1. Prof Dr Guy JOOS Dept Respiratory Medicine Ghent University Hospital
COPD
GOLD guidelines
Prof Dr Guy JOOS
Dept Respiratory Medicine
Ghent University Hospital

2. Noncommunicable Diseases (NCDs)
Responsible for up to 60% of all deaths, 80% are in low- and middle-income countries
Major noncommunicable diseases:
Cardiovascular disease
Cancer
Chronic Respiratory disease
Diabetes
Shared preventable risk factors:
Tobacco use
Unhealthy diet
Physical inactivity
Harmful use of alcohol
Cancer
Chronic
Respiratory
Diseases
Diabetes
Cardiovascular
Disease
Other NCDs
60% of all global deaths. About 80% of the global deaths due to NCDs occur in low and middle income countries. The global strategy for NCD prevention and control focuses on four groups of disease: Cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes which represent the overwhelming proportion of the NCD burden and mortality. These four groups of diseases are largely caused by shared preventable risk factors, mainly tobacco use, unhealthy diet, physical inactivity, and the harmful use of alcohol.
Physical inactivity
Unhealthy
diets
Obesity
Smoking
Harmful use of alcohol 2

3. Global Alliance against Chronic Respiratory Diseases
GARD (September 2007)
Disease
Prevalence
Asthma
300 million
COPD
210 million
Allergic rhinitis
400 million
Sleep apnea
>100 million
Others
>50 million
Everyone in the world is exposed to
CRD risk factors
often common with other NCDs
Co-morbidities
paramount importance
Global Alliance against Chronic Respiratory Diseases 3

4. Definition of COPD
COPD 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.
GOLD 2006

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

6. Risk Factors for COPD Aging Populations Nutrition Infections
Socio-economic status
Aging Populations 6

8. Fabbri et al., Eur Respir J, 2008, 31, 204-212

9. COPD and Co-Morbidities
COPD patients are at increased risk for:
Myocardial infarction, angina
Osteoporosis
Respiratory infection
Depression
Diabetes
Lung cancer

10. COPD and Co-Morbidities
COPD has significant extrapulmonary
(systemic) effects including:
Weight loss
Nutritional abnormalities
Skeletal muscle dysfunction

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

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

13. 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

14. 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

15. 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 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 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

16. Causes of death in patients with COPD
Rabe, N Engl J Med, 2007, 356,

17. Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee
McGarvey et al., Thorax, 2007, 62,

18. Chronic obstructive pulmonary disease

19. Chronic overlooked pulmonary disease

20. 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

21. GOALS of COPD MANAGEMENT
VARYING EMPHASIS WITH DIFFERING SEVERITY
Relieve symptoms
Prevent disease progression
Improve exercise tolerance
Improve health status
Prevent and treat complications
Prevent and treat exacerbations
Reduce mortality

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

23. Global Initiative for Chronic Obstructive Lung Disease

24. Therapy at Each Stage of COPD
I: Mild
II: Moderate
III: Severe
IV: Very Severe
FEV1/FVC < 70%
FEV1 < 30% predicted
or FEV1 < 50% predicted plus chronic respiratory failure
FEV1/FVC < 70%
30% < FEV1 < 50% predicted
FEV1/FVC < 70%
50% < FEV1 < 80%
predicted
FEV1/FVC < 70%
FEV1 > 80% predicted
Active reduction of risk factor(s); influenza vaccination
Add short-acting bronchodilator (when needed)
This provides a summary of the recommended treatment at each stage of COPD.
Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation
Add inhaled glucocorticosteroids if repeated exacerbations
Add long term oxygen if chronic respiratory failure. Consider surgical treatments 24