Background and Aim: Many studies have found association between Red Cell Distribution Width (RDW) values and hypertension, dipping pattern, and end-organ damage. RDW values are affected by blood vitamin B12, iron, and folic acid levels, parameters that were not assessed in the previous studies. The aim of our study was to evaluate the relation between RDW and hypertension, dipper pattern, and end-organ damage independently from vitamin B12, folic acid, and ferritin levels in newly diagnosed hypertensive patients.
Background and Aim: Many studies have found association between Red Cell Distribution Width (RDW) values and hypertension, dipping pattern, and end-organ damage. RDW values are affected by blood vitamin B12, iron, and folic acid levels, parameters that were not assessed in the previous studies. The aim of our study was to evaluate the relation between RDW and hypertension, dipper pattern, and end-organ damage independently from vitamin B12, folic acid, and ferritin levels in newly diagnosed hypertensive patients.
EVALUATING RISK OF HEART FAILURE WITH ERYTHROPOIETIN IN CHRONIC ANEMIAPARUL UNIVERSITY
Erythropoietin (EPO) is the primary regulatory hormone of
erythropoiesis. Hypoxia induces an increase in EPO hormone
production in the kidney which promotes the viability, proliferation,
and terminal differentiation of erythroid precursors, and causing an
increase in red blood cell mass. Any abnormality that reduces the renal
secretion of or bone marrow response to erythropoietin may result in
anemia. The approval of recombinant human erythropoietin
(epoetinalfa) by the US FDA in 1989, epoetinalfa and similar agents
now collectively known as erythropoietin stimulating agents (ESA)
have become the standard of care for the treatment of the
erythropoietin-deficient anemia. Studies suggest that in patients with
high serum erythropoietin is associated with risk of recurrent heart
failure (HF) and mortality. Thromboembolic complications can be
increased in patients receiving erythropoietin. the use of
erythropoiesis-stimulating agents though reduces the need for transfusions it is associated
with increased complications, including higher mortality and increased risk of
thromboembolic and cardiovascular events leading to congestive heart failure.
John B. Buse, MD, PhD; David Cherney, MD, PhD, FRCP(C); and Mikhail Kosiborod, MD, FACC, FAHA, prepared useful Practice Aids pertaining to SGLT2 inhibitors for this CME activity titled “Complex Cases in Contemporary Practice: Applying New Evidence for SGLT2 Inhibitors in the Management of Patients With Comorbid Cardiometabolic Diseases.” For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at https://bit.ly/3dFKZhs. CME credit will be available until July 22, 2021.
Hypertension is a major public health problem and important area of research due to its high prevalence and being major risk factor for cardiovascular diseases and other complications. Objectives 1. To assess the prevalence of hypertension and its associated factors and 2. to estimate awareness, treatment, and adequacy of control of hypertension among study subjects. According to the Joint National Committee 7 JNC7 , normal blood pressure is a systolic BP 120 mmHg and diastolic BP 80 mm Hg. Hypertension is defined as systolic BP level of =140 mmHg and or diastolic BP level = 90 mmHg. A number of factors increase BP, including 1 obesity, 2 insulin resistance, 3 high alcohol intake, 4 high salt intake in salt sensitive patients , 5 aging and perhaps 6 sedentary lifestyle, 7 stress, 8 low potassium intake, and 9 low calcium intake. Shweta Pawar | Sujit Kakde | Ashok Bhosale "A Review: Hypertension" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd42416.pdf Paper URL: https://www.ijtsrd.commedicine/other/42416/a-review-hypertension/shweta-pawar
Hypertension is a silent, invisible killer that rarely causes symptoms. Increasing public awareness is key, as is access .Raised blood pressure is a warning sign that significant lifestyle changes are urgently needed. People need to know why raised blood pressure is dangerous, and how to take steps to control it.
Select one (1) peer-reviewed research article that you used in you.docxzenobiakeeney
Select one (1) peer-reviewed research article that you used in your research paper to share with the class.
Do not discuss en editorial or letter to editor.
After reading your selected article, post the following information:
1. Why is the research question significant to your research paper?
2. What was the purpose of the study?
3. What was the study design?
4. Who was in the study population(s)/sample(s)?
5. What was the outcome and was it consistent with the researcher(s)' original research question?
6. What recommendation(s) did the researcher offer for future studies?
7. How do you know this article was peer-reviewed?
OBSTRUCTIVE PULMONARY
DI
SEASE (COPD)
1
Chronic Obstructive Pulmonary Disease (
COPD
)
Name
Course
Tutor
Date
Chronic Obstructive Pulmonary Disease (
COPD
)
Abstract
A chronic obstructive pulmonary disease (COPD) is one of the current killers in the world. It is a preventable disease that makes it difficult for the affected individual to empty air out of the lungs otherwise referred to as airflow obstruction. The difficulties in breathing that is brought about by this condition leaves one feeling tired because they use
much
energy to
breathe
than required.
The c
hronic
obstructive pulmonary disease is a term that is used to include other types of pulmonary diseases that include chronic bronchitis, emphysema or both. Although asthma is a health condition that results in difficulties in breathing it is not included among the chronic obstructive pulmonary disease.
The effects of the disease are not instant but rather evolve at a slower rate inhibiting the breathing system of a patient.
However,
the
most important thing to note is that the disease can
be prevented
and it is relatively easier when it
is detected
in its earlier stages than in advanced stage.
In the United States, between 10 % and 20% of the chronic obstructive pulmonary disease is said to have been caused by occupational or exposure to chemical vapors,
irritants
,
and fumes which are very much contaminated. A
large
percentage of patients who are suffering from COPD are said to be
smokers
,
but a recent research indicated that 25 % of patients with COPD have never smoked in the United States. This paper provides an in-depth analysis into chronic obstructive pulmonary diseases including the historical perspective,
symptoms, and causes
of COPD,
method of spread, how it can
be contained
, and its implication on the economy,
treatment
,
and efforts being put in place to ensure that the disease is
contained
.
Keywords
COPD,
Chronic, Obstructive. Bronchodilators,
Pulmonary,
Prevalence, Mortality
.
History of the diseases
The c
hronic
obstructive pulmonary disease has been in existence for the last 200
years;
the only difference is that its prevalence back in the day was much lower mainly because of
the
lower
presence of risk factors than they are currently.
The disease
was recognized
by the.
EVALUATING RISK OF HEART FAILURE WITH ERYTHROPOIETIN IN CHRONIC ANEMIAPARUL UNIVERSITY
Erythropoietin (EPO) is the primary regulatory hormone of
erythropoiesis. Hypoxia induces an increase in EPO hormone
production in the kidney which promotes the viability, proliferation,
and terminal differentiation of erythroid precursors, and causing an
increase in red blood cell mass. Any abnormality that reduces the renal
secretion of or bone marrow response to erythropoietin may result in
anemia. The approval of recombinant human erythropoietin
(epoetinalfa) by the US FDA in 1989, epoetinalfa and similar agents
now collectively known as erythropoietin stimulating agents (ESA)
have become the standard of care for the treatment of the
erythropoietin-deficient anemia. Studies suggest that in patients with
high serum erythropoietin is associated with risk of recurrent heart
failure (HF) and mortality. Thromboembolic complications can be
increased in patients receiving erythropoietin. the use of
erythropoiesis-stimulating agents though reduces the need for transfusions it is associated
with increased complications, including higher mortality and increased risk of
thromboembolic and cardiovascular events leading to congestive heart failure.
John B. Buse, MD, PhD; David Cherney, MD, PhD, FRCP(C); and Mikhail Kosiborod, MD, FACC, FAHA, prepared useful Practice Aids pertaining to SGLT2 inhibitors for this CME activity titled “Complex Cases in Contemporary Practice: Applying New Evidence for SGLT2 Inhibitors in the Management of Patients With Comorbid Cardiometabolic Diseases.” For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at https://bit.ly/3dFKZhs. CME credit will be available until July 22, 2021.
Hypertension is a major public health problem and important area of research due to its high prevalence and being major risk factor for cardiovascular diseases and other complications. Objectives 1. To assess the prevalence of hypertension and its associated factors and 2. to estimate awareness, treatment, and adequacy of control of hypertension among study subjects. According to the Joint National Committee 7 JNC7 , normal blood pressure is a systolic BP 120 mmHg and diastolic BP 80 mm Hg. Hypertension is defined as systolic BP level of =140 mmHg and or diastolic BP level = 90 mmHg. A number of factors increase BP, including 1 obesity, 2 insulin resistance, 3 high alcohol intake, 4 high salt intake in salt sensitive patients , 5 aging and perhaps 6 sedentary lifestyle, 7 stress, 8 low potassium intake, and 9 low calcium intake. Shweta Pawar | Sujit Kakde | Ashok Bhosale "A Review: Hypertension" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd42416.pdf Paper URL: https://www.ijtsrd.commedicine/other/42416/a-review-hypertension/shweta-pawar
Hypertension is a silent, invisible killer that rarely causes symptoms. Increasing public awareness is key, as is access .Raised blood pressure is a warning sign that significant lifestyle changes are urgently needed. People need to know why raised blood pressure is dangerous, and how to take steps to control it.
Select one (1) peer-reviewed research article that you used in you.docxzenobiakeeney
Select one (1) peer-reviewed research article that you used in your research paper to share with the class.
Do not discuss en editorial or letter to editor.
After reading your selected article, post the following information:
1. Why is the research question significant to your research paper?
2. What was the purpose of the study?
3. What was the study design?
4. Who was in the study population(s)/sample(s)?
5. What was the outcome and was it consistent with the researcher(s)' original research question?
6. What recommendation(s) did the researcher offer for future studies?
7. How do you know this article was peer-reviewed?
OBSTRUCTIVE PULMONARY
DI
SEASE (COPD)
1
Chronic Obstructive Pulmonary Disease (
COPD
)
Name
Course
Tutor
Date
Chronic Obstructive Pulmonary Disease (
COPD
)
Abstract
A chronic obstructive pulmonary disease (COPD) is one of the current killers in the world. It is a preventable disease that makes it difficult for the affected individual to empty air out of the lungs otherwise referred to as airflow obstruction. The difficulties in breathing that is brought about by this condition leaves one feeling tired because they use
much
energy to
breathe
than required.
The c
hronic
obstructive pulmonary disease is a term that is used to include other types of pulmonary diseases that include chronic bronchitis, emphysema or both. Although asthma is a health condition that results in difficulties in breathing it is not included among the chronic obstructive pulmonary disease.
The effects of the disease are not instant but rather evolve at a slower rate inhibiting the breathing system of a patient.
However,
the
most important thing to note is that the disease can
be prevented
and it is relatively easier when it
is detected
in its earlier stages than in advanced stage.
In the United States, between 10 % and 20% of the chronic obstructive pulmonary disease is said to have been caused by occupational or exposure to chemical vapors,
irritants
,
and fumes which are very much contaminated. A
large
percentage of patients who are suffering from COPD are said to be
smokers
,
but a recent research indicated that 25 % of patients with COPD have never smoked in the United States. This paper provides an in-depth analysis into chronic obstructive pulmonary diseases including the historical perspective,
symptoms, and causes
of COPD,
method of spread, how it can
be contained
, and its implication on the economy,
treatment
,
and efforts being put in place to ensure that the disease is
contained
.
Keywords
COPD,
Chronic, Obstructive. Bronchodilators,
Pulmonary,
Prevalence, Mortality
.
History of the diseases
The c
hronic
obstructive pulmonary disease has been in existence for the last 200
years;
the only difference is that its prevalence back in the day was much lower mainly because of
the
lower
presence of risk factors than they are currently.
The disease
was recognized
by the.
Epidemiological studies that can be conducted in respiratory research?Pubrica
The purpose of this theme is to give suggestions for the conduct of general population studies on COPD in order to promote comparative and credible estimations of COPD prevalence by various risk variables. Diagnostic criteria in epidemiological contexts, as well as standardized procedures for examining the disease and its associated risk factors, are reviewed. This blog also provides practical guidance for organizing and carrying out epidemiological research on COPD.
Read more @ https://pubrica.com/academy/systematic-review/different-epidemiological-studies-in-respiratory-research/
Visit us @ https://pubrica.com/
#Medical data collection
#Scientific communication services
#Data analytics and machine learning
#Epidemiological studies
#respiratory research
#case-control studies epidemiology
#clinical epidemiology and biostatistics
#cohort epidemiological study
#cross-sectional study in epidemiology
#respiratory epidemiology
#research design
#cohort studies
#biostatistics
Study of clinical and etiological profile of community acquired pneumonia in ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Tiêu chuẩn chẩn đoán và điều trị copd của ats 1995
CTMT Quốc gia phòng chống bệnh phổi tắc nghẽn mạn tính và hen phế quản http://benhphoitacnghen.com.vn/
Chuyên trang bệnh hô hấp mãn tính: http://benhkhotho.vn/
Background- The chronic obstructive pulmonary disease is a chronic inflammatory disease and a leading cause of morbidity and mortality worldwide. Smoking is the major risk factor in COPD. Smoking damages the air sacs, airway and the lining of the lungs and due to this lung have trouble moving enough air in and out making hard to breathe. Smoking may act as a trigger factor for many people who have COPD and can either cause an exacerbation or flare-up of symptoms. The present study aims to determine the association of smoking status with different stages of COPD and clinical symptoms in a North Indian population. Methods- The present study was conducted on 160 stable COPD patients in the department of Respiratory Medicine, King George Medical University, Lucknow. Results- Out of 160 patients enrolled there were 41.8% smokers, 24.3% non-smokers, and 33.7% ex-smokers. The present study found a significant association (p<0.02) of smoking status with different stages of COPD, although non-significant association (p=0.96) was observed between smoking status and clinical symptoms. Conclusion- The significant association of smoking status was observed with different stages of COPD while the non-significant association was observed with clinical symptoms in the present study in north Indian population. Smoking cessation will be helpful in reducing the progression and management of this disease in smokers. Key-words- Chronic Obstructive pulmonary disease, Smoking, Clinical symptoms, Gold stage
2018 GOLD POCKET GUIDE
Evidence-based strategy document for COPD diagnosis, management, and prevention, with citations from the scientific literature.
2018 GOLD POCKET GUIDE
http://goldcopd.org/gold-reports/
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. American Thoracic Society, British Thoracic Society and European Respiratory
Society: Chronic bronchitis (clinical) and Emphysema (pathological).
Global Initiative for Chronic Obstructive Lung Disease (GOLD): airflow
limitation that is not fully reversible and is progressive and associated with an
abnormal inflammatory response of the lungs to noxious particles or gases.
Emphysema Normal
William MacNee. ABC of chronic obstructive pulmonary disease. Pathology, pathogenesis, and pathophysiology. BMJ. 2006 May 20; 332(7551): 1202–1204.
Definition of COPD
3. When to consider COPD in individuals over 40?
• Progressive and persistent dyspnea, which is worse with exercise.
• Chronic cough, which may be intermittent and unproductive.
• Chronic productive cough (any pattern of chronic sputum production).
• History of exposure to risk factors like tobacco smoke, domestic smoke and
occupational dust.
• Family history of COPD
Perform SpirometryAny of the above key indicators
Source: At-A-Glance Outpatient Management Reference for Chronic Obstructive Pulmonary Disease (COPD).
http://www.goldcopd.org/uploads/users/files/WatermarkedAt-A-Glance%202016(1).pdf Accessed on 08/07/2016
5. • Chronic Lower Respiratory Diseases (CLRD) are the 3rd leading cause of death
in US (2013)
• CLRD including asthma: 149,205
• CLRD excluding asthma: 136,627
Source: Deaths: Final Data for 2013, tables 9, 10, 11. http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf Accessed on 08/07/2016
Source: Chronic Respiratory Diseases. Burden of COPD. http://www.who.int/respiratory/copd/burden/en/ Accessed on 08/07/2016
• More than 90% of COPD deaths occur in low- and
middle-income countries in 2005.
Global Burden of Disease Study 2013 Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and
chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:743–800.
• One of the leading cause of disability worldwide.
• COPD is an iceberg disease.
Regan EA, et al. Clinical and Radiologic Disease in Smokers With Normal Spirometry. JAMA Intern Med. 2015 Sep;175(9):1539-49.
Source: Morbidity and Mortality: 2012 Chart Book on cardiovascular,
Lung, and Blood Diseases.
http://www.nhlbi.nih.gov/files/docs/research/2012_ChartBook.pdf
Accessed on 08/07/2016
Numbers in COPD
Source: Summary Health Statistics Tables for U.S. Adults: National Health Interview
Survey, 2014, Table A-2
http://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2014_SHS_Table_A-
2.pdf Accessed on 08/07/2016.
• Adults diagnosed with chronic bronchitis in 2013: 8.7 million
• Adults diagnosed with emphysema in 2013: 3.4 million
6. Source: Trends in COPD (Chronic Bronchitis and Emphysema): Morbidity and Mortality.
http://www.lung.org/assets/documents/research/copd-trend-report.pdf Accessed on 08/07/2016
• Prevalence rates increase with age. • Prevalence rates from 1980-2011
Sourc: Chronic Obstructive Pulmonary Disease Surveillance — United States, 1971–2000.
http://www.cdc.gov/mmwr/pdf/ss/ss5106.pdf Accessed on 08/07/2016
Source: COPD Surveillance—United States, 1999-2011.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3707177/pdf/chest_144_1_284.pdf Accessed on 08/07/2016
Disease prevalence
7. Age-adjusted death rates for selected causes of
death for all ages, by sex: United States, 2003-2013
Source: Health. United States. 2014, table 18. http://www.cdc.gov/nchs/data/hus/hus14.pdf#018
Males
Females
Source: Disease Statistics. National Heart, Lung and Blood Institute.
http://www.nhlbi.nih.gov/about/documents/factbook/2012/chapter4#4_1
Males Females
Mortality
9. COPD death rates among people aged 55 years
and over in relation to smoking (Australia)
Source: How many die from COPD? COPD is a major leading cause of death in Australia. http://www.aihw.gov.au/copd/mortality/
10. Modified version of Fletcher and Peto’s. from Daniel Kotz, et al Efficacy of confrontational counselling for smoking cessation in smokers with previously undiagnosed mild to
moderate airflow limitation: study protocol of a randomized controlled trial. BMC Public Health. 2007; 7: 332.. C Fletcher, R Peto. The natural history of chronic airflow obstruction.
Br Med J. 1977 June 25; 1(6077): 1645–1648.
Lung function and smoking
11. Genes may play a role in COPD
Hersh CP, et al. Family history is a risk Factor for COPD. Chest. 2011 Aug;140(2):343-50.
Salvi SS and Barnes PJ. Chronic obstructive pulmonary disease n non-smokers. Lancet. 2009 Aug 29;374(9691):733-43.
13. Assessment of COPD
• Symptoms
• Degree of airflow limitation (using spirometry)
• Risk of exacerbations
• Comorbidities
• Symptoms assessed by a questionnaire containing 8 questions.
Source: How is your COPD? Take the COPD AssessmentTestTM (CAT). http://www.catestonline.org/english/indexEN.htm Accessed on 08/07/2016
Modified from Source: At-A-Glance Outpatient Management Reference for Chronic Obstructive Pulmonary Disease
(COPD). http://www.goldcopd.it/materiale/2015/GOLD_Pocket_2015.pdf Accessed on 08/07/2016
14. Source: How is your COPD? Take the COPD AssessmentTestTM (CAT). http://www.catestonline.org/english/indexEN.htm Accessed on 08/07/2016
15. Assessment of COPD
• Symptoms
• Degree of airflow limitation (using spirometry)
• Risk of exacerbations
• Comorbidities
• Symptoms assessed by a questionnaire containing 8 questions.
Source: How is your COPD? Take the COPD AssessmentTestTM (CAT). http://www.catestonline.org/english/indexEN.htm Accessed on 08/07/2016
• Degree of airflow limitations discussed in the next slide.
Modified from Source: At-A-Glance Outpatient Management Reference for Chronic Obstructive Pulmonary Disease
(COPD). http://www.goldcopd.it/materiale/2015/GOLD_Pocket_2015.pdf Accessed on 08/07/2016
16. Classification of Severity of Airflow Limitation
in COPD (Based on Post-Bronchodilator FEV1)
In patients with FEV1/FVC < 0.70 (Normal: > 0.70 of predicted ratio)
GOLD 1 Mild FEV1 ≥ 80% predicted
GOLD 2 Moderate 50% ≤ FEV1 < 80% predicted
GOLD 3 Severe 30% ≤ FEV1 < 50% predicted
GOLD 4 Very severe FEV1 < 30% predicted
Normal FEV1 and FVC volumes depends on the age, height
and gender of the person.
Modified from Source: At-A-Glance Outpatient Management Reference for Chronic Obstructive Pulmonary Disease
(COPD). http://www.goldcopd.org/uploads/users/files/WatermarkedAt-A-Glance%202016(1).pdf Accessed on 08/07/2016
17. Assessment of COPD
• Symptoms
• Degree of airflow limitation (using spirometry)
• Risk of exacerbations
• Comorbidities
• Symptoms assessed by a questionnaire containing 8 questions.
Source: How is your COPD? Take the COPD AssessmentTestTM (CAT). http://www.catestonline.org/english/indexEN.htm Accessed on 08/07/2016
• Degree of airflow limitations discussed in the next slide.
• Risk of exacerbations:
Low Risk: ≤ 1 per year and no hospitalization for exacerbation
High Risk: ≥ 2 per year or ≥ 1 with hospitalization
Modified from Source: At-A-Glance Outpatient Management Reference for Chronic Obstructive Pulmonary Disease
(COPD). http://www.goldcopd.it/materiale/2015/GOLD_Pocket_2015.pdf Accessed on 08/07/2016
19. Exacerbation
Celli BR, MacNee W; ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary
of the ATS/ERS position paper. Eur Respir J. 2004;23(6):932-946.
O'Reilly JF, et al. Defining COPD exacerbations: impact on estimation of incidence and burden in primary care. Prim Care
Respir J 2006; 15: 346–353.
Causes of exacerbation: Bacterial (55%) and viral respiratory
infections, inflammatory (eosinohilic) and air pollution. But in some
cases of exacerbations the cause remains unknown.
Common bacterial causes include Haemophilus influenza, Haemohilus
parainfluenza, Streptococcus pneumoniae and Moraxella catarrhalis.
Less common causes include Pseudomonas aeruginosa,
Enterobacteriaceae and Staphylococcus aureus.
The most common viral cause is Rhinovirus.
Budev MM and Wiedemann HP. Acute bacterial exacerbation of chronic bronchitis.
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/acute-bacterial-exacerbation-chronic-
bronchitis/
Bafadhel M, et al. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers.
Am J Respir Crit Care Med. 2011 Sep 15;184(6):662-71.
Bafadhel M, et al. Acute exacerbations of chronic obstructive pulmonary disease: identification of biologic clusters and their biomarkers. Am J Respir Crit Care Med. 2011 Sep
15;184(6):662-71.
Agusti A, et al. Prevention of exacerbations in chronic obstructive pulmonary disease: knowns and unknowns. J COPD F. 2014; 1(2): 166-184. doi:
http://dx.doi.org/10.15326/jcopdf.1.2.2014.0134 - See more at: http://journal.copdfoundation.org/jcopdf/id/1041/Prevention-of-Exacerbations-in-Chronic-Obstructive-Pulmonary-
Disease-Knowns-and-Unknowns#sthash.gXOGSqp9.dpuf
Wedzicha JA, Donaldson GC. Exacerbations of chronic obstructive pulmonary disease. Respir Care. 2003 Dec;48(12):1204-13; discussion 1213-5.
An exacerbation of COPD is an increase from the patient's baseline
dyspnea, cough and/or sputum beyond day-to-day variability
warranting a change in management strategy.
20. Exacerbation
Mild: Can be controlled with an increase in dosage of regular
medication
Moderate: Requires treatment with systemic corticosteroids and/or
antibiotics
Severe: Requires hospitalization or evaluation in the ED and can lead
to respiratory failure
Evensen AE. Management of COPD exacerbation. Am Fam Physician. 2010 Mar 1;81(5):607-13.
Laue J, Reierth E and Melbye H. When should acute exacerbations of COPD be treated with systemic corticosteroids and antibiotics in primary
care: a systematic review of current COPD guidelines. NPJ Prim Care Respir Med. 2015 Feb 19;25:15002.
Burge S and Wedzicha JA. COPD exacerbations: definitions and classifications. Eur Respir J Suppl. 2003 Jun;41:46s-53s.
21. But the most reliable predictor of an exacerbation is the previous history
of exacerbation.
Exacerbation
Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012 Nov;67(11):957-63.
22. Assessment of COPD
• Symptoms
• Degree of airflow limitation (using spirometry)
• Risk of exacerbations
• Comorbidities
• Symptoms assessed by a questionnaire containing 8 questions.
Source: How is your COPD? Take the COPD AssessmentTestTM (CAT). http://www.catestonline.org/english/indexEN.htm Accessed on 08/07/2016
• Degree of airflow limitations discussed in the next slide.
• Risk of exacerbations:
Low Risk: ≤ 1 per year and no hospitalization for exacerbation
High Risk: ≥ 2 per year or ≥ 1 with hospitalization
• Comorbidities: Cardiovascular diseases, osteoporosis, depression and anxiety,
skeletal muscle dysfunction, metabolic syndrome, and lung cancer among other
diseases affect the morbidity and mortality of COPD.
Modified from Source: At-A-Glance Outpatient Management Reference for Chronic Obstructive Pulmonary Disease
(COPD). http://www.goldcopd.it/materiale/2015/GOLD_Pocket_2015.pdf Accessed on 08/07/2016
24. Systemic effects and comorbidities of COPD
P. J. Barnes, and B. R.. Systemic manifestations and comorbidities of COPD. Celli Eur Respir J 2009;33:1165-1185
26. Assessment of COPD
• Symptoms
• Degree of airflow limitation (using spirometry)
• Risk of exacerbations
• Comorbidities
• Symptoms assessed by a questionnaire containing 8 questions.
Source: How is your COPD? Take the COPD AssessmentTestTM (CAT). http://www.catestonline.org/english/indexEN.htm Accessed on 08/07/2016
• Degree of airflow limitations discussed in the next slide.
• Risk of exacerbations:
Low Risk: ≤ 1 per year and no hospitalization for exacerbation
High Risk: ≥ 2 per year or ≥ 1 with hospitalization
• Comorbidities: Cardiovascular diseases, osteoporosis, depression and anxiety,
skeletal muscle dysfunction, metabolic syndrome, and lung cancer among other
diseases affect the morbidity and mortality of COPD.
Modified from Source: At-A-Glance Outpatient Management Reference for Chronic Obstructive Pulmonary Disease
(COPD). http://www.goldcopd.it/materiale/2015/GOLD_Pocket_2015.pdf Accessed on 08/07/2016
27. Combined Assessment of COPD
Patient Characteristic Spirometric
classification
Exacerbations
per year
CAT*
A
Low risk
Less symptoms
GOLD 1-2 ≤1 < 10
B
Low risk
More symptoms
GOLD 1-2 ≤1
≥ 10
C
High risk
Less symptoms
GOLD 3-4 ≥2 < 10
D
High risk
More symptoms
GOLD 3-4 ≥2 ≥ 10
Modified from Source: At-A-Glance Outpatient Management Reference for Chronic Obstructive Pulmonary Disease
(COPD). http://www.goldcopd.it/materiale/2015/GOLD_Pocket_2015.pdf Accessed on 08/07/2016
*CAT: COPD assessment test http://www.catestonline.org/images/pdfs/CATest.pdf
28. Management of COPD
Patient
group
Recommended first
choice
Alternative choice
A
SA anticholinergic prn
or
SA beta2-agonist prn
LA anticholinergic
or
LA beta2-agonist
or
SA anticholinergic and
SA beta2-agonist
B
LA anticholinergic
or
LA beta2-agonist
LA anticholinergic and
LA beta2-agonist
C
LA beta2-agonist
or
ICS + LA anticholinergic
LA anticholinergic and
LA beta2-agonist
or
LA anticholinergic and
PDE-4 inhibitor
or
LA beta2-agonist and PDE-4 inhibitor
D
LA beta2-agonist
and/or
ICS + LA anticholinergic
ICS + LA anticholinergic and
LA beta2-agonist
or
ICS + LA beta2-agonist and PDE-4 inhibitor
or
LA anticholinergic and
LA beta2-agonist
or
LA anticholinergic and
PDE-4 inhibitor
Modified from Source: At-A-Glance Outpatient
Management Reference for Chronic Obstructive
Pulmonary Disease (COPD).
http://www.goldcopd.it/materiale/2015/GOLD_Pocket_20
15.pdf Accessed on 08/07/2016
29. How the interventions help?
Kim V and Criner GJ. Chronic bronchitis and chronic obstructive
pulmonary disease. Am J Respir Crit Care Med. 2013 Feb 1;187(3):228-37.
30. Treatment of exacerbation is bronchodilators, oxygen therapy,
antibiotics and/or inhaled/systemic corticosteroid therapy.
Pavord ID, et al. Exacerbations of COPD. Int J Chron Obstruct Pulmon Dis. 2016 Feb 19;11 Spec Iss:21-30
Source: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease updated 2016.
http://www.goldcopd.org/uploads/users/files/WatermarkedGlobal%20Strategy%202016(1).pdf Accessed on 08/07/2016
.
But use of antibiotics in mild to moderate COPD exacerbation is
fraught with controversy.
Puhan M, et al. Where is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease
exacerbations with antibiotics? A systematic review. BMC Med 2008; 6: 28.
Systemic corticosteroid use is associated with several adverse effects,
especially in patients with co-morbidities.
Bach PB, et al. Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and
appraisal of published evidence. Ann Intern Med 2001; 134: 600–620.
In spite of the above facts, antibiotics and corticosteroids are used in
almost all cases of acute exacerbation of COPD.
Laue J, Reierth E and Melbye H. When should acute exacerbations of COPD be treated with systemic corticosteroids and
antibiotics in primary care: a systematic review of current COPD guidelines. NPJ Prim Care Respir Med. 2015 Feb
19;25:15002.
Treatment of acute exacerbation of COPD
Oxygen therapy has a demonstrable beneficial effect in the
management of exacerbation of COPD
Simon E Brill, Jadwiga A Wedzicha. Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease. Int
J Chron Obstruct Pulmon Dis. 2014; 9: 1241–1252.
31. Moderate or Severe
At least two or three cardinal symptoms*
Simple (no major risk factors**) Complicated (≥ 1 major risk factors**)
Treat for 5 days with
β-lact/Doxy/Bactrim/Cephalosporin
(2nd or 3rd gen)/Macrolides
Treat for 5 days with
β-lact+lactamase/fluroquinolone
Clinical improvement in 72 hours?
• Change to oral antibiotics
• Vaccinate for influenza and pneumo
• Smoking cessation
• Reevaluate history/exam/data
• Sputum culture
• Broaden antibiotic coverage
* Increased dyspnea, sputum and sputum purulence
** FEV1 <50% predicted, >3 exacerbations/year, comorbid diseases, antibiotic use in the past 3 months
YES NO
Antibiotics in acute exacerbation of COPD
Anthonisen NR, al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987 Feb;106(2):196-204.
Source: Kelly Cunningham Sponsler, J. Daniel Markley and Joshua LaBrin. What Is the Appropriate Use of Antibiotics In Acute Exacerbations of COPD? The Hospitalist. January 26, 2012. http://www.the-hospitalist.org/article/what-is-the-appropriate-use-of-antibiotics-in-acute-exacerbations-of-copd/?singlepage=1 Accessed on 08/07/20166
32. Empirical selection of antibiotics in exacerbation of COPD
Source: What Is the Appropriate Use of Antibiotics In Acute Exacerbations of COPD? http://www.the-hospitalist.org/article/what-is-the-appropriate-use-of-antibiotics-in-acute-exacerbations-of-
copd/?singlepage=1 Accessed on 08/07/2016
33. Prevention of acute exacerbation of COPD
http://dx.doi.org/10.15326/jcopdf.1.2.2014.0134 - See
more at:
http://journal.copdfoundation.org/jcopdf/id/1041/Pr
evention-of-Exacerbations-in-Chronic-Obstructive-
Pulmonary-Disease-Knowns-and-
Unknowns#sthash.gXOGSqp9.dpuf Accessed on
08/07/2016
Inhibitor of
phosphodiesterase type 4
34. Conclusions
• COPD is a disease, which is significant for prevalence, morbidity,
mortality, and economic burden (both on the individual and the
healthcare system).
• It is a disease that is largely preventable.
• Unfortunately, once acquired, the course is relentless leading to
considerable morbidity and ultimately to death.
• Co-morbidities play a significant role on the outcome of the disease.
• Acute exacerbations are a natural course of the disease.
• Antibiotics, steroids, bronchodilators and oxygen therapy are the
main stay in treating the exacerbations.
• Control of risk factors is essential to prevent exacerbations.
• Maintaining a baseline disease process involves risk prevention and
non-pharmacological as well as pharmacological methods.
• Medication compliance, smoking cessation and vaccination has
proven highly beneficial in keeping the disease under control.
