Bartolomé R. Celli, M.D. Montevideo. ALAT.

CAD Cancer CVA COPD

COPD: Global Impact

Objectives

• Magnitude of the COPD problem world-wide • We are making progress • The future: the era of the “omics”

WHO report 2012

COPD, a big problem!!!

Causes of death 2005

WHO 2012

Prevalence of COPD

NHLBI Fact Book 2006

Death rate from COPD in the world: Men and Women

Determinants of Health and their Contribution to Premature Death

Behavioral Patterns

40%

Genetic Predisposition

30%

Social Circunstances

15%

Environmental Exposure

5%

Health Care10%

McGinnis et al Health Affairs 2002;21:78

Smoking at the center………but not the only cause

Worldwide Problem of Smoking

1,2 billion

Deaths

6 Millions

Obstruction in non-smokers: NHANESIII

Ex or Smokers

76%

Non-smoker

24%

Unknown76%

Asthma24%

Celli et al Am J Med 2005:118:1364

N Projected = 19 millions

4.5 millions

n = 3.4 millions

26%

COPD costs a lot!!!!!!

Wouters et al Respir Med 2003;97:3

Cost of caring for one COPD patient per year

US $ 2500 per year Total = 875 billion dollars a year

US: Allocation of costs for the Care of COPD

NHLBI 2007

The other problem… Underdiagnosis!!!!

Soriano et al Lancet 2009;721

Underdiagnosis in COPD

Under-treatment

Chronic Obstructive Pulmonary Disease

• “Preventable and treatable disease characterized by airflow limitation, resulting from an abnormal inflammatory reaction to inhaled particles (smoking) and associated with co-morbidities” GOLD accessed May 2012

Which Co-morbidities?

Lung cancer

Cachexia vs myopathy Osteoporosis

Anemia CAD/CHF

Anxiety and

COPD

9 - 20%

30%

30-50% 17%

30-50%

20-60%

Barnes and Celli ERJ 2008

Prevalence

50%

10%

Comorbidities prevalence and mortality risk in COPD Orbital representation

Death

Divo et al AJRCCM 2012; e-published

Lung Cancer

Anxiety*

Breast Cancer*

CAD

A. Fibrillation

CHF

OSA

Pulmonary HTN/RHF

Pulmonary Fibrosis

BPH

CRF

Diabetes w/ Neuropathy

Diabetes

Erectile Dysfunction

Gastric Duodenal Ulcer

Liver Cirrhosis

Esophageal Cancer Pancreatic

Cancer

Hypertension

PAD

CVA Hyperlipidemia

Substance Abuse

DJD Depression

GERD

The “Comorbidome”

Prevalence

50%

10% Divo et al AJRCCM 2012; e-published GERD

CRF

Depression

BPH

OSA

Pulmonary HTN/RHF

BPH

CRF

Diabetes

Erectile Dysfunction

Hypertension

PAD

CVA Hyperlipidemia

Substance Abuse

DJD Depression

GERD

Prevalence

50%

10%

Comorbidities in COPD: >10% Prevalence

Divo et al AJRCCM 2012; e-published

BPH

CRF

GERD

Depression

Lung Cancer

Anxiety*

Breast Cancer*

CAD

A. Fibrillation

CHF

Pulmonary Fibrosis

Diabetes w/ Neuropathy

Gastric Duodenal Ulcer

Liver Cirrhosis

Esophageal Cancer

Pancreatic Cancer

Comorbidities and mortality risk in COPD

Prevalence

50%

10%

Divo et al AJRCCM 2012; e-published

Genome

Transcriptome

Proteome Environment

Inflammation Thrombosis

Hemorrhage Fibrosis

Immune

response

Apoptosis

Necrosis

Cell

proliferation

Loscalzo et al Mol Sys Bio 20007;3:124

Genome

Transcriptome

Proteome Environment

Inflammation Thrombosis

Hemorrhage Fibrosis

Immune

response

Apoptosis

Necrosis

Cell

proliferation

Intermediate phenotype

Loscalzo et al Mol Sys Bio 20007;3:124

Genome

Transcriptome

Proteome Environment

Inflammation Thrombosis

Hemorrhage Fibrosis

Immune

response

Apoptosis

Necrosis

Cell

proliferation

Intermediate phenotype

Distinct phenotype: Syndrome and clinical disease

Loscalzo et al Mol Sys Bio 20007;3:124

How do we do it?

Clinician

Bench scientist

Data Integration Manager

A Road to the Future

• COPD is here to stay • It remains underdiagnosed, under or

miss-treated • COPD may be one of several related

diseases • We are learning more • Adelante!!!!