THE COPD PATIENT – APATIENT WITH A COMPLEX PATHOLOGY Sandrina Maria Dăscălescu Scientific Coordinator: Maria Pănescu“Gr.T.Popa” University of Medicine and Pharmacy, Iasi
GOLD deffinition: COPD, a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients.
Risk factors Genes Infections Socio-economic status Aging Populations
Mechanisms Underlying Airflow Limitation in COPDSmall Airways Disease Parenchymal Destruction• Airway inflammation • Loss of alveolar attachments• Airway fibrosis, luminal plugs • Decrease of elastic recoil• Increased airway resistance AIRFLOW LIMITATION
Diagnosis EXPOSURE TO RISK SYMPTOMS FACTORSshortness of breath tobacco chronic cough occupation sputum indoor/outdoor pollution SPIROMETRY: Required to establish diagnosis
ClassificationIn patients with FEV1/FVC < 0.70:• Stage I: Mild - FEV1 > 80% predicted with or without symptoms• Stage II: Moderate - 50% < FEV1 < 80% predicted usually with symptoms• Stage III: Severe - 30% < FEV1 < 50% predicted with cough, sputum, dyspnea• Stage IV: Very Severe - FEV1 < 30% predicted with clinical signs of respiratory failure and right-sided heart failure
Background• COPD represents one of the most important health issues, assessed to become the 3rd leading cause of morbidity by 2030, due to continued exposure to risk factors and the aging of the world’s population;• associated with several comorbidities (cardiovascular disease, lung cancer, diabetes, chronic respiratory diseases, etc.);• Multi-systemic disease;• significant economic expenses.
Aim to establish how the diseases evolution is affected by different comorbidities found in every patient of the studied group.
Material and method• 40 patients that were diagnosed with COPD according to the Global initiative for chronic obstructive lung disease (GOLD) definition have been analyzed.• The analysis has been done retrospectively, by making use of the patients individual treatment files, the spirometry results and other investigations specific for the associated comorbidities.
Results• 38 male patients, 2 female• Age – between 40 and 80 years• 38 smokers, ex-smokers 87.5% of the studied patients presented two or more comorbidities.
• At the time of the initial diagnosis of COPD: 1 patient - stage I 13 patients - stage II 19 patients - stage III 7 patients - stage IV
TreatmentStage I patient - no medications, helped to quit smoking, received annual flu vaccine and the pneumococcal vaccine in every 5 years; - Evolution - good, no exacerbationsStage II patients- 11 - treated with Tiotropium (Spiriva);- 2 - Salbutamol (Ventolin) +/- Theophylline - retard;- Evolution: 1-2 exacerbation/ year, 4 patients went to stage III of disease, one died of heart attack.
Stage III patients Treated with Seretide or Symbicort Evolution: ~2 exacerbations/ year, mostly on pacientswith diabetes, TB sequelae and autoimmuneconditions. 3 died - 1 of age, 2 of heart attack.Stage IV patients 1 pacient treated with Ventolin – because of lowincome, the proper scheme could not be applied.Evolution: 4 exacerbations in one year. 3 pacients – Seretide/ Symbicort +/ - Spiriva,theophylline – retard, Ventolin 3 patients – + oxygen Evolution: no exacerbations.
The average cost of care for thesepatients goes up to 200 euros/ month, or evenmore, in case of associated comorbidities. Every new exacerbation multiplies thiscost up to 8 times. Number of premature deaths and numberof missed days of work are also very importantfacts to be considered when calculatingCOPD’s costs.
Conclusions • COPD and associated comorbidities are consequences of smoking, and treatment for these patients is highly expensive, because it involves not only the COPD treatment, but also the treatment of associated illnesses.• When a new case of COPD is found, one should always consider the presence of associated diseases; these should be properly treated because they have a great influence on the COPD evolution.