1. COPD: Welcome to the 1 st Patient and Caregiver Support Series COPD: Support for Today, Solutions for Tomorrow To Join the Audio Conference: Dial (646) 216-7221 | (866) 200-6965 Participant PIN Code: 29739952#

2. Kristin DiFoglio, MPA Assistant Vice President, Development American Lung Association Elizabeth Lancet, MPH Assistant Vice President, Research American Lung Association Moderators

3. 15 million diagnosed with COPD; up to 24 million with impaired lung function As the baby boomer population enters their golden years, COPD is expected to be an issue for many Isolating / diagnosing COPD is difficult Diagnostic testing not always done well or often enough in primary care settings Influence of stigma You are not ALONE

4. Joe Ramsdell, MD Professor of Medicine University of California San Diego Guest Speaker

5. Smoking and COPD: Inflammation Leads to Tissue Destruction

6. What is the medical and research community doing to help patients and caregivers with COPD?

7. Disability Smoker 60708050403020 Nonsmoker Death 0 25 50 75 100 FEV 1.0 (%) Age (Years) Smoking Cessation and the Natural History of COPD Symptoms

8. Bronchodilators: Lots of Choices What they do: – May reduce inflammation and swelling – Relax the airways of the lungs making it easier to breathe Common Benefits: decrease in symptoms & hospitalization for exacerbations Options include: – Short-acting (albuterol, levalbuterol, ipratropium): provides quick or "rescue" relief from acute tightening – Long-acting (salmeterol, fometerol,, tiotropium, aclidinium, theophylline): help to control and prevent symptoms

9. Corticosteroids What they do: Decreases inflammation in the airways (reducing swelling and mucus production), making breathing easier Common Benefits: improves lung function; decreases symptoms, hospitalizations for exacerbations & incidence of treatment failures Can be given orally or inhaled Options include: beclomethasone, fluticasone, budesonide, combinations with bronchodilators (budesonide and formoterol, fluticasone and salmeterol)

10. Other Drugs Romfumlast: reduces the risk of exacerbation and improves airflow – Common Benefits: improves lung function; decreases symptoms, hospitalizations for exacerbations & incidence of treatment failures – A once a day pill Mucolytics: improve mucus layer, usefulness is not clear

11. Pulmonary Rehabilitation American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation Evidence-based exercise program Proven benefits from endurance and strength training – reduces shortness of breath – increases exercise performance – improves quality of life – Reduced healthcare utilization

12. Effects of Pulmonary Rehabilitation after Hospital Admission for an Exacerbation Adapted from Seymore, J, Moore L, Jolley CJ, et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax. 2010;65:423-428.

13. Oxygen & Surgery – For Severe COPD Oxygen recommended for those with PaO 2 ≤ 55mmHg or SaO 2 ≤ 88% Lung Volume Reduction Surgery (LVRS) reduces the size of the lungs by removing about 20-30% of the most diseased lung tissues so that the healthier portion can perform better Lung transplants are a last resort treatment for irreversible lung failure

14. Emerging Research on Smoking/COPD connection COPD Clinical Research Network – understanding the best treatments for COPD COPDGene – understanding the causes and consequences of smoking ALA Asthma Clinical Research Centers SAPS – understanding the best treatment for smoking in asthma

15. Drugs in the Pipeline Antibiotics (Low dose continuous azithromycin, intermittent fluoroquinolones) New combinations (Corticosteroids and tiotropium, bronchodilator combinations) Protease inhibitors Statins Vasodilators (sildenafil) Anti-inflammatories (anti-leukotriene) Biological anti-inflammatory agents (mixed results) Growth factors

16. Emerging Research on Pulmonary Rehabilitation Chronic oxygen use Patient selection Effects on depression, quality of life Home-based Muscle-training (transcutaneous neuromuscular stimulation) Use of oxygen New approaches to surgery (bullectomy, bronchial stenting, bronchoalveolar fenestration)

17. Participation in Clinical Trials Only way to identify useful therapeutics – Identify successes as well as failures (Infliximab, retinoids) Update on COPDGene – New candidate genes – New understandings of pathophysiology in classification of COPD

18. Conclusions Current drugs are effective in treating symptoms, but disease modifying drugs are still not available Behavioral, rehabilitation and surgical approaches improve quality of life and functional ability Research requires participation of physicians, nurses and patients with COPD if progress is to be made. Be an active participant – volunteer for a COPD trial!

19. What is the American Lung Association doing for COPD patients and their caregivers? – Self-Management Tools

20. What is the American Lung Association doing for COPD patients and their caregivers? –Support Groups

21. What is the American Lung Association doing for COPD patients and their caregivers? – COPD Action Plan

22. 1.Learn more! www.lung.org 1-800-LUNGUSAwww.lung.org 2.Bring the COPD Action Plan to your doctor 3.Attend a Better Breathers Club 4.Join the Lung Connection 5.Get a Flu Shot! 5 easy steps you can take today:

23. Guest Speakers Bill and Katherine Carroll COPD Patient and Caregiver Beth Slick BBC Facilitator Leonardtown, Maryland

24. Type your questions into the chat box!

25. Thank you! For more information: 1.Look out for our follow up email with answers to your questions and links to additional resources 2.Call our Lung Helpline at 800-LUNG-USA with any medical questions 3.Visit the Lung Association’s COPD webpage to learn more and join a support group: www.lung.org/lung-disease/copd www.lung.org/lung-disease/copd