Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. It is characterized by persistent respiratory symptoms and airflow limitation caused by exposure to noxious particles or gases. A diagnosis of COPD requires risk factors like smoking, symptoms like dyspnea, and spirometry showing post-bronchodilator FEV1/FVC < 0.70. Acute exacerbations of COPD (AeCOPD) are defined as acute worsening of respiratory symptoms and are classified based on severity of symptoms and oxygen levels. Treatment depends on a patient's clinical phenotype and exacerbation history.

1. Chronic obstructive pulmonary
disease (COPD)
BSNT Hiền- Trung- Lương

2. Content
COPD: definition,etiology, dignosis
AeCOPD: definition,etiology,
dignosis , classification
Conclusion
2
1
3

3. Epidemiology
• COPD is the currently the fourth leading cause of death in
the world
• Based on BOLD , it’s estimated that number of COPDcases was
384 million in 2010 .
• More than 3 million people died of COPD in 2012 accounting
for 6 % all death globally.
• More than 90% of COPD deaths occur in low and middle -
income countries.
BOLD: Burden of obstructive lungdiseases
Global Initiative for Chronic Obstructive Lung Disease 2019

4. Definition of COPD
Global Initiative for Chronic Obstructive Lung Disease 2020
COPDis acommon preventable and treatable disease that is
characterized by persistent respiratory symptoms and airflow
limitation that is due to airway and/or alveolar abnormalities
usually caused by significant exposure to noxious particles or
gases and influenced by host factors including abnormal lung
development

5. Etiology , pathobiology and pathology of COPD
Etiology
- Smoking & pollutants
- Host factors
Pathobiology
- Impaired lung growth
- Accelerated decline
- Lung injury
- Lung & systematic inflammation
Pathology
- Small airway disorders or abnormalities
- Emphysema
- Systemic effect
Air flow limitation
Persistent airflow limitation
Clinical manifestations
- Symptoms
- Exacerbations
- Comorbidities

6. Risk factor COPD

7. Risk factor COPD
Prevalence of chronic bronchitis in relation to active smoking, stratified by age.
□: nonsmokers; ▒: 1–10 cigarettes per day; ░: 11–20 cigarettes per day;
▪: >20 cigarettes per day.

8. Risk factor COPD

9. Exposure to particles
- Smoke
- Organic and inorganic dust
- Chemical agents
- Fumes

11. Diagnosis and Assessment: KeyPoints
COPDshould be considered in any patient who had :
1)Dyspnea
2) Chronic cough
3) Sputum production and / or ahistory of exposure
to risk factors for thedisease.
Spirometry is required to make
the diagnosis:Post- bronchodilator
FEV1/FVC <0.70
Global Initiative for Chronic Obstructive Lung Disease2017

12. Post- bronchodilator FEV1/FVC < 70%

15. Additional investigations
• 1. Imaging
- Not useful to establish a
diagnosis in COPD
- Valuable in excluding
alternative diagnoses
- Signs of lung hyperinflation,
hyperlucency of the lung,
rapid tapering of the
vascular markings

16. Emphysema
Gas trapping

17. Aterial blood gas

18. Definition of AeCOPD
The GOLD 2017: “an acute
worsening of respiratory symptoms
that results in additional therapy”.
Increase cough
More breathless
Change color and/or amount of
sputum

19. Etiology of AeCOPD
30% unknown

20. Symptoms

21. We born to become expert in TB and Lungs Diseases
Diagnosis
a) My breathing is much better than usual
b) My breathing is better than usual
c) My breathing is the same as usual
d) My breathing is worse than usual
e) My breathing is much worse than usual
A daily diary card assessment of COPD symptoms for patient
An exacerbation can be defined as “d” or “e” occurring
for at least two consecutive days
S. Burge, J.A. Wedzicha, European Respiratory Journal 2003 21: 46s-53s

22. We born to become expert in TB and Lungs Diseases
Diagnosis
CAT Score Health impact
0-10 Low
11-20 Medium
21-30 High
31-40 Very high

23. We born to become expert in TB and Lungs Diseases
Diagnosis
Marc Miravitlles: Course of COPD assessment test (CAT) and clinical COPD questionnaire (CCQ) scores during recovery
from exacerbations of chronic obstructive pulmonary disease

24. - Level I: outpatient treatment
- Level II: requiring hospital treatment
- Level III: requiring hospital treatment special or ICU
Classification

26. We born to become expert in TB and Lungs Diseases
Criteria Severe Very severe
Speak Word -
Mental status unconsious
Using accessory respiratory
muscles
+++ abnormal
Respiratory rate 25-35 < 12
- Change sputum color
- Change sputum amount
- Fever
- New onset edema and
cyanosis
3/4 4/4
Pulse rate > 120 Abnormal, < 60
SpO2 % 87-85 < 85
PaO2 mmHg 40-50 < 40
PaCO2 mmHg 55-65 > 65
pH 7.25-7.30 < 7.25
Classification
Guideline for Diagnosis COPD 2018 VN Ministry of public health

27. Phenotype Infrequent exacerbator
Bronchodilators
ACOS
Exacerbator with
emphysema
Bronchodilators Bronchodilators
+ ICS (in some cases + ICS)
Exacerbator with chronic
bronchitis
Bronchodilators
+ ICSTreatment strategy*
YesNo
Diagnosis of COPD and ≥2 exacerbations per year?
No Yes
ACOS? ACOS?
No Yes Yes No
Chronic cough?
*Choice of treatment should be based on clinical phenotype and the intensity determined by severity
• *Choice of treatment should be based on clinical phenotype and the intensity determined by severity
• ACOS = asthma‒COPD overlap syndrome; GesEPOC = Guía Española de la EPOC [Spanish Guidelines for COPD]; ICS = inhaled corticosteroid
Miravitlles M, et al. Arch Bronconeumol 2012
Characterization ofpatients with COPD:GesEPOC

28. Several risk factors and triggers are involved in exacerbations of chronic obstructive pulmonary
disease (COPD).
Christian Viniol, and Claus F. Vogelmeier Eur Respir Rev
2018;27:170103
©2018 by European Respiratory Society

29. Conclusion
• Pathology of COPD are: small airway disorders or
abnormalities, emphysema and systemic effect.
• Diagnosis of COPD depend on risk factor,
symptoms and spirometry
• Diagnosis of AeCOPD