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Copd 30
This document discusses COPD (chronic obstructive pulmonary disease), including its definition, symptoms, pathology, diagnosis, management, and treatment. Some key points include: - COPD is characterized by persistent respiratory symptoms and airflow limitation usually caused by significant exposure to noxious particles or gases. It involves chronic inflammation in the airways, lung parenchyma, and pulmonary vasculature. - Diagnosis is based on spirometry showing airflow limitation that is not fully reversible. Severity is classified based on lung function tests and exacerbation history. - Management focuses on smoking cessation, vaccinations, pulmonary rehabilitation, pharmacologic therapy including bronchodilators and inhaled corticosteroids,
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Copd 30
- 1. COPD Islam Ibrahim, MD,FACP, FCCP, Associate professor of Pulmonary and Critical care medicine, University of California San Diego, USA. Consultant ICU, IMC, KSA. imibrahim@ucsd.edu iibrahim@imc.med.sa
- 2. (COPD) DEFINITION •A common, preventableand treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.
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- 14. Gas trapping -Hyperinflation Airflow limitation Pathology
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- 20. Pathology pulmonary Vasculature Right ventricular hypertrophy Pulmonaryhypertension. Hypoxic vasoconstriction
- 21. Pathology pulmonary Vasculature Right ventricular hypertrophy Pulmonaryhypertension. Hypoxic vasoconstriction Right-side cardiac failure.
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- 33. COPD Phenotypes • Alpha-1antitrypsin deficiency • Emphysema/ hyperinflation • Frequent exacerbators • Mild airway obstruction but disproportionately severe dyspnea • Rapid lung function decline • Comorbidities • Persistent inflammation, CRP, fibrinogen, WBC • Chronic bacterial airway colonization • Lung cancer phenotype • Severe pulmonary hypertension • Non-smokers • Overlap of symptoms between asthma and COPD
- 34. COPD Severity exacerbation risk >2exacerbations / year
- 35. GOLD 3 and4 Deteriorating airflow
- 36. GOLD 3 and4 Deteriorating airflow
- 37. Differential diagnosis • Asthma • CongestiveHeart Failure • Bronchiectasis • Tuberculosis • Obliterative Bronchiolitis • Diffuse Panbronchiolitis • Alpha-1 antitrypsin deficiency
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- 44. stable COPD management strategy > Healthstatus • < symptoms • > exercise tolerance
- 45. stable COPD management strategy > Healthstatus • < symptoms • > exercise tolerance REDUCE RISK • < COPD progression • < exacerbations • < mortality
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- 54. Brief strategies tohelp the patient willing to quit
- 55. Brief strategies tohelp the patient willing to quit • ASK: • ADVISE: • ASSESS: • ASSIST: • counseling • pharmacotherapy • ARRANGE: • follow up
- 56. Treating tobacco dependence cost effective Effectivetreatments exist • should be offered Evidence A • Documentation at every visit. counseling is effective- every contact • Practical • social support • pharmacotherapies • varenicline, • bupropion • nicotine • gum • inhaler, • nasal spray • patch Financial incentive programs
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- 59. PHARMACOLOGIC THERAPY FOR STABLE COPD Reduce Symptoms Exacerbations Improve Exercisetolerance Health status.
- 60. PHARMACOLOGIC THERAPY FOR STABLE COPD Reduce Symptoms Exacerbations Improve Exercisetolerance Health status. Modify decline in lung function. No evidence
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- 63. Proper technique Check ateach visit Individually tailored Cost, Patient’s preference. Inhalation drugs
- 64. Adherence Proper technique Check ateach visit Individually tailored Cost, Patient’s preference. Inhalation drugs
- 65. Beta 2 Agonists SABA • Formoterol •Salmeterol • Indacaterol • Oladaterol • Vilanterol LABA
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- 67. Anti muscarinic M3 muscarinicreceptors in airway smooth muscle.
- 68. Anti muscarinic M3 muscarinicreceptors in airway smooth muscle. SAMA Ipratropium Oxitropium
- 69. Anti muscarinic M3 muscarinicreceptors in airway smooth muscle. SAMA Ipratropium Oxitropium LAMA Tiotropium Aclidinium Glycopyrronium Umeclidinium
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- 71. Regular Use ofSABA
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- 76. LABA- LAMA formoterol -tiotropium • bigger impact on FEV1 than either component alone 1
- 77. Comb. LABA- LAMA Formoterol /aclidinium Formoterol / glycopyrronium Indacaterol / glycopyrronium Vilanterol / umeclidinium Olodaterol / tiotropium
- 78. LABAs and LAMAs> SABAs • Evidence A 1 bronchodilator - escalate to 2 • Evidence A Inhaled bronchodilators > oral • Evidence A Theophylline is not recommended • Evidence B Bronchodilators.
- 79. LABAs and LAMAs> short acting agents • Evidence A 1 bronchodilator - escalate to 2 • Evidence A Inhaled bronchodilators > oral • Evidence A Theophylline is not recommended • Evidence B Bronchodilators.
- 80. LABAs and LAMAs> short acting agents • Evidence A 1 bronchodilator - escalate to 2 • Evidence A Inhaled bronchodilators > oral • Evidence A Theophylline is not recommended • Evidence B Bronchodilators.
- 81. LABAs and LAMAs> short acting agents • Evidence A 1 bronchodilator - escalate to 2 • Evidence A Inhaled bronchodilators > oral • Evidence A Theophylline is not recommended • Evidence B Bronchodilators.
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- 83. Anti inflammatory agents •ICSLong term monotherapy •is not recommended •Evidence A
- 84. ICS / LABAs for patientswith exacerbations Evidence A
- 85. Combination LABA - ICS Formoterol/ beclomethasone Formoterol / budesonide Formoterol / mometasone Salmeterol / fluticasone Vilanterol / fluticasone
- 86. Anti inflammatory therapy instable COPD
- 87. EVIDENCE ICS - LABA> individual components Evidence A Regular ICS > pneumonia Evidence A ICS/LAMA/LABA improves lung function Evidence A ICS/LAMA/LABA reduces exacerbations Evidence B
- 88. EVIDENCE ICS - LABA> individual components Evidence A Regular ICS > pneumonia Evidence A ICS/LAMA/LABA improves lung function Evidence A ICS/LAMA/LABA reduces exacerbations Evidence B
- 89. EVIDENCE ICS - LABA> individual components Evidence A Regular ICS > pneumonia Evidence A ICS/LAMA/LABA improves lung function Evidence A ICS/LAMA/LABA reduces exacerbations Evidence B
- 90. EVIDENCE ICS - LABA> individual components Evidence A Regular ICS > pneumonia Evidence A ICS/LAMA/LABA improves lung function Evidence A ICS/LAMA/LABA reduces exacerbations Evidence B
- 91. EVIDENCE ICS - LABA> individual components Evidence A Regular ICS > pneumonia Evidence A ICS/LAMA/LABA improves lung function Evidence A ICS/LAMA/LABA reduces exacerbations Evidence B
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- 93. anti inflammatory agents Long term –oralcorticosteroids
- 94. anti inflammatory agents is not recommended Longterm –oral corticosteroids
- 95. anti inflammatory agents Evidence A is notrecommended Long term –oral corticosteroids
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- 98. WHO ? Severe airflowobstruction Exacerbations despite comb.
- 99. Bronchodilators in stableCOPD Regular Inhaled bronchodilators Evidence A SABA or SAMA Evidence A SABA and SAMA are superior Evidence A LABAs and LAMAs Evidence A LAMAs < exacerbation LABAs Evidence A LABA - LAMA > monotherapy Evidence A LABA - LAMA > ICS/LABA Evidence B Tiotropium improves exercise performance Evidence B Theophylline small bronchodilator effect Evidence A
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- 106. Long term azithromycinand erythromycin reduces exacerbations Evidence A Antibiotics
- 107. Long term azithromycinand erythromycin reduces exacerbations Evidence A increased bacterial resistance Evidence A Antibiotics
- 108. Evidence B Alpha 1antitrypsin augmentation therapy • slow down the progression of emphysema
- 109. alpha-1 antitrypsin augmentationtherapy severe deficiency emphysema Evidence B
- 110. other pharmacologic treatments. Evidence B opioids - dyspnea-severe disease Evidence B primary pulmonary hypertension Drugs are not recommended Evidence C Antitussives not recommended
- 113. Pulmonary Rehabilitation Evidence AImproves • Dyspnea, • Health status • Exercise tolerance reduces hospitalizations Evidence B
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- 115. NPPV < hospitalization (PaCO₂ ≥52 Evidence B < morbidity and mortality
- 118. lung transplantation Evidence C Very severeCOPD > quality of life > functional capacity.
- 120. PALLIATIVE, END-OF-LIFE &HOSPICE CARE •Symptom control •Palliative approaches •less than 6 months to live.
- 121. PALLIATIVE, END-OF-LIFE & HOSPICE CARE Opiates oxygen Evidence A fans EvidenceC nutritional supplementation Evidence B