Presentation on theme: "Definition of COPD COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual."— Presentation transcript:
1 Definition of COPDCOPD 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.1
4 indoor/outdoor pollution Diagnosis of COPDEXPOSURE TO RISKFACTORSSYMPTOMScoughtobaccosputumoccupationdyspneaindoor/outdoor pollutionDiagnosis of COPD is based on a history of exposure to risk factors and the presence of airflow limitation that is not fully reversible, with or without the presence of symptoms.Patients who have chronic cough and sputum production with a history of exposure to risk factors should be tested for airflow limitation, even if they do not have dyspnea.For the diagnosis and assessment of COPD, spirometry is the gold standard.Health care workers involved in the diagnosis and management of COPD patients should have access to spirometry.SPIROMETRY4
6 Spirometry “How-To” Resources from GOLD Spirometry GuideSpirometry Quick GuideSpirometry Teaching Slide SetTo help health care professionals understand how to perform & evaluate spirometry.All resources available at
7 Classification of COPD Severity by SpirometryStage I: Mild FEV1/FVC < 0.70FEV1 > 80% predictedStage II: Moderate FEV1/FVC < 0.7050% < FEV1 < 80% predictedStage III: Severe FEV1/FVC < 0.7030% < FEV1 < 50% predictedStage IV: Very Severe FEV1/FVC < 0.70FEV1 < 30% predicted orFEV1 < 50% predicted plus chronic respiratory failure7
8 Therapy at Each Stage of COPD I: MildII: ModerateIII: SevereIV: Very SevereFEV1/FVC < 70%FEV1 < 30% predictedor FEV1 < 50% predicted plus chronic respiratory failureFEV1/FVC < 70%30% < FEV1 < 50% predictedFEV1/FVC < 70%50% < FEV1 < 80%predictedFEV1/FVC < 70%FEV1 > 80% predictedActive reduction of risk factor(s); influenza vaccinationAdd short-acting bronchodilator (when needed)Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitationThis provides a summary of the recommended treatment at each stage of COPD.Add inhaled glucocorticosteroids if repeated exacerbationsAdd long term oxygen if chronic respiratory failure. Consider surgical treatments8
9 Differential Diagnosis: COPD and Asthma Onset in mid-lifeSymptoms slowly progressiveLong smoking historyDyspnea during exerciseLargely irreversible airflowlimitationOnset early in life (often childhood)Symptoms vary from day to daySymptoms at night/early morningAllergy, rhinitis, and/or eczema also presentFamily history of asthmaLargely reversible airflow limitation9
10 COPD and Co-morbid Conditions Common co-morbid conditions in COPD patients:Cardiovascular diseaseLung cancerOsteoporosisMusculoskeletal disordersDepression/anxietyObesity/type II diabetesPhysicians should identify and treat co-morbid conditions that impact on the clinical course of COPD.Smoking prevention and cessation, weight control, exercise, and rehabilitation have the potential to beneficially affect COPD and co-morbid conditions.
11 Preventing COPD Exacerbations Prevent respiratory infections: pneumococcal vaccine, annual influenza vaccine.Avoid air pollution: remain indoors and close windows on bad air pollution days.Quit smoking and avoid exposure to secondhand smoke.Understand medication regimen and proper inhaler use.Patients with severe COPD and repeated exacerbations (3 or more in a year): use inhaled glucocorticosteroids.Recognize and respond to early signs of exacerbations to minimize impact when exacerbations do occur.
12 Risk Factors for COPD Genes Oxidative stress Exposure to particles Tobacco smokeOccupational dusts, organic and inorganicIndoor air pollution from heating and cooking with biomass in poorly ventilated dwellingsOutdoor air pollutionLung growth and developmentOxidative stressGenderAgeRespiratory infectionsSocioeconomic statusNutritionComorbidities12
13 Brief Strategies to Help the Patient Willing to Quit Smoking ASK Systematically identify all tobacco users at every visit.ADVISE Strongly urge all tobacco users to quit.ASSESS Determine willingness to make a quit attempt.ASSIST Aid the patient in quitting.ARRANGE Schedule follow-up contact.Reduction of total personal exposure to tobacco smoke, occupational dusts and chemicals, and indoor and outdoor air pollutants are important goals to prevent the onset and progression of COPD.Smoking cessation is the single most effective - and cost effective - intervention to reduce the risk of developing COPD and stop its progression.Brief tobacco dependence treatment is effective, and every tobacco user should be offered at least this treatment at every visit to a health care provider.Three types of counseling are especially effective: practical counseling, social support as part of treatment, and social support arranged outside of treatment.13
14 Lower Respiratory System Anatomy of theLower Respiratory SystemTracheaMain bronchiLeftRightBronchiolesAcinusBronchusrigid because of C-shaped cartilage ringsAlveolusAcinusCapillaryAttenuated epitheliumAlveolusAlveolar spaceCapillaries14
15 Trachea and major bronchi Anatomy of the AirwaysTrachea and major bronchiBronchiolesSmooth muscleConnective tissueCartilageMucous membraneAirway mucous membraneMucusCiliaSecretory cellsEpitheliumCiliated cellsBasal membraneSubmucosa15