a disease state of airflow limitation that is not fully reversible
a chronic inflammatory condition
often caused by chronic bronchitis, emphysema or a mixture of both
pathologically different from asthma
usually the result of cigarette smoking or occupational exposure to small particles or dusts
increasing in prevalence, particularly in women
the cause of significant direct and indirect costs
Learning objectives – 2
To understand that COPD is:
associated with symptoms such as chronic cough, chronic mucus production and breathlessness
diagnosed by assessment of clinical signs and symptoms together with spirometric measurements of airflow obstruction
To understand the importance of spirometry and the use of flow-volume loops in the diagnosis of COPD
To understand current guidelines for the diagnosis and staging of COPD (GOLD)
Learning objectives – 3
To understand current guidelines for the treatment of COPD (GOLD)
To understand the unique position of Foradil ® Aerolizer™ in the treatment of COPD
The common component of COPD is airflow obstruction Chronic bronchitis Emphysema Airflow obstruction Asthma
Summary of risk factors for the development of COPD
Smoking and passive smoking
Genetic factors, e.g. AAT deficiency
Atopy and hyperresponsive airways
Clinical features of advanced COPD
Distention of veins in neck
Anorexia and weight loss
Diagnostic measures recommended by major Thoracic Societies
Clinical and smoking history
Symptoms (especially dyspnoea, cough, sputum and wheezing)
Pre- and post-bronchodilator spirometry
Chest radiography (to exclude other diseases)
ATS. Am J Respir Crit Care Med 1995 ERS. Eur Respir J 1995 BTS. Thorax 1997 Pauwels RA, et al. Am J Respir Crit Care Med 2001
GOLD guidelines outline key points in COPD diagnosis Chronic cough Present intermittently or every day Often present throughout the day; seldom only nocturnal Chronic sputum production Any pattern of chronic sputum production may indicate COPD Dyspnoea that is: Progressive (worsens over time) Persistent (present every day) Described by the patient as an ‘increased effort to breathe’, or ‘gasping’ Worse during exercise Worse during respiratory infections History of exposure to risk factors, especially: Tobacco smoke Occupational dusts and chemicals Smoke from home cooking and heating fuels Pauwels RA, et al. Am J Respir Crit Care Med 2001
GOLD guidelines: Classification of severity of COPD Stage Characteristics 0: At risk - Normal spirometry - Chronic symptoms (cough, sputum production) I: Mild COPD - FEV 1 /FVC <70% - FEV 1 80% predicted - With or without chronic symptoms (cough, sputum production) II: Moderate COPD - FEV 1 /FVC <70% - 30% FEV 1 <80% predicted (IIA: 50% FEV 1 <80% predicted, IIB: 30% FEV 1 <50% predicted) - With or without chronic symptoms (cough, sputum production, dyspnoea) III: Severe COPD - FEV 1 /FVC <70% - FEV 1 <30% predicted or FEV 1 <50% predicted plus respiratory failure or clinical signs of right heart failure
What Is Asthma?
Asthma is a chronic disease that affects the airways, which causes breathing problems. It can be life threatening.
The inside walls of the airways are inflamed (swollen). The inflammation makes the airways very sensitive, and they tend to react strongly to allergens or irritants.
When the airways react, they get narrower and less air flows through to the lung tissues. This causes symptoms like wheezing (a whistling sound when you breathe), coughing, chest tightness, and trouble breathing. Breathing problems are called attacks or episodes of asthma.
About 150 million people around the world suffer from asthma.
Most common chronic illness of childhood: 10% of children and 5% of adults) / Prevalence is approximately 6% (3% in Japan).
More boys than girls, but in adulthood, more women than men.
Coughing. Coughing from asthma is often worse at night or early in the morning, making it hard to sleep.
Wheezing. Wheezing is a whistling or squeaky sound when you breathe.
Chest tightness. This can feel like something is squeezing or sitting on the chest.
Shortness of breath. Some people say they can't catch their breath, or they feel breathless or out of breath. You may feel like you can't get enough air in or out of your lungs.
Faster breathing or noisy breathing.
Etiology is unknown as of today. However, the factors listed below may worsen asthma:
Animal dander (from the skin, hair, or feathers of animals)
Dust mites (contained in house dust)
Pollen from trees and grass
Mould (indoor and outdoor)
Cold air or changes in weather
Strong odors from painting or cooking
Strong emotional expression (including crying or laughing hard), and stress
Medications such as aspirin and beta-blockers
Sulfites in food (dried fruit) or beverages (wine)
A condition called gastroesophageal reflux disease (GERD) that causes heartburn and can worsen asthma symptoms, especially at night.
Irritants or allergens that you may be exposed to at your work such as special chemicals or dusts
Extrinsic factors: the incidence and prevalence of asthma vary from country to country and region to region. The exact reasons behind such differences are unknown but are presumed to be due to the differences in external factors (socioeconomic, types of environmental allergens, dietary, etc.)
Intrinsic factors: no clear racial predisposition has been identified although some genetic linkages have been demonstrated.
(Need assessment in disease prevalence, medical practice, drug metabolism, availability of medical technologies, laboratory test ordering practicing, drug prescribing practice, healthcare financing policy must be considered. )
Diagnosis and Classification
Hyper-expansion of the thorax,
Sounds of wheezing during normal breathing, or a prolonged phase of forced exhalation
Increased nasal secretion, mucosal swelling, and nasal polyps.
Atopic dermatitis/eczema or any other manifestation of an allergic skin condition.
PULMONARY FUNCTION TESTING (SPIROMETRY)
Spirometry measurements (FEV1, FVC, FEV1/FVC).
( 肺活量計 )
Standard of Care
National Institutes of Health National Asthma Education and Prevention Program divides the medication into two:
Quick Relief medicines give rapid, short-term treatment and are taken when you have worsening asthma symptoms that can lead to asthma episodes or attacks. You will feel the effects of these medicines within minutes. An example is a short-acting inhaled bronchodilator.
Long-term Control medicines are taken every day, usually over long periods of time, to control chronic symptoms and to prevent asthma episodes or attacks. You will feel the full effects of these medicines after taking them for a few weeks. People with persistent asthma need long-term control medicines. Examples are inhaled corticosteroids, long-acting beta agonists, leukotriene modifier, theophyline, Cromolyn, nedocromil