BPCO: concetti base 1

La BPCO: premessa Chronic Obstructive Pulmonary Disease (COPD) is one of the top five causes of global mortality Current barriers to effective treatment of COPD include poor awareness and understanding of the disease, and the lack of new and effective treatments It is therefore important to raise awareness of COPD and its underlying causes 2

La BPCO: definizione Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD as: “a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterised by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with abnormal inflammatory response of the lung to noxious particles or gases” Key points: COPD is preventable and treatable Airway limitation is not fully reversible and usually progressive Extrapulmonary (systemic) effects play a significant role Associated with chronic inflammation in response to inhaled noxious irritants Speaker notes This definition of COPD comes from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. This document is widely accepted as the most up-to-date guidance on COPD management. Reference Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.org 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 3

L’impatto economico e sanitario della BPCO COPD affects 210 million people worldwide and causes 3 million deaths annually (5% of all deaths worldwide)1 It is predicted to become the third leading cause of global mortality by 20302 The economic burden of COPD is high, with costs increasing as the disease progresses Costs associated with severe COPD are up to 17 times higher than those associated with mild COPD3 High costs are associated with treatment of exacerbations, such as hospitalisation3 Indirect costs include loss of productivity in the workplace owing to symptoms3 Speaker notes Although preventable and treatable, COPD remains a significant burden on global healthcare and economic resources.1-3 Prevalence varies between countries, but reflects the level of tobacco smoking.4 References 1. World Health Organization. COPD Fact Sheet No 315. 2009. www.who.int/mediacentre/factsheets/fs315/en/index.html 2. World Health Organization. Chronic respiratory diseases. Accessed 2010. http://www.who.int/respiratory/copd/burden/en/index.html 3. Wouters EFM. Economic analysis of the Confronting COPD survey: an overview of results. Respir Med 2003;97:S3-S14. 4. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.org 1. WHO. COPD Fact Sheet No 315. 2009. Available from www.who.int/mediacentre/factsheets/fs315/en/index.html 2. WHO. Chronic respiratory diseases. Accessed 2010. http://www.who.int/respiratory/copd/burden/en/index.html 3. Wouters EFM. Respir Med 2003;97:S3-S14. 4

Esposizione a sostanze nocive: la causa della BPCO Speaker notes Tobacco smoking is the most important risk factor for COPD in developed countries. However, an estimated 25–45% of patients with COPD have never smoked.1 Other risk factors include indoor and outdoor air pollution. Burning biomass fuels such as wood for heating is a major risk factor in developing nations. Outdoor air pollution, from motor vehicle emissions and combustion of other fossil fuels, presents a smaller risk for COPD.2 Inhalation of occupational dusts and chemicals, such as coal dust, chemical vapours and fumes, significantly increases the risk of developing COPD in workers exposed to these substances.2,3 References Salvi SS, Barnes PJ. Chronic Obstructive Pulmonary Disease in non-smokers. Lancet 2009;374;733-743. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.com Boschetto P, Quintavalle S, Miotto D, et al. Chronic obstructive pulmonary disease (COPD) and occupational exposures. J Occup Med Toxic 2006;1:11. 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 5

BPCO, effetti a carico delle vie respiratorie e a livello sistemico Breathlessness Bronchitis: coughing, sputum production Emphysema: hyperinflation, wheezing Weight changes Co-morbidities (e.g. diabetes, cardiovascular disease) Inhaled substances + Genetic susceptibility Systemic inflammation Airway limitation Airway inflammation Structural changes Mucociliary dysfunction Speaker notes GOLD states that COPD has pulmonary and extra-pulmonary, or systemic, components, which arise from a mixture of inhalation of noxious substances and genetic susceptibility.1 In the lungs, exposure to noxious substances causes inflammation of the airways, mucociliary dysfunction (overproduction of mucus and reduced ability to clear mucus from the lungs) and structural changes (such as degradation of elastin). These factors result in airway limitation. COPD has a variable natural history that affects all patients differently, and a patient may exhibit symptoms of bronchitis, emphysema or both.1 The type of damage to the lungs determines the symptoms of COPD. COPD caused primarily by obstructive bronchiolitis can be associated with chronic coughing and/or sputum production, while lung damage caused primarily by emphysema is characterised by hyperinflation of the lungs and wheezing. Systemic inflammation in COPD is associated with development of many co-morbidities, such as cardiovascular disease, diabetes and osteoporosis. A recent study reported that among approximately 70,000 patients hospitalized for COPD exacerbations in 2007, over half had hypertension, one-third had diabetes or ischaemic heart disease and one-quarter had congestive heart failure.2 References Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.org Silver H, Blanchette CM, Roberts M, et al. Prevalence of comorbidities in patients hospitalized for COPD exacerbations and impact on inpatient mortality and hospital expenditures. Am J Respir Crit Care Med 2010;181:A5943. 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 6

BPCO e attività quotidiane Healthy elderly (n=25) 6 27 52 12 COPD patients 11 41 42 4 (n=50) Speaker notes GOLD states that COPD has pulmonary and extra-pulmonary, or systemic, components, which arise from a mixture of inhalation of noxious substances and genetic susceptibility.1 In the lungs, exposure to noxious substances causes inflammation of the airways, mucociliary dysfunction (overproduction of mucus and reduced ability to clear mucus from the lungs) and structural changes (such as degradation of elastin). These factors result in airway limitation. COPD has a variable natural history that affects all patients differently, and a patient may exhibit symptoms of bronchitis, emphysema or both.1 The type of damage to the lungs determines the symptoms of COPD. COPD caused primarily by obstructive bronchiolitis can be associated with chronic coughing and/or sputum production, while lung damage caused primarily by emphysema is characterised by hyperinflation of the lungs and wheezing. Systemic inflammation in COPD is associated with development of many co-morbidities, such as cardiovascular disease, diabetes and osteoporosis. A recent study reported that among approximately 70,000 patients hospitalized for COPD exacerbations in 2007, over half had hypertension, one-third had diabetes or ischaemic heart disease and one-quarter had congestive heart failure.2 References Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.org Silver H, Blanchette CM, Roberts M, et al. Prevalence of comorbidities in patients hospitalized for COPD exacerbations and impact on inpatient mortality and hospital expenditures. Am J Respir Crit Care Med 2010;181:A5943. 0% 20% 40% 60% 80% 100% Walking Standing Sitting Lying Others Pitta et al, AJRCCM 2005 7

BPCO e attività fisica 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 I II III IV Fibrinogen < 436 mg/dL Fibrinogen > 436 mg/dL Steps per day Speaker notes GOLD states that COPD has pulmonary and extra-pulmonary, or systemic, components, which arise from a mixture of inhalation of noxious substances and genetic susceptibility.1 In the lungs, exposure to noxious substances causes inflammation of the airways, mucociliary dysfunction (overproduction of mucus and reduced ability to clear mucus from the lungs) and structural changes (such as degradation of elastin). These factors result in airway limitation. COPD has a variable natural history that affects all patients differently, and a patient may exhibit symptoms of bronchitis, emphysema or both.1 The type of damage to the lungs determines the symptoms of COPD. COPD caused primarily by obstructive bronchiolitis can be associated with chronic coughing and/or sputum production, while lung damage caused primarily by emphysema is characterised by hyperinflation of the lungs and wheezing. Systemic inflammation in COPD is associated with development of many co-morbidities, such as cardiovascular disease, diabetes and osteoporosis. A recent study reported that among approximately 70,000 patients hospitalized for COPD exacerbations in 2007, over half had hypertension, one-third had diabetes or ischaemic heart disease and one-quarter had congestive heart failure.2 References Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.org Silver H, Blanchette CM, Roberts M, et al. Prevalence of comorbidities in patients hospitalized for COPD exacerbations and impact on inpatient mortality and hospital expenditures. Am J Respir Crit Care Med 2010;181:A5943. GOLD stage Watz H et al, Am J Respir Crit Care Med 2008 8

Concetti chiave COPD is a debilitating disease that presents a huge healthcare and economic burden around the world The major risk factor for developing COPD is tobacco smoking COPD encompasses damage to the airways, and chronic pulmonary and systemic inflammation The symptoms of COPD include breathlessness, chronic cough and sputum production 9