BY DR.Khaled Helmy Chest Specialist Al Mahmora Chest Hospital Ministry of Health - Egypt COPD SCOPE ON

Facts About COPD Cigarette smoking is the primary Cause of COPD. The WHO estimates 1.1 billion smoker worldwide, increasing to 1.6 billion by 2025 in low&middle-income countries. In 2000,the WHO estimated 2.74 million deaths worldwide from COPD. In 1990,COPD was ranked 12 th as burden of disease,by 2020 it is projected to rank 5th

Burden Of COPD Most epidemiological studies have found that COPD prevalence,morbidity and mortality increase over time and are greater in men than in women. COPD prevalence is directly related to prevalence of smoking. Very few studies have quantified the economic and social burden of COPD and its quality of life. Directed costs of COPD are substantial in developed countries while indirect cost are important in developing countries.

GOLD Definition: COPD i s a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases Chronic Obstructive Pulmonary Disease ( COPD ) This definition does not use the terms chronic bronchitis and emphysema and excludes asthma (reversible airflow limitation). and associated with systemic manifestations.

Chronic Obstructive Pulmonary Disease ( COPD ) Chronic bronchitis Defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years, is not necessarily associated with airflow limitation. Emphysema Defined as destruction of the alveoli, is a pathological term that is sometimes (incorrectly) used clinically.

Indicators for Considering a COPD Diagnosis Chronic cough Present intermittently or every day. Often present throughout the day; seldom only nocturnal. Chronic sputum production Any pattern of chronic sputum production may indicate COPD. Acute bronchitisRepeated episodes. Dyspnea that is Progressive (worsens over time). Persistent (present every day). Worse on exercise. Worse during respiratory infections. History of exposure to risk factors Tobacco smoke …. (including popular local preparations). Occupational dusts and chemicals. Smoke from home cooking and heating fuel. Diagnosis Of COPD The diagnosis should be confirmed by Spirometry

N FEV1/FVC FVC FEV1 PFT Quick interpretation N NN NN =N = = = TLV + Obst Rest Mix

When performing spirometry, measure: Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1). Calculate the FEV1/FVC ratio. Patients with COPD typically show : a decrease in both FEV1 and FEV1/FVC With limited reversibility after bronchodilators Diagnosis Of COPD, cont The diagnosis should be confirmed by Spirometry However, both symptoms and spirometry should be considered when developing an individualized management strategy for each patient.

Role of Inflammation in COPD Small airway disease Parenchymal destruction Airflow Limitation Inflammation

Asthma Onset in mid-life. Symptoms slowly progressive. Long smoking history. Dyspnea during exercise. Largely irreversible airflow limitation. Onset early in life (often childhood)..Symptoms vary from day to day..Symptoms at night/early morning..Allergy, rhinitis, and/or eczema also present..Family history of asthma..Largely reversible airflow limitation. COPD ASTHMA & COPD COPD Asthma

Stage III Severe COPD FEV1 /FVC < 70% FEV1 < 30% predicted or FEV1 <50% predicted +presence of respiratory failure or clinical signs of right heart failure. At this stage, quality of life is very impaired and exacerbations may be life-threatening. GOLD Classification of COPD Stage 0 At Risk normal spirometry Chronic symptoms (cough and sputum production) Stage I Mild COPD FEV1 / FVC < 70% but FEV1 > or equal to 80 % predicted With or without chronic symptoms cough and sputum production. Stage II Moderate COPD :FEV1/FVC<70% 30% < or equal FEV1<80% predicted (IIA:50% < or equal FEV1<80% ) (IIB:30% < or equal FEV1<50% ) With or without chronic symptoms (cough, sputum production and dyspnea)

Prevent disease progression. Relieve symptoms. Improve exercise tolerance. Improve health status. Prevent and treat complications. Prevent and treat exacerbations. Reduce mortality. Prevent or minimize side effects from treatment. Goals of COPD management

1. Assess and Monitor Disease 2. Reduce Risk Factors 3. Manage Stable COPD 4. Manage Acute Exacerbations COPD FOUR COMPONENT MANAGEMENT PROGRAM

A detailed medical history. Spirometry. Bronchodilator reversibility testing. Inhaled glucocorticosteroid trial (6 weeks to 3 months). Chest X-ray. Arterial blood gas measurement. Alpha-1 antitrypsin deficiency screening. Assess and Monitor Disease

Smoking cessation is the single most effective And cost-effective - intervention to reduce the risk of developing COPD and slow its progression. Smoking Prevention Avoid occupational Exposures Reduce Risk Factors

Patient education. Pharmacologic Treatment. - Bronchodilators, - Glucocorticosteroids, - Vaccines, - Antibiotics, - Mucolytic - Antitussives, - Respiratory Stimulants Non-Pharmacologic Treatment - Rehabilitation, - Oxygen Therapy, - Surgical Treatments(Bullectomy,LVRS,L.T) Management of stable COPD

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Home Management Bronchodilators : Increase dose and/or frequency of existing bronchodilator therapy. If not already used, add anticholinergics until symptoms improve. Glucocorticosteroids : If baseline FEV1 < 50% predicted, add 40 mg oral prednisolone per day for 10 days to the bronchodilator regimen. Antibiotics : When symptoms of breathlessness and cough are increased and sputum is purulent and increased in volume, provide antibiotic coverage of the major bacterial pathogens involved in exacerbations, taking into account local patterns of antibiotic sensitivity. Management Of Acute Exacerbation

. Marked increase in intensity of symptoms, such as sudden development of resting dyspnea Newly occuring arrhythmias. Diagnostic uncertainty. Older age Insufficient home support Failure of exacerbation to respond to initial medical management Indications for Hospital Admission for Acute Exacerbations Onset of new physical signs (e.g.,cyanosis, peripheral edema) Severe background COPD

. Survival figures for COPD are worse, COPD patients are often stranded at home with little support &suffered from depression. In contrast lung cancer sufferers have access to a wide network of support such as palliative care services, and have lower depression Importance of Quality Of Life In Patients With COPD 50 patients with inoperable lung cancer Vs 50 with severe COPD All >60y, were questioned about their quality of life. 80%of COPD patients were housebound, with 36% largely confined to a chair. In comparison 36% of lung cancer patients were housebound, only 10% chair-bound

One study in UK examined whether COPD patients were relatively disadvantaged in terms of medical and social care compared with a group with inoperable lung cancer. Conclusion: This study suggests that : patients with end stage COPD have significantly impaired quality of life and emotional well being which may not be as well met as those of patients with lung cancer,. COPD patients palliative care needs remain unaddressed Importance of Quality Of Life In Patients With COPD