JORGE GUERRERO     Residente 1er añoMedicinaFalimiaryComunitaria    FarmacologíaClínica
Focus on both the short-term andlongterm impact of COPD on our patients.
EPIDEMIOLOGY                                      14.78% (2005-2008)ClinGastroenterolHepatol. 2011 Jun;9(6):524-530.e1; qu...
DEFINITION CHRONIC OBSTRUCTIVEPULMONARY DISEASE    Preventable  PERSISTENT   Treatable                   Chronic        ...
DEFINITION CHRONIC OBSTRUCTIVEPULMONARY DISEASE   This definition does not use the terms    chronicbronchitis and emphyse...
SYNTOMS OF COPD
CARDINAL SYNTOMS
WHAT CAUSE COPD ?   TABACCO SMOKERS
WHAT CAUSE COPD ?     INDOOR AIR POLLUTIONBiomass fuel used for cooking and heating in poorly venteddwellings, a risk fac...
WHAT CAUSE COPD ?   OCCUPATIONAL DUST AND CHEMICALS
WHAT CAUSE COPD ?     OUTDOOR AIR POLLUTIONTotal burden of inhaled particles
DIAGNOSIS OF COPD
DIAGNOSIS OF COPD+    SPIROMETRY (Air flow limitation)Simple test to measure the amount of air a person  can breathe out,...
WHY DO SPIROMETRY FOR COPD? Spirometry is needed to make a clinical  diagnosis of COPD. A normal value for spirometry ef...
ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation(using spirometry)• Risk of e...
ASSESS SYMTOMSCAT             COPD Assessment Test        Modified British Medical ResearchmMRC     Council breathlessness...
ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Como...
DEGREE OF AIR FLOW LIMITATION
ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Como...
ASSESSMENT OF RISK OF             EXACERBATIONS   CONCEPT.     Acute event.     Worsening of the patient’s respiratory ...
ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Como...
ASSESSMENT OF COMORBIDITIES
ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Como...
COMBINED COPD ASSESMENT • Symptoms (impact on patient’s health status) • Degree of airflow limitation • Risk of exacerbati...
COMBINED COPD ASSESMENTWhen assessing risk, choose the highest risk according to GOLDgrade or exacerbation history. (One o...
 Patient Group A – Low Risk, Less SymptomsTypically GOLD 1 or GOLD 2 (Mild or Moderate  airflow limitation) and/or 0-1 ex...
 Patient Group C – High Risk, Less SymptomsTypically GOLD 3 or GOLD 4 (Severe or Very Severe  airflow limitation) and/or ...
   Example: Imagine a patient with a CAT score of 18,    FEV1 of 55% of predicted, and a history of 3    exacerbations wi...
   Example: Imagine a patient with a CAT score of 18,    FEV1 of 55% of predicted, and a history of 3    exacerbations wi...
TO BE CONTINUED…
Gold 2013 famracologia clinica
Gold 2013 famracologia clinica
Gold 2013 famracologia clinica
Gold 2013 famracologia clinica
Gold 2013 famracologia clinica
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.
  • Gold 2013 famracologia clinica

    1. 1. JORGE GUERRERO Residente 1er añoMedicinaFalimiaryComunitaria FarmacologíaClínica
    2. 2. Focus on both the short-term andlongterm impact of COPD on our patients.
    3. 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. 4. DEFINITION CHRONIC OBSTRUCTIVEPULMONARY DISEASE  Preventable PERSISTENT  Treatable Chronic Response not Reversible
    5. 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. 6. SYNTOMS OF COPD
    7. 7. CARDINAL SYNTOMS
    8. 8. WHAT CAUSE COPD ? TABACCO SMOKERS
    9. 9. WHAT CAUSE COPD ?  INDOOR AIR POLLUTIONBiomass fuel used for cooking and heating in poorly venteddwellings, a risk factor that particularly affects
    10. 10. WHAT CAUSE COPD ? OCCUPATIONAL DUST AND CHEMICALS
    11. 11. WHAT CAUSE COPD ?  OUTDOOR AIR POLLUTIONTotal burden of inhaled particles
    12. 12. DIAGNOSIS OF COPD
    13. 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. 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. 15. ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation(using spirometry)• Risk of exacerbations• Comorbidities
    16. 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. 17. ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Comorbidities
    18. 18. DEGREE OF AIR FLOW LIMITATION
    19. 19. ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Comorbidities
    20. 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. 21. ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Comorbidities
    22. 22. ASSESSMENT OF COMORBIDITIES
    23. 23. ASSESMENT OF COPD• Symptoms (impact on patient’s health status)• Degree of airflow limitation• Risk of exacerbations• Comorbidities
    24. 24. COMBINED COPD ASSESMENT • Symptoms (impact on patient’s health status) • Degree of airflow limitation • Risk of exacerbations • Comorbidities
    25. 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. 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. 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. 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. 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. 30. TO BE CONTINUED…
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