This document provides an overview of chronic obstructive pulmonary disease (COPD). It defines COPD as a progressive lung disease characterized by limited airflow. The two major types are chronic bronchitis and emphysema. Risk factors include smoking, air pollution, and aging. Symptoms include chronic cough, shortness of breath, and limited activity. Treatment focuses on bronchodilators, steroids, oxygen therapy, and smoking cessation. Proper management can control symptoms and reduce exacerbations.

1. COPD
By: Dr. Shima Ghavimi
PGY-1

2. Overview
What is COPD?
How common is it?
How can COPD be prevented ?
How is COPD treated?

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

6. Risk Factors for COPD
Socio-economic status
© 2013 Global Initiative for Chronic Obstructive Lung Disease
Genes
Infections
Aging Populations

7. COPD Comorbidities

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