3. What is COPD ?
A set of lung diseases that limit air flow and
is not fully reversible.
COPD patients report they are “in so need”
for air
Usually progressive and is associated with
inflammation of the lungs
Potentially preventable with proper
precautions and avoidance of precipitating
factors
Symptomatic treatment is available
4. 2 Major Causes of COPD
Chronic Bronchitis is characterized by
Chronic inflammation and excess mucus
production
Presence of chronic productive cough
Emphysema is characterized by
Damage to the small, sac-like units of the lung
that deliver oxygen into the lung and remove
Chronic cough
*Update on the ATS Guidelines for COPD. Medscape Pulmonary Medicine. 2014
5. Primary Symptoms
Chronic Bronchitis
Chronic cough
Shortness of breath
Increased mucus
Frequent clearing of throat
Emphysema
Chronic cough
Shortness of breath
Limited activity level
8. How common is COPD ?
12.7 million U.S. adults (aged 18 and over) were
estimated to have COPD.*
24 million other adults have evidence of
troubled breathing, indicating COPD is under
diagnosed by up to 60%*
*COPD Fact Sheet. Aug, 2014. www/lungusa.org
9. COPD-A Major Cause of
Hospitalization & Death
COPD is the:
Fourth leading cause of death
Leading cause of hospitalizations in the
U.S. in 2013
10. How Can COPD be
Prevented ?
Stop Smoking
- Smokers are 90% more likely to develop
COPD
Avoid or protect yourself from exposures to
- Second-hand smoke
- Also avoid substances such as chemical
vapors, fumes, dusts, and exhaust fumes that
11. Opportunities for
Improvement
Currently, care outcomes less than optimal
Unplanned re-admissions are costly
-30 day re-admits largely preventable
COPD evidence-based care exist for both
in-patient (exacerbation) and out-patient (Sx
control)
- Use of evidence-based care is low
12. Stable phase COPD
Only 3 interventions have been
demonstrated to influence the natural
history of patients with COPD:
Smoking cessations
O2 therapy in chronically hypoxemic
patients
Lung volume reduction surgery in
selected patients with emphysema
13. There is currently suggestive, but not
definitive, evidence that the use of
inhaled glucocorticoids may alter the
mortality rate (but not lung function).
All the other current therapies are
directed at improving symptoms and
decreasing the frequency and severity of
exacerabations.
14. • FEV /FVC < 0.70
1
• FEV ≥ 80% predicted
1
• FEV /FVC < 0.70
1
• 50% ≤ FEV
predicted
1 < 80%
• FEV /FVC < 0.70
1
• 30% ≤ FEV
predicted
1 < 50%
• FEV /FVC < 0.70
1
• FEV
1 < 30% predicted
1
predicted plus
respiratory failure or
failure
Add regular treatment with long-acting bronchodilators; Begin Pulmonary
Rehabilitation
Add inhaled glucocorticosteroids if repeated acute
exacerbations
Add LTOT for chronic
hypoxemia.
Consider surgical
options
III: Severe
I: Mild
II: Moderate
IV: Very Severe
Active reduction of risk factor(s); smoking cessation, flu vaccination
Add short-acting bronchodilator (as needed)
GOLD Guideline
15. Treatment option
Bronchodilators –
- Relaxes muscles around airways
Steroids
- Reduces inflammation
Oxygen therapy
- Helps with shortness of breath
16. Treatments Cont.
Most commonly prescribed short acting
Bronchodilators are:
- Anti-Cholenergic: Ipratropium bromide
- Beta-2 agonist: Albuterol, Metaproterenol
- 2-4 puffs every 6 hours
- Ipratropium Bromide is preferred as the
first line agent: b/c of it’s longer duration of
action and absence of sympathomimetic SE.
17. Treatments Cont.
Short acting Beta-2 agonist – are less
expensive and more rapid action of onset.
and at maximal doses they have
bronchodilator action equivalent to
ipratropium.
- But they may cause Tachacardia, Tremors
and Hypkolemia.
18. Treatment cont,
Oral glucocorticoid-chronic use of oral
glucocorticoid is not recommended
Theophylline: produces modest
improvements in expiratory flow rates
and vital capacity and a slight
improvement in arterial O2 and CO2
N/V is a common S/E. But tachycardia and
tremor have been reported.
19. Other agents:
N—acetyl cysteine has been used in
patients with COPD for both its mucolytic
and antioxidant properties. But
prospective trial failed to find any benefit
with respect to decline in lung function or
prevention of exacerbations.
a1AT for individual with severe deficiency
(a1AT less than 50mg/dl), but not
recommended for patients with severe
20. 1AT but normal pulmonary function and a
normal chest CT scan. And if the patient is
eligible to get this treatment prior to that
they need to be vaccinated for Hep B.
21. Medication for Prevention
of Complications
Annual flu vaccine
-Reduces risk of flu and its complications
Pneumonia vaccine
-Reduces risk of common cause of
pneumonia
22. Under Treatment of COPD
COPD - an expensive, chronic condition
- Incidence is increasing
- Financial liability is escalating
Diagnostic spirometry is woefully under-used
Use of evidence-based treatment guidelines is low
Failure to control symptoms a precursor to exacerbations
COPD hospital re-admissions are largely preventable
Chronic disease management strategies a necessity
23. Managing Stable COPD
Goals of Therapy
-Relieve airflow obstruction
-Improve exercise tolerance
Reduce symptoms
-Improve health status
Reduced symptoms + Reduced risk = Successful disease management
24. Resources & References
American Lung Association. Chronic obstructive pulmonary disease (COPD) Fact Sheet, 2014
www.lungusa.org
National Heart, Lung, and Blood Institute, NIH. Global strategy for the diagnosis, management, and prevention
of chronic obstructive pulmonary disease Executive Summary, Updated 2014
National Heart, Lung, and Blood Institute, NIH. COPD-Key points and How is COPD treated? August, 2014
http://www.nhlbi.nih.gov/health
