Prof Dr Guy JOOS Dept Respiratory Diseases Ghent University Hospital COPD GOLD guidelines Prof Dr Guy JOOS Dept Respiratory Diseases Ghent University Hospital

COPD Chronic Obstructive Pulmonary Disease Causes: cigarette smoking, indoor cooking/heating Symptoms: cough, sputum production, dyspnea Small airways and lung parenchyma Chronic bronchitis and emphysema

Small airways and lung parenchyma Lung Pathology in COPD Small airways and lung parenchyma Chronic bronchitis Emphysema

Global Initiative for Chronic Obstructive Lung Disease www.goldcopd.com

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Mortality related to COPD 6th leading cause of death worldwide 2.2 million deaths Global Burden of Disease study 1999 Dia Hansel and Barnes Global Burden of Disease Study 1999

COPD - Deaths / 1000 1990 Data projected to 2000 L e g n d < . 6 2 . 6 2 7 5 - 9 8 1 4 3 > N o D a t

Voor BelgiE betekent dit 100x 25 a 50 = 2500 tot 5000

COPD is the only one of the major causes of death that has increased significantly in recent years Proportion of 1965 rate 3.0 Coronary heart disease Stroke Other CVD COPD All other causes 2.5 2.0 1.5 1.0 These data from the USA, collected from 1965 to 1998, show a 163% increase in age-adjusted death rates from COPD. While the death rate is declining from diseases such as coronary heart disease (a 59% decrease) and cerebrovascular disease (a 35% decrease), the death rate from COPD is increasing markedly. All other causes of age-adjusted US deaths also saw a decline of 7%. The Global Burden of Disease (GBD) study attributed more than 2.2 million deaths to COPD in 1990 (4.4% of worldwide deaths), ranking COPD as the sixth most serious cause of worldwide mortality.1 Furthermore, the 2002 World Health Organization (WHO) report indicated that COPD deaths are on the increase, with over 2.7 million deaths (5%) in 2001.2 Even more concerning, COPD deaths are projected to rise to third place in the worldwide ranking with 4.5 million deaths in 2020.1 The 2004 American Lung Association Report estimated approximately 120,000 deaths in the USA in 2002.3 The European Lung White Book, the first comprehensive survey on respiratory health in Europe, estimated annual COPD mortality in Europe as 200,000–300,000.4 References Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997;349:1498–504. World Health Organization. The World Health Report: Reducing Risks, Promoting Healthy Life. 2002. American Lung Association Epidemiology and Statistics Unit Research and Scientific Affairs. Trends in Chronic Bronchitis and Emphysema: Morbidity and Mortality. November 2004. European Lung White Book: The First Comprehensive Survey on Respiratory Health in Europe. Editor in chief R Loddenkemper. ERSJ Ltd. 200;34–43. 0.5 –59% –64% –35% +163% –7% Percentage change in age-adjusted death rates in USA, from 1965 to 1998 CVD = cerebrovascular disease www.copdgold.com

COPD is projected to be the third biggest killer by 2020 1990 2020 Ischemic heart disease CVD disease Lower respiratory infection Diarrhoeal disease Perinatal disorders COPD Tuberculosis Measles Road traffic accident Lung cancer 3rd 6th As part of the Global Burden of Disease Study, Murray and Lopez1 projected future mortality rates based on the most common causes of death in 1990. The top 10 most important causes of death are presented in this slide. The majority of these leading causes of deaths are projected to remain stable or decline. Notably, COPD is expected to rise from the sixth biggest killer in 1990 to the third in 2020. Of the top 10 leading causes of death in 1990, only deaths caused by COPD, lung cancer and road traffic accidents are projected to rise. Reference Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997;349:1498–504. Stomach cancer HIV Suicide Murray & Lopez 1997

COPD Mortality by Gender, U.S., 1980-2000 Number Deaths x 1000 Source: US Centers for Disease Control and Prevention, 2002

Voor België betekent dit 100 x 2 a 5000 ttz 500.000 mensen met COPD

COPD Pathogenesis of COPD NOXIOUS AGENTS (tobacco smoke, indoor air pollution, occupational agents) Genetic factors Respiratory infections Other COPD

European Lung White Book

indoor/outdoor pollution Diagnosis of COPD EXPOSURE TO RISK FACTORS SYMPTOMS cough tobacco sputum occupation shortness of breath indoor/outdoor pollution A diagnosis of COPD should be considered in any patient who has cough, sputum production, or dyspnea and/or a history of exposure to risk factors. The diagnosis is confirmed by spirometry. To help identify individuals earlier in the course of disease, spirometry should be performed for patients who have chronic cough and sputum production even if they do not have dyspnea. Spirometry is the best way to diagnose COPD and to monitor its progression and health care workers to care for COPD patients should have assess to spirometry. è è è SPIROMETRY

Four Components of COPD Management Assess and monitor disease Reduce risk factors Manage stable COPD Education Pharmacologic Non-pharmacologic Manage exacerbations

COPD Underrecognized Underdiagnosis Undertreatment Insufficiently prevented  WHO: GARD (Global Alliance against Chronic Respiratory Diseases) – may 2005

Chronic obstructive pulmonary disease

Chronic overlooked pulmonary disease

GOLD Website Address http://www.goldcopd.org