COPD is a common lung disease characterized by persistent airflow limitation that is usually progressive. It is caused by exposure to noxious particles or gases, most commonly from tobacco smoke. The goals of COPD assessment are to determine the severity and impact on health status, as well as risks of future events and common comorbidities. Diagnosis requires symptoms, exposure to risk factors, and confirmation by spirometry showing severe airflow obstruction. Management involves smoking cessation, vaccination, bronchodilators, inhaled corticosteroids, rehabilitation, and treatment of exacerbations.
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness
Asthma vs COPD - A quick summary of the differences between themLGM Pharma
Asthma is a lung disease that affects almost 20 million Americans. COPD, or chronic obstructive pulmonary disease is a chronic lung disease that afflicts 24 million patients in the U.S. COPD is mainly caused by smoking or secondhand smoke, while asthma can by caused by exposure to allergens, dust and air pollutants. Innovative treatments are needed to combat both asthma and COPD, and LGM Pharma provides quality API's for the R&D needs of clients seeking treatments for these lung diseases.
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness
Asthma vs COPD - A quick summary of the differences between themLGM Pharma
Asthma is a lung disease that affects almost 20 million Americans. COPD, or chronic obstructive pulmonary disease is a chronic lung disease that afflicts 24 million patients in the U.S. COPD is mainly caused by smoking or secondhand smoke, while asthma can by caused by exposure to allergens, dust and air pollutants. Innovative treatments are needed to combat both asthma and COPD, and LGM Pharma provides quality API's for the R&D needs of clients seeking treatments for these lung diseases.
Etiopathogenesis and pharmacotherapy of COPD
a. the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects).
Chronic Obstructive Pulmonary Disease BY
Dr Akram Yousuf
Resident Internal Medicine
Liaquat University of Medical Health and Sciences Jamshoro Pakistan
Pulmonary function tests (PFTs) are noninvasive tests that show how well the lungs are working. The tests measure lung volume, capacity, rates of flow, and gas exchange. This information can help your healthcare provider diagnose and decide the treatment of certain lung disorders.
chronic obstructive pulmonary disease and its management
chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease.
Etiopathogenesis and pharmacotherapy of COPD
a. the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects).
Chronic Obstructive Pulmonary Disease BY
Dr Akram Yousuf
Resident Internal Medicine
Liaquat University of Medical Health and Sciences Jamshoro Pakistan
Pulmonary function tests (PFTs) are noninvasive tests that show how well the lungs are working. The tests measure lung volume, capacity, rates of flow, and gas exchange. This information can help your healthcare provider diagnose and decide the treatment of certain lung disorders.
chronic obstructive pulmonary disease and its management
chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease.
The latest guidelines on the management of a COPD patient ( Stable COPD, patient with an exacerbation of COPD), latest modalities of treatment of a COPD patient
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
COPD 2014
1. Guides : Dr. Jitendra Bhargava
Dr. Sanjay Bharty
Dr. Brahma Prakash
By-DR ANKUR KAUSHIK
2. COPD, a common preventable and treatable disease,
is characterized by persistent airflow limitation that
is usually progressive and associated with an
enhanced chronic inflammatory response in the
airways and the lung to noxious particles or gases.
Exacerbations and comorbidities contribute to the
overall severity in individual patients.
Definition from GOLD 2014
3. COPD is a leading cause of morbidity and mortality worldwide. COPD
also accounts for more than 3 million deaths per year globally making it the
third leading cause of death worldwide. According to World Health
Organization estimates, 400 million people worldwide suffers from COPD.
The estimated burden of COPD in India is about 15 million cases (males
and females contributing to 9.02 and 5.75 million, respectively).
In India, according to INSEARCH I and II trials, prevalence of COPD
is 3.67% (4.46 and 2.86% among males and females, respectively).The
prevalence was found to be increasing with an increase in age.
The burden of COPD is projected to increase in coming decades due to
continued exposure to COPD risk factors and the aging of the world’s
population. it is estimated to be the third leading cause of death by 2030.
Data from Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint
ICS/NCCP (I) recommendations 2013
4. AIRFLOW
LIMITATION
Small Airways Disease
• Airway inflammation
• Airway fibrosis,
luminal plugs
• Increased airway
resistance
Parenchymal
Destruction
• Loss of alveolar
attachments
• Decrease of elastic
recoil
5. Picture from Gold 2014 updates
Professor Peter J. Barnes, MD
National Heart and Lung Institute, London UK
6. • Genes
• Exposure to particles
Tobacco smoke
Occupational dusts, organic
and inorganic
Indoor air pollution from
heating and cooking with
biomass in poorly ventilated
dwellings
Outdoor air pollution
• Lung growth and development
• Gender
• Age
• Respiratory infections
• Socioeconomic status
• Asthma/Bronchial hyperactivity
• Chronic Bronchitis
7. The goals of COPD assessment are to
determine
the severity of the disease,
including the severity of airflow limitation.
The impact on the patient’s
health status, and the risk of future
events.
Comorbidities that occur frequently in COPD
patients, and should be actively looked
for and treated appropriately if present.
8. Chronic cough Present intermittently or every day, often
present throughout
the day
Chronic sputum
production
Any pattern of sputum production may
indicate COPD
Acute bronchitis Repeated episodes
Dyspnea that is Progressive, persistent, worse on exercise,
worse during
respiratory infections
History of exposure
to risk factors
Smoke, biomass fuel, occupational dusts
The diagnosis should be
confirmed by Spirometry
9. Diagnosis of COPD
SYMPTOMS
• shortness of breath
• chronic cough
• sputum
EXPOSURE
TO RISK
FACTORS
• Tobacco
• Occupation
• indoor/outdoor
pollution
SPIROMETRY: Required
to establish diagnosis
10. ASSESSMENT OF COPD
Assess symptoms
Assess risk of exacerbations
Assess degree of airflow limitation using
spirometry
12. COPD Assessment Test (CAT): An 8-item measure of
health status impairment in COPD
(http://catestonline.org).
Clinical COPD Questionnaire (CCQ): Self-administered
questionnaire developed to measure clinical
control in patients with COPD (http://www.ccq.nl).
Breathlessness Measurement using the Modified
British Medical Research Council (mMRC)
Questionnaire: relates well to other measures of health
status and predicts future mortality risk
16. Spirometry should be performed after the
administration of an adequate dose of a short acting
inhaled bronchodilator to minimize variability.
A post-bronchodilator FEV1/FVC < 0.70 confirms the
presence of airflow limitation.
Where possible, values should be compared to age-related
normal values to avoid over diagnosis of COPD
in the elderly.
17.
18. We use spirometry for grading severity according to spirometry, using four
grades split at 80%, 50% and 30% of predicted value
Classification of Severity of Airflow Limitation in COPD*
In patients with FEV1/FVC < 0.70:
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
*Based on Post-Bronchodilator FEV1
19. To assess risk of exacerbations use history of
exacerbations and spirometry:
• Two or more exacerbations within the last year or an
FEV1 < 50 % of predicted value are indicators of high
risk.
• One or more hospitalizations for COPD exacerbation
should be considered high risk.
20.
21.
22. Patient Characteristic Spirometry
Classification
Exacerbations per
year
CAT mMRC
A Low Risk
Less Symptoms
GOLD 1-2 ≤ 1 < 10 0-1
B Low Risk
More Symptoms
GOLD 1-2 ≤ 1 > 10 > 2
C High Risk
Less Symptoms
GOLD 3-4 > 2 < 10 0-1
D High Risk
More Symptoms
GOLD 3-4 > 2 > 10 > 2
23. COPD patients are at increased risk for:
Cardiovascular diseases
Osteoporosis
Respiratory infections
Anxiety and Depression
Diabetes
Lung cancer
Bronchiectasis
24. Chest X-ray: Valuable to exclude alternative diagnoses and
establish presence of significant comorbidities.
Lung Volumes and Diffusing Capacity: Help to
characterize severity.
Oximetry and Arterial Blood Gases: Pulse oximetry can be
used to evaluate a patient’s oxygen saturation and need for
supplemental oxygen therapy.
Alpha-1 Antitrypsin Deficiency Screening: Perform when
COPD develops in patients of Caucasian descent under 45
years or with a strong family history of COPD.
25. Exercise Testing: Objectively measured exercise
impairment, assessed by a reduction in self-paced
walking distance (such as the 6 min walking test) or
during incremental exercise testing in a laboratory, is a
powerful indicator of health status impairment and
predictor of prognosis.
26. • Smoking cessation has the greatest capacity to influence the natural
history of COPD. Health care providers should encourage all
patients who smoke to quit.
• Pharmacotherapy and nicotine replacement reliably increase long-term
smoking abstinence rates.
• All COPD patients benefit from regular physical activity and
should repeatedly be encouraged to remain active.
• Appropriate pharmacologic therapy can reduce COPD symptoms,
reduce the frequency and severity of exacerbations, and improve
health status and exercise tolerance.
• Influenza and pneumococcal vaccination should be offered
depending on local guidelines.
27. Beta2-agonists
Short-acting beta2-agonists
Long-acting beta2-agonists
Anticholinergic
Short-acting anticholinergic
Long-acting anticholinergic
Combination short-acting beta2-agonists + anticholinergic in one inhaler
Combination long-acting beta2-agonists + anticholinergic in one inhaler
Methylxanthines
Inhaled corticosteroids
Combination long-acting beta2-agonists + corticosteroids in one inhaler
Systemic corticosteroids
Phosphodiesterase-4 inhibitors
28. Bronchodilator medications are central to the
symptomatic management of COPD.
The principal bronchodilator treatments are beta2
agonists, anticholinergic, theophylline or
combination therapy.
The choice of treatment depends on the availability
of medications and each patient’s individual response
in terms of symptom relief and side effects.
29. Regular treatment with inhaled corticosteroids improves
symptoms, lung function and quality of life and reduces
frequency of exacerbations for COPD patients with an FEV1
< 60% predicted.
30. An inhaled corticosteroid combined with a long-acting
beta2-agonist is more effective than the
individual components in improving lung function
and health status and reducing exacerbations in
moderate to very severe COPD.
Addition of a long-acting beta2-agonist/inhaled
glucorticosteroid combination to an anticholinergic
(tiotropium) appears to provide additional benefits.
31. Theophylline is less effective and less well tolerated than
inhaled long-acting bronchodilators and is not
recommended if those drugs are available and affordable.
There is evidence for a modest bronchodilator effect and
some symptomatic benefit compared with placebo in stable
COPD. Addition of theophylline to salmeterol produces a
greater increase in FEV1 and breathlessness than
salmeterol alone.
Low dose theophylline reduces exacerbations but does not
improve post-bronchodilator lung function.
32. Chronic treatment with systemic corticosteroids
should be avoided because of an unfavorable benefit-to-
risk ratio.
33. First novel therapy for COPD in nearly 20 years.
In patients with severe and very severe COPD
(GOLD 3 and 4) and a history of exacerbations and
chronic bronchitis, it’s a selective phospodiesterase-4
inhibitor, roflumilast, reduces exacerbations treated
with oral glucocorticosteroids.
This medication is not a bronchodilator, and it is not
indicated for the treatment of acute bronchospasm.
34.
35. Influenza vaccines can reduce serious illness. Pneumococcal
polysaccharide vaccine is recommended for COPD patients 65
years and older and for COPD patients younger than age 65
with an FEV1 < 40% predicted.
The use of antibiotics, other than for treating infectious
exacerbations of COPD and other bacterial infections, is
currently not indicated.
36. Alpha-1 antitrypsin augmentation therapy: not recommended
for patients with COPD that is unrelated to the genetic deficiency.
Mucolytics: Patients with viscous sputum may benefit from
mucolytics; overall benefits are very small. Example, n-acetyl
cystiene.
Antitussives: Not recommended.
Vasodilators: Nitric oxide is contraindicated in stable COPD.
The use of endothelium-modulating agents for the treatment of
pulmonary hypertension associated with COPD is not
recommended.
37. All COPD patients benefit from exercise training programs
with improvements in exercise tolerance and symptoms of
dyspnea and fatigue.
Although an effective pulmonary rehabilitation program is 6
weeks, the longer the program continues, the more effective
the results.
If exercise training is maintained at home, the patient's health
status remains above pre-rehabilitation levels.
38. Oxygen Therapy: The long-term administration of oxygen (>
15 hours per day) to patients with chronic respiratory failure
has been shown to increase survival in patients with severe,
resting hypoxemia.
Ventilatory Support: Combination of noninvasive
ventilation (NIV) with long-term oxygen therapy may be of
some use in a selected subset of patients, particularly in those
with pronounced daytime hypercapnia.
39. Lung volume reduction surgery (LVRS) is more
efficacious than medical therapy among patients with
upper-lobe predominant emphysema and low exercise
capacity.
LVRS is costly relative to health-care programs not
including surgery.
In appropriately selected patients with very severe
COPD, lung transplantation has been shown to
improve quality of life and functional capacity
40. • Relieve symptoms
• Improve exercise tolerance
• Improve health status
• Prevent disease progression
• Prevent and treat exacerbations
• Reduce mortality
41. Avoidance of risk factors
- smoking cessation
- reduction of indoor pollution
- reduction of occupational exposure
Influenza vaccination
42. Long-acting formulations of beta2-agonists and
anticholinergics are preferred over short-acting
formulations. Based on efficacy and side effects, inhaled
bronchodilators are preferred over oral bronchodilators.
Long-term treatment with inhaled corticosteroids added
to long-acting bronchodilators is recommended for
patients with high risk of exacerbations.
The phospodiesterase-4 inhibitor roflumilast may be
useful to reduce exacerbations for patients with FEV1 <
50% of predicted, chronic bronchitis, and frequent
exacerbations.
43. Patient
Group
Essential Recommended Depending on local
guidelines
A
Smoking cessation (can
include pharmacologic
treatment)
Physical activity
Flu vaccination
Pneumococcal
vaccination
B, C, D
Smoking cessation (can
include pharmacologic
treatment)
Pulmonary rehabilitation
Physical activity
Flu vaccination
Pneumococcal
vaccination
44. Patient Recommended
First choice
Alternative choice Other Possible
Treatments
A
SAMA prn
or
SABA prn
LAMA
or
LABA
or
SABA and SAMA
Theophylline
B
LAMA
or
LABA
LAMA and LABA
SABA and/or SAMA
Theophylline
C
ICS + LABA
or
LAMA
LAMA and LABA or
LAMA and PDE4-
inh. or
LABA and PDE4-
inh.
SABA and/or SAMA
Theophylline
D
ICS + LABA
and/or
LAMA
ICS + LABA and
LAMA or
ICS+LABA and
PDE4-inh. or
LAMA and LABA or
LAMA and PDE4-
inh.
Carbocysteine
SABA and/or SAMA
Theophylline
45.
46.
47. Osteoporosis and anxiety/depression: often under-diagnosed
and associated with poor health status
and prognosis.
Lung cancer: frequent in patients with COPD; the
most frequent cause of death in patients with mild
COPD.
Serious infections: respiratory infections are
especially frequent.
Metabolic syndrome and manifest diabetes: more
frequent in COPD and the latter is likely to impact
on prognosis.
48. COPD VS ASTHMA
Feature: if present suggest ASTHMA COPD
Age of Onset Before 20 After 40
Pattern of Symptoms • Variation of minutes, hours, days
• Worst during night or early morning
• Triggered by exercise, emotions,
including laughter dust or emotions
• Persistent besides treatment
• Good and bad days but always daily
symptoms and exertional dyspnea
• Chronic cough and sputum
precedes onset of dyspnea unrelated
to trigger.
Lung Functions Record of variable airflow limitation
(spirometry or peak flow
Records persistent airflow limitation
FEV1/FVC < 0.70 post BD
Lung functions between symptoms Normal Abnormal
Past history or family history • Previous doctor diagnosis of asthma
• Family history of asthma, or other
allergic condition (allergic rhinitis or
eczema)
• Previous doctor diagnosis of COPD,
chronic bronchitis or emphysema
• Heavy exposure to risk factors-tobacco
smoke or biomass fuel
Time course • No worsening of symptoms over time.
Variation in symptoms either seasonally
or from year to year.
• May improve spontaneously or have an
immediate response to bronchodilators
or ICS over weeks
• Symptoms slowly worsen over time
(progressive course over years
• Rapid acting bronchodilator
treatment only provide limited relief
Chest xray Normal Severe hyperinflation
49. Professor Peter J. Barnes, MD
National Heart and Lung Institute, London UK