Diagnosi della BPCO 1

GOL D lobal Initiative for Chronic bstructive ung isease © Global Initiative for Chronic Obstructive Lung Disease 2

Global Strategy for Diagnosis, Management and Prevention of COPD Diagnosi e valutazione del paziente con BPCO A clinical diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum production, and/or 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. 3

Indoor/outdoor pollution Diagnosi della BPCO sulla base di sintomi, fattori di rischio e spirometria SYMPTOMS Cough Sputum production Shortness of breath RISK FACTORS Tobacco Occupational hazards Indoor/outdoor pollution + Spirometry Speaker notes Spirometry is recommended at the time of diagnosis to assess the presence and severity of airflow limitation.1,2 A diagnosis of COPD should be considered in any patient who has cough, sputum production, or dyspnoea and/or a history of exposure to risk factors.1 References Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.org Celli BR, MacNee W, ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004;23:932–946. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2010. Available from www.goldcopd.org 4

Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO Determine the severity of the disease, its impact on the patient’s health status and the risk of future events (for example exacerbations) to guide therapy. Consider the following aspects of the disease separately:  current level of patient’s symptoms severity of the spirometric abnormality frequency of exacerbations presence of comorbidities. 5

Assess degree of airflow limitation using spirometry Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO Assess symptoms Assess degree of airflow limitation using spirometry Assess risk of exacerbations Assess comorbidities 6

Use the COPD Assessment Test (CAT) or mMRC Breathlessness scale Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO Assess symptoms Assess degree of airflow limitation using spirometry Assess risk of exacerbations Assess comorbidities Use the COPD Assessment Test (CAT) or mMRC Breathlessness scale 7

Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO Assess symptoms Assess degree of airflow limitation using spirometry Assess risk of exacerbations Assess comorbidities Use spirometry for grading severity according to spirometry, using four grades split at 80%, 50% and 30% of predicted value 8

In patients with FEV1/FVC < 0.70: Global Strategy for Diagnosis, Management and Prevention of COPD Classificazione della gravità della BPCO in base alla limitazione al flusso aereo* In patients with FEV1/FVC < 0.70: GOLD 1: Mild FEV1 > 80% predicted GOLD 2: Moderate 50% < FEV1 < 80% predicted GOLD 3: Severe 30% < FEV1 < 50% predicted GOLD 4: Very Severe FEV1 < 30% predicted *Based on Post-Bronchodilator FEV1 9

Use history of exacerbations and spirometry. Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO Assess symptoms Assess degree of airflow limitation using spirometry Assess risk of exacerbations Assess comorbidities Use history of exacerbations and spirometry. Two exacerbations or more within the last year or an FEV1 < 50 % of predicted value are indicators of high risk 10

Global Strategy for Diagnosis, Management and Prevention of COPD Determinare il rischio di riacutizzazioni To assess risk of exacerbations use history of exacerbations and spirometry: Two or more exacerbations within the last year or an FEV1 < 50 % of predicted value are indicators of high risk. 11

Assess degree of airflow limitation using spirometry Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione del paziente con BPCO Assess symptoms Assess degree of airflow limitation using spirometry Assess risk of exacerbations Combine these assessments for the purpose of improving management of COPD 12

COPD patients are at increased risk for: Global Strategy for Diagnosis, Management and Prevention of COPD Valutazione delle comorbilità COPD patients are at increased risk for: Cardiovascular diseases Osteoporosis Respiratory infections Anxiety and Depression Diabetes Lung cancer These comorbid conditions may influence mortality and hospitalizations and should be looked for routinely, and treated appropriately. 13