1. BY
DR .Khaled Helmy
Chest Specialist
Al Mahmora Chest Hospital
Ministry of Health - Egypt
COPD
SCOPE ON
2. Facts About COPD
•Cigarette smoking is the primary Cause of COPD.
•The WHO estimates 1.1 billion smoker
worldwide, increasing to 1.6 billion by
2025 in low&middle-income countries.
•In 2000,the WHO estimated 2.74 million
deaths worldwide from COPD.
•In 1990 ,COPD was ranked 12th
as burden
of disease,by 2020 it is projected to rank 5th
3. Burden Of COPD
•Most epidemiological studies have found that COPD
prevalence,morbidity and mortality increase over
time and are greater in men than in women.
•COPD prevalence is directly related to prevalence
of smoking.
•Very few studies have quantified the economic
and social burden of COPD and its quality of life.
•Directed costs of COPD are substantial in
developed countries while indirect cost are
important in developing countries.
4. GOLD Definition:
COPD is a disease state characterized by airflow
limitation that is not fully reversible. The airflow
limitation is usually both progressive and associated
with an abnormal inflammatory response of the
lungs to noxious particles or gases
Chronic Obstructive Pulmonary Disease
(COPD)
This definition does not use the terms chronic bronchitis and
emphysema and excludes asthma (reversible airflow limitation).
and associated
with systemic manifestations.
5. Chronic Obstructive Pulmonary Disease
(COPD)
Chronic bronchitis
Defined as the presence of cough and sputum
production for at least 3 months in each of
2 consecutive years, is not necessarily associated
with airflow limitation.
Emphysema
Defined as destruction of the alveoli, is a pathological
term that is sometimes (incorrectly) used clinically.
6. Indicators for Considering a COPD Diagnosis
Chronic cough
Present intermittently or every day. Often
present throughout the day; seldom only
nocturnal.
Chronic sputum
production
Any pattern of chronic sputum production
may indicate COPD.
Acute bronchitis Repeated episodes.
Dyspnea that is
Progressive (worsens over time).
Persistent (present every day).
Worse on exercise.
Worse during respiratory infections.
History of
exposure to
risk factors
Tobacco smoke
…. (including popular local preparations).
Occupational dusts and chemicals.
Smoke from home cooking and heating fuel.
Diagnosis Of COPD
The diagnosis should be confirmed by Spirometry
8. When performing spirometry, measure:
• Forced Vital Capacity (FVC) and
• Forced Expiratory Volume in one second (FEV1).
•Calculate the FEV1/FVC ratio.
Patients with COPD typically show :
a decrease in both FEV1 and FEV1/FVC
With limited reversibility after bronchodilators
Diagnosis Of COPD,cont
The diagnosis should be confirmed by
Spirometry
However, both symptoms and spirometry should be considered when
developing an individualized management strategy for each patient.
9. Role of Inflammation in COPD
Small airway disease Parenchymal destruction
Airflow Limitation
Inflammation
10. Asthma
•Onset in mid-life.
•Symptoms slowly progressive.
•Long smoking history.
•Dyspnea during exercise.
•Largely irreversible airflow limitation.
•Onset early in life (often childhood).
.Symptoms vary from day to day.
.Symptoms at night/early morning.
.Allergy, rhinitis, and/or eczema also present.
.Family history of asthma.
.Largely reversible airflow limitation.
COPD
ASTHMA & COPD
COPDAsthma
11. Stage III Severe COPD
FEV1 /FVC < 70%
FEV1 < 30% predicted or
FEV1 <50% predicted +presence of respiratory failure or
clinical signs of right heart failure.
At this stage, quality of life is very impaired and exacerbations
may be life-threatening.
GOLD Classification of COPD
Stage 0 At Risk normal spirometry
Chronic symptoms (cough and sputum production)
Stage I Mild COPD FEV1 / FVC < 70% but
FEV1 > or equal to 80 % predicted
With or without chronic symptoms cough and sputum production.
Stage II Moderate COPD :FEV1/FVC<70%
30% < or equal FEV1<80% predicted (IIA:50% < or equal FEV1<80% )
(IIB:30% < or equal FEV1<50% )
With or without chronic symptoms (cough, sputum production and dyspnea)
12. •Prevent disease progression .
•Relieve symptoms.
•Improve exercise tolerance.
•Improve health status.
•Prevent and treat complications.
•Prevent and treat exacerbations.
•Reduce mortality.
•Prevent or minimize side effects from
treatment.
Goals of COPD management
13. 1. Assess and Monitor Disease
2. Reduce Risk Factors
3. Manage Stable COPD
4. Manage Acute Exacerbations
COPD
FOUR COMPONENT
MANAGEMENT PROGRAM
14. • A detailed medical history.
• Spirometry.
• Bronchodilator reversibility testing.
• Inhaled glucocorticosteroid trial
(6 weeks to 3 months).
• Chest X-ray.
• Arterial blood gas measurement.
• Alpha-1 antitrypsin deficiency screening.
Assess and Monitor Disease
15. •Smoking cessation is the single most effective
And cost-effective - intervention to reduce the
risk of developing COPD and slow its progression.
•Smoking Prevention
•Avoid occupational Exposures
Reduce Risk Factors
18. Home Management
Bronchodilators: Increase dose and/or frequency of
existing bronchodilator therapy. If not already used,
add anticholinergics until symptoms improve.
Glucocorticosteroids: If baseline FEV1 < 50%
predicted, add 40 mg oral prednisolone per day for 10
days to the bronchodilator regimen.
Antibiotics: When symptoms of breathlessness and
cough are increased and sputum is purulent and
increased in volume, provide antibiotic coverage of
the major bacterial pathogens involved in
exacerbations, taking into account local patterns of
antibiotic sensitivity.
Management Of Acute Exacerbation
19. .Marked increase in intensity of symptoms,
such as sudden development of resting dyspnea
•Newly occuring arrhythmias
.Diagnostic uncertainty
.Older age
•Insufficient home
support
•Failure of exacerbation to respond to initial medical management
Indications for Hospital Admission for
Acute Exacerbations
•Onset of new physical signs (e.g.,cyanosis, peripheral edema)
•Severe background COPD
20.
21. .
•Survival figures for COPD are worse , COPD patients are often stranded at
home with little support &suffered from depression.
In contrast
lung cancer sufferers have access to a wide network of support such
as palliative care services, and have lower depression
Importance of Quality Of Life
In Patients With COPD
50 patients with inoperable lung cancer Vs 50 with severe COPD
All >60y, were questioned about their quality of life.
80%of COPD patients were housebound
, with 36% largely confined to a chair.
In comparison
36% of lung cancer patients were housebound,
only 10% chair-bound
22. One study in UK examined whether COPD patients were relatively
disadvantaged in terms of medical and social care compared with
a group with inoperable lung cancer.
Conclusion: This study suggests that :
•patients with end stage COPD have significantly impaired quality of
life and emotional well being which may not be as well met as those
of patients with lung cancer,.
•COPD patients palliative care needs remain unaddressed
Importance of Quality Of Life
In Patients With COPD
