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State-of-the-Art Overview of COPD and its Management

Presentation by Dr David Pierson, faculty of Pulmonary Medicine Update Course, Egypt. Knowledge resources at Scribe : www.scribeofegypt.com

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State-of-the-Art Overview of COPD and its Management  David J Pierson MD Professor of Medicine University of Washington Seattle, WA, USA December, 2008
What’s New in COPD in 2008? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What’s New in COPD in 2008? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Current Guidelines:  www.goldcopd.org ,[object Object],[object Object],[object Object],[object Object],[object Object]
Consensus Standards and Practice Guidelines for COPD Management GOLD :  Respir Care . 2001 Aug;46(8):798-825; Updated  Eur Respir J . 2003 Jul;22(1):1-2.  www.goldcopd.com American Thoracic Society - European Thoracic Society :  Eur Respir J . 2004 Jun;23(6):932-46.  www.thoracic.org (Other national guidelines from Australia–New Zealand, Canada, Finland, France, Germany, India, Malaysia, South Africa, Switzerland, the UK, and others) Review and comparison of current guidelines:  Pierson DJ,  Respir Care  2006 (Mar);51(3):277-288.
State-of-the-Art Overview of COPD in 2008 ,[object Object],[object Object],[object Object],[object Object],[object Object]

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State-of-the-Art Overview of COPD and its Management

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  • 5. Consensus Standards and Practice Guidelines for COPD Management GOLD : Respir Care . 2001 Aug;46(8):798-825; Updated Eur Respir J . 2003 Jul;22(1):1-2. www.goldcopd.com American Thoracic Society - European Thoracic Society : Eur Respir J . 2004 Jun;23(6):932-46. www.thoracic.org (Other national guidelines from Australia–New Zealand, Canada, Finland, France, Germany, India, Malaysia, South Africa, Switzerland, the UK, and others) Review and comparison of current guidelines: Pierson DJ, Respir Care 2006 (Mar);51(3):277-288.
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  • 8. Change in Age-Adjusted US Death Rates, 1965-1998* *www.goldcopd.com Percentage of 1965 Rate 50 100 150 200 250 Coronary Heart Disease Stroke Other CVD All Other Causes COPD -59% -64% -35% +163% -7%
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  • 13. Diagnosing COPD with Spirometry* *www.goldcopd.com
  • 14. Use of Spirometry to Diagnose COPD* *Global Initiative for Obstructive Lung Disease Guideline (2007 Revision); www.goldcopd.org
  • 15. Should the General Public Be Screened for COPD with Spirometry?
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  • 18. GOLD Staging System for COPD* *www.goldcopd.com
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  • 27. Using More Different Smoking Cessation Formats Increases the Success Rate *Marlow SP,Stoller JK, Respir Care 2003;48(12):1238-54
  • 28. More Individual Smoking Cessation Sessions Increase the Success Rate *Marlow SP,Stoller JK, Respir Care 2003;48(12):1238-54
  • 29. More Contact Time Increases the Likelihood of Success *Marlow SP,Stoller JK, Respir Care 2003;48(12):1238-54
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  • 33. *Sutherland & Cherniack, NEJM 2004;350:2689-97 Lung Hyperinflation in COPD*
  • 34. Effect of Long-Acting Beta 2 -Agonists on COPD Exacerbations* *Sin DD et al, JAMA 2003;290:2301-12 Meta-analysis of 9 clinical trials (4198 patients)
  • 35. Effect of Tiotropium on COPD Exacerbations* *Sin DD et al, JAMA 2003;290:2301-12 Meta-analysis of 5 clinical trials (3574 patients)
  • 36. Relationship Between FEV 1 and Effect of Inhaled Corticosteroids in Preventing COPD Exacerbations* Greater Effect in More Severely Obstructed Patients *Sin DD et al, JAMA 2003;290:2301-12
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  • 45. Effects of Pulmonary Rehabilitation on Functional Exercise Capacity* *Lacasse Y et al, Cochrane Database Syst Rev 2006;Oct 18(4):CD007793
  • 46. Effects of Pulmonary Rehabilitation on Dyspnea* *Lacasse Y et al, Cochrane Database Syst Rev 2006;Oct 18(4):CD007793
  • 47. Effects of Pulmonary Rehabilitation on St Georges Respiratory Questionnaire (Total)* *Lacasse Y et al, Cochrane Database Syst Rev 2006;Oct 18(4):CD007793
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  • 60. Cost of Managing COPD According to Current Guidelines (Pierson DJ, Respir Care 2006;51(3):277-288) Monthly Cost ($) add LTOT add ICS add LABD SABD as needed 0 100 200 300 400 500 600 700 800 Mild (GOLD I) Moderate (GOLD II) Severe (GOLD III) Very Severe (GOLD IV)
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  • 65. Language Barriers to Health Care in the US* *Data from US Census Bureau; Flores G, NEJM 2006;355(3):229-31 *
  • 66. * Prose Literacy Levels Among US Adults in 2003. Marcus EN, NEJM 2006;355(4):339-41 Barriers to Effective Health Care: Literacy in the US*
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