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Gold 2013 famracologia clinica

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  • On current knowledge, a cut point of 0-1 CCQ could be considered for Patient Groups A and C; a CCQ ≥1 for Patient Groups B and D.
  • Transcript

    • 1. JORGE GUERRERO Residente 1er añoMedicinaFalimiaryComunitaria FarmacologíaClínica
    • 2. Focus on both the short-term andlongterm impact of COPD on our patients.
    • 3. EPIDEMIOLOGY 14.78% (2005-2008)ClinGastroenterolHepatol. 2011 Jun;9(6):524-530.e1; quiz e60. doi: 10.1016/j.cgh.2011.03.020. Epub 2011 Mar 25
    • 4. DEFINITION CHRONIC OBSTRUCTIVEPULMONARY DISEASE  Preventable PERSISTENT  Treatable Chronic Response not Reversible
    • 5. DEFINITION CHRONIC OBSTRUCTIVEPULMONARY DISEASE This definition does not use the terms chronicbronchitis and emphysema and excludes asthma (reversible airflow limitation).Chronic bronchitis, defined as the presenceof cough and sputum production for at least3 months in each of 2 consecutive years, isnot necessarily associated with airflowlimitation.Emphysema, defined as destructionof the alveoli.
    • 6. SYNTOMS OF COPD
    • 7. CARDINAL SYNTOMS
    • 8. WHAT CAUSE COPD ? TABACCO SMOKERS
    • 9. WHAT CAUSE COPD ?  INDOOR AIR POLLUTIONBiomass fuel used for cooking and heating in poorly venteddwellings, a risk factor that particularly affects
    • 10. WHAT CAUSE COPD ? OCCUPATIONAL DUST AND CHEMICALS
    • 11. WHAT CAUSE COPD ?  OUTDOOR AIR POLLUTIONTotal burden of inhaled particles
    • 12. DIAGNOSIS OF COPD
    • 13. DIAGNOSIS OF COPD+ SPIROMETRY (Air flow limitation)Simple test to measure the amount of air a person can breathe out, and the amount of time taken to do so.  FVC (Forced Vital Capacity): maximum volume of air that can be exhaled during a forced maneuver.  FEV1 (Forced Expired Volume in one second): volume expired in the first second of maximal expiration after a maximal inspiration. This is a measure of how quickly the lungs can be emptied.  FEV1/FVC: FEV1 expressed as a proportion of the FVC, gives a clinically useful index of airflow limitation.
    • 14. WHY DO SPIROMETRY FOR COPD? Spirometry is needed to make a clinical diagnosis of COPD. A normal value for spirometry effectively excludes the diagnosis of clinically relevant COPD. Together with the presence of symptoms, spirometry helps gauge COPD severity and can be a guide to specific treatment steps.
    • 15. ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation(using spirometry)• Risk of exacerbations• Comorbidities
    • 16. ASSESS SYMTOMSCAT COPD Assessment Test Modified British Medical ResearchmMRC Council breathlessness scale measures of health status91 and predicts future mortality riskCCQ Clinical COPD Questionnaire measure clinical control self administered
    • 17. ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Comorbidities
    • 18. DEGREE OF AIR FLOW LIMITATION
    • 19. ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Comorbidities
    • 20. ASSESSMENT OF RISK OF EXACERBATIONS CONCEPT.  Acute event.  Worsening of the patient’s respiratory symptoms.  leads to a change in medication. The best predictor of having frequent exacerbations = Previous Exacerbations
    • 21. ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Comorbidities
    • 22. ASSESSMENT OF COMORBIDITIES
    • 23. ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Comorbidities
    • 24. COMBINED COPD ASSESMENT • Symptoms (impact on patient’s health status) • Degree of airflow limitation • Risk of exacerbations • Comorbidities
    • 25. COMBINED COPD ASSESMENTWhen assessing risk, choose the highest risk according to GOLDgrade or exacerbation history. (One or more hospitalizations for COPD exacerbations should be considered high risk.
    • 26.  Patient Group A – Low Risk, Less SymptomsTypically GOLD 1 or GOLD 2 (Mild or Moderate airflow limitation) and/or 0-1 exacerbation per year and mMRC grade 0-1 or CAT score < 10 Patient Group B – Low Risk, More SymptomsTypically GOLD 1 or GOLD 2 (Mild or Moderate airflow limitation) and/or 0-1 exacerbation per year and mMRC grade ≥ 2 or CAT score ≥ 10
    • 27.  Patient Group C – High Risk, Less SymptomsTypically GOLD 3 or GOLD 4 (Severe or Very Severe airflow limitation) and/or ≥ 2 exacerbations per year and mMRC grade 0-1 or CAT score <10 Patient Group D – High Risk, More SymptomsTypically GOLD 3 or GOLD 4 (Severe or Very Severe airflow limitation) and/or ≥ 2 exacerbations per year and mMRC grade ≥ 2 or CAT score ≥ 10
    • 28.  Example: Imagine a patient with a CAT score of 18, FEV1 of 55% of predicted, and a history of 3 exacerbations within the last 12 months.
    • 29.  Example: Imagine a patient with a CAT score of 18, FEV1 of 55% of predicted, and a history of 3 exacerbations within the last 12 months.
    • 30. TO BE CONTINUED…