicating Pneumonia Coincidential Diabetes mellitus Arthritis hip/knee Depression Comorbid heterogeneity Common cause Heart failure Lung cancer Complicating Pneumonia Coincidential Diabetes mellitus Arthritis hip/knee Depression

40 PATIENT – DISEASE ANOMALY COPD – The Disease n Airflow obstruction n Function decline n Continuous treatment n Lifestyle n Regular follow-up n Management plan n Compliance n Effects, safety treatment COPD – The Disease n Airflow obstruction n Function decline n Continuous treatment n Lifestyle n Regular follow-up n Management plan n Compliance n Effects, safety treatment Patient with COPD n Social isolation n Unhealthy environment n Poverty n Poor self-efficacy n Multiple health problems n Disruptive life conditions n Trust & support n Safety line

41 VERTICAL vs HORIZONTAL PROGRAMS OF CARE HIVAIDSHIVAIDS MALARIAMALARIA TBTB COPDCOPD INTEGRATED PRIMARY CARE

42 Practical Considerations: Conclusions Link science to money Organize special programs through primary care: Ten for 2010 Make a portion (10%) of special program money available for primary care development

43 Dr. Claude Lenfant Closing Comments GOLD Executive Director Gaithersburg, Maryland, US GOLD Executive Director Gaithersburg, Maryland, US

44 COPD: An Increasing Public Health Problem Worldwide COPD is increasing in prevalence in many countries of the world COPD is treatable and preventable The GOLD program offers a strategy to identify patients and to treat them according to the best medications available

45 COPD: An Increasing Public Health Problem Worldwide COPD can be prevented by avoidance of risk factors, the most notable being tobacco smoke Patients with COPD have multiple other conditions (comorbidities) that must be taken into consideration GOLD has developed a global network to raise awareness of COPD and disseminate information on diagnosis and treatment

46 United States United Kingdom Argentina Australia Brazil Austria Canada Chile Belgium China Denmark Columbia Costa Rica Croatia Egypt France Germany Greece Ireland Italy Guatemala Hong Kong China Japan Iceland India Korea Kyrgyzstan Latvia Lithuania Mexico Moldova Nepal Macedonia Malta Netherlands New Zealand Poland Norway Portugal Republic of Georgia Romania Russia Singapore Slovakia Slovenia Saudi Arabia South Africa Tatarstan Republic Spain Sweden Thailand Turkey Switzerland Ukraine United Arab Emirates Taiwan ROC Venezuela Vietnam Peru Yugoslavia Albania Bangladesh

47 World Health Organization - Global Alliance Against Chronic Respiratory Diseases - GARD

48 World COPD Day Chronic Obstructive Pulmonary Disease Press Conference Kyoto, Japan November 19, 2006


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