The document provides information on chronic obstructive pulmonary disease (COPD), including its definition, epidemiology, risk factors, pathogenesis, clinical manifestations, diagnosis, screening tools, management, and preventive strategies. It describes COPD as a common lung disease characterized by persistent respiratory symptoms and airway limitation usually caused by significant exposure to noxious particles or gases like smoke. The summary discusses COPD's prevalence, risk factors like smoking and indoor air pollution, methods of diagnosis including spirometry, and approaches to management such as reducing exacerbations and risk factors.

2. LEARNING OBJECTIVES:
The participant will be able to:
• Describe the epidemiology, risk factors and pathogenesis of
COPD
• Describe the diagnostic approach in COPD
• Define COPD screening tools
• Explain strategies for prevention of COPD
• Manage COPD

3. Definition
A common, preventable and treatable disease 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

4. Outline
 Definition, Epidemiology, risk factors & pathogenesis
 Clinical manifestations
 Diagnosis and initial assessment
 Preventive strategies
 Management of stable COPD

5. Definition
• Chronic bronchitis
Clinically defined condition with chronic cough and phlegm
Small airways disease
A condition in which small bronchioles are narrowed
• Emphysema
Anatomically defined condition
Characterized by destruction and enlargement of the lung alveoli

6. COPD

7. Epidemiology
• NCDIs
-Major public health problem in Ethiopia
accounting for an estimated
-52% of the total annual mortality
-46% of total national disease burden (DALY’s lost) in
2016
• Based on Global Burden of Diseases Study 2016
CRDs contribute to
-2.5% of the deaths due to NCDs

8. Epidemiology
Third leading cause of death in the world
 Estimated 384 million cases of COPD globally with estimated
prevalence of 12%
More than 3 million people died of COPD in 2016 accounting for
6% of all deaths globally
Burden is projected to increase because of continued exposure to
COPD risk factors and aging of the population
Prevalence of COPD is higher in smokers and ex-smokers compared
to non-smokers
Higher in ≥ 40year group compared to those < 40 years of age
Higher in men than in women
The prevalence of COPD is not precisely known even though
hospital based studies show it is probably fairly common in Ethiopia

9. Underdiagnoses in COPD

10. Epidemiology
STEPS Survey indicated
-Prevalence of current smokers to be 4.2% of adults
GATS
-29.3% (6.5 million) were exposed to environmental tobacco smoke
(ETS) in their workplace in the past 30 days
-Overall, 12.6% (8.4 million) of adults were exposed to ETS
at home
-60.4% in bars and nightclub
-31.1% in restaurant
-19.7% in government buildings
-11.4% in public transportation
-7.0% in health-care facilities

11. Epidemiology
Shisha use
Indoor air pollution due to biomass fuel use
Industrialization and urbanization -exposure to particulate
matter are rising
Whereas,
Availability of services for CRDs is very low at 45% in
Health facilities
Among those facilities mean readiness was only 55% based
on SARA 2016 report

12. Risk factors

13. PATHOGENESIS AND PATHOPHYSIOLOGY OF COPD
• The chronic air flow limitation caused by a mixture of small
air ways diseases (e.g. Obstructive bronchiolitis) and
parenchymal destruction(emphysema), the relative
contributions of which of which vary from person to person
• COPD is characterized by:
– Airflow limitation and gas trapping
– Gas exchange abnormalities
– Mucus hypersecretion
– Pulmonary hypertension

15. Noxious particles
and gases
Lung inflammation
Host factors
COPD pathology
Proteinases
Oxidative stress
Anti-proteinases
Anti-oxidants
Repair mechanisms

16. CHANGES IN LUNG
VOLUMES

17. Note: This is a simplified diagram of FEV1 progression over time. In reality, there is tremendous heterogeneity in the rate of decline in FEV1
owing to the complex interactions of genes with environmental exposures and risk factors over an individual’s lifetime
[adapted from Lange et al. NEJM 2015;373:111-22].

19. Clinical
manifestations
Symptoms of COPD
– Cough(usually the first symptoms)
– Sputum production
– Chronic and progressive dyspnea
– Wheezing and chest tightness
– Others – including fatigue, weight
loss, anorexia, syncope, rib
fractures, ankle swelling,
depression, anxiety
Physical examination in COPD
– The respiratory examination is
the most important examination
when assessing a COPD patient
– Even in quite severe disease
there may be no physical
findings in a COPD patients
– Chest auscultation may
demonstrate bilateral wheeze or
crackles

20. DIAGNOSIS OF COPD

21. Pathways to diagnosis of COPD at primary health care

22. Pathways to diagnosis of COPD at General hospital
& above

23. © 2020 Global Initiative for Chronic Obstructive Lung Disease

24. CLINICAL SCREENING OF COPD
• Spirometry is required to make the diagnosis of COPD
• Clinical criteria can be used to determine probability of COPD
in the absence of spirometry
• The COPD Population Screener™ (COPD-PS™)
Easy-to-use
Validated tool designed to identify patients at risk for COPD

25. About the score:
Score 5-10 — High risk of COPD
Score 0-4 — Low risk of COPD
Confirmation of COPD diagnosis requires spirometry.

26. Management of COPD
• An effective COPD management plan includes
four components:
1. Assess and monitor disease
2. Reduce risk factors
3. Manage stable COPD
4. Manage exacerbations

27. Initial assessment
 The goals of COPD assessment are to determine
-Level of airflow limitation
-Impact of disease on the patient’s health status
-Risk of future events (such as exacerbations, hospital admissions, or
death)
in order to guide therapy
 Concomitant chronic diseases occur frequently in COPD patients
 Cardiovascular disease
 Skeletal muscle dysfunction
 Metabolic syndrome
 Osteoporosis
 Depression
 Anxiety
 Lung cancer

28. © 2020 Global Initiative for Chronic Obstructive Lung Disease

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33. Pharmacologic treatment of COPD in Ethiopia

34. © 2020 Global Initiative for Chronic Obstructive Lung Disease

35. © 2019 Global Initiative for Chronic Obstructive Lung Disease

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42. COPD PREVENTIVE
STRATEGIES
• The following are strategies to prevent COPD:
– Reduce indoor air pollution
• Smokeless cooking stoves
• Cooking in a well-ventilated room
• Cooking meals outside the house
•
– Smoking cessation-counseling
• Smoking cessation has the greatest capacity to influence the
natural history of COPD
• If effective resources and time are dedicated to smoking
cessation, long-term quit success rates of up to 25% can be
achieved

43. Case study 4 (30 min )
• A 45yearold woman from rural village has noticed a persistent,
occasionally productive cough for the past 6 months. The cough is worse
whenever she spends the day at her home while cooking where is exposed
to the smoke of the wood fire. She finally decides to visit the health
center. Her husband and she never smoked cigarettes.
• The cough has been present for almost a year. She has no fever or chills.
She does admit to more shortness of breath when she walks for long
distance over the past six months.
• Physical examination was normal findings.
• Discussion points:
• What further questions do you want to ask?
• What differential diagnoses do you consider?
• At this point, what further investigations do you think would be
appropriate?
• What would be the best option to improve her symptoms and slow
progression?

44. Summary
– COPD is characterized by chronic cough, dyspnea, wheezing and
sputum production
– Caused by exposure to inhaled pollutants, almost always smoke from
either domestic fires or tobacco smoking
– Rhonchi, decreased intensity of breathe sounds, and prolonged
expiration on physical examination
– Airflow limitation on pulmonary function testing that is not fully
reversible and is most often progressive
– Occurs later in life, usually older than 35 years old
– Prevention involves decreasing exposure to tobacco and avoiding
indoor air pollution

45. • We would like to thank
– Dr. Tewodros Haile, Dr. Aschalew Worku, Dr
Amsalu Bekele, Dr Hanan Yusuf and Dr Rahel
Argaw for preparing this powerpoint