Dr. Danny Galdermans Dept Respiratory Medicine ZNA Middelheim Antwerp COPD GOLD guidelines.
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Transcript of Dr. Danny Galdermans Dept Respiratory Medicine ZNA Middelheim Antwerp COPD GOLD guidelines.
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Dr. Danny Galdermans
Dept Respiratory Medicine
ZNA Middelheim Antwerp
COPDGOLD guidelines
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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
Chronic
RespiratoryDiseases
CardiovascularDisease
Diabetes Cancer
Physical inactivity
Obesity
Unhealthy diets
Smoking Harmful use of alcohol
Other NCDs
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Global Alliance against Chronic Respiratory Diseaseswww.who.int/respiratory/gard
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- often common with other NCDs
GARD (September 2007)GARD (September 2007)
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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
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Lung Pathology in COPDSmall airways and lung parenchyma
Chronic bronchitis Emphysema
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Risk Factors for COPD
NutritionNutrition
InfectionsInfections
Socio-economic Socio-economic statusstatus
Aging PopulationsAging Populations
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Fabbri et al., Eur Respir J, 2008, 31, 204-212
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COPD and Co-MorbiditiesCOPD and Co-Morbidities
COPD patients are at increased risk for: • Myocardial infarction, angina
• Osteoporosis
• Respiratory infection
• Depression
• Diabetes
• Lung cancer
COPD patients are at increased risk for: • Myocardial infarction, angina
• Osteoporosis
• Respiratory infection
• Depression
• Diabetes
• Lung cancer
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COPD and Co-MorbiditiesCOPD and Co-Morbidities
COPD has significant extrapulmonary
(systemic) effects including:
• Weight loss
• Nutritional abnormalities
• Skeletal muscle dysfunction
COPD has significant extrapulmonary
(systemic) effects including:
• Weight loss
• Nutritional abnormalities
• Skeletal muscle dysfunction
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COPD - Deaths / 10001990 Data projected to 2000
Legend<0.62756.275 - 9.6589.659 - 15.68715.688 - 18.14518.146 - 19.88919.89 - 22.11622.117 - 35.54835.549 - 38.177>38.178No Data
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6th leading cause of death worldwide 2.2 million deaths
Mortality related to COPD
Global Burden of Disease Study 1999
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COPD is projected to be the third biggest killer by 2020
Murray & Lopez 1997
Ischemic heart disease
CVD disease
Lower respiratory infection
Diarrhoeal disease
Perinatal disorders
COPD
Tuberculosis
Measles
Road traffic accident
Lung cancer
Stomach cancer
HIV
Suicide
1990 2020
3rd
6th
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Causes of death in patients with COPD
Rabe, N Engl J Med, 2007, 356, 851-854
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Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical
Endpoint Committee
McGarvey et al., Thorax, 2007, 62, 411-415
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Chronic obstructive pulmonary disease
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Chronic overlooked pulmonary disease
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SYMPTOMScoughcough
sputumsputumshortness of breathshortness of breath
EXPOSURE TO RISKFACTORS
tobaccotobaccooccupationoccupation
indoor/outdoor pollutionindoor/outdoor pollution
SPIROMETRYSPIROMETRY
Diagnosis of COPDDiagnosis of COPD
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• Relieve symptoms • Prevent disease progression• Improve exercise tolerance• Improve health status• Prevent and treat complications• Prevent and treat exacerbations• Reduce mortality
GOALS of COPD MANAGEMENTVARYING EMPHASIS WITH DIFFERING SEVERITY
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Four Components of COPD
Management
Four Components of COPD
Management
1. Assess and monitor disease
2. Reduce risk factors
3. Manage stable COPD Education Pharmacologic Non-pharmacologic
4. Manage exacerbations
1. Assess and monitor disease
2. Reduce risk factors
3. Manage stable COPD Education Pharmacologic Non-pharmacologic
4. Manage exacerbations
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IV: Very Severe III: Severe II: Moderate I: Mild
Therapy at Each Stage of COPD
FEV1/FVC < 70%
FEV1 > 80% predicted
FEV1/FVC < 70%
50% < FEV1 < 80%
predicted
FEV1/FVC < 70%
30% < FEV1 < 50% predicted
FEV1/FVC < 70%
FEV1 < 30% predicted
or FEV1 < 50% predicted plus chronic respiratory failure
Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation
Add inhaled glucocorticosteroids if repeated exacerbations
Active reduction of risk factor(s); influenza vaccinationAdd short-acting bronchodilator (when needed)
Add long term oxygen if chronic respiratory failure. Consider surgical treatments
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Global Initiative for ChronicObstructiveLung Disease
www.goldcopd.com