The document discusses COPD (chronic obstructive pulmonary disease), its causes, symptoms, differences from asthma, classifications, treatments, and management. It provides information from Dr. Mohammad Zannatul Rayhan on COPD, including that it is a lung disease caused by chronic interference with lung airflow and impairs breathing. The major cause of COPD is smoking. Treatments discussed include bronchodilators, anti-inflammatory drugs, oxygen therapy, pulmonary rehabilitation, and smoking cessation.

1. World COPD Day
Dr. Mohammad Zannatul Rayhan
MBBS, MD(Pulmonology)
Medical Officer
Chest Disease Hospital, Rajshahi

3. COPD
 COPD is a lung disease caused by
chronic interference with lung airflow
that impairs breathing, and is not fully
reversible
 Usually symptoms- shortness of breath,
recurrent coughing, clearing throat, and
progressive exercise intolerance,
worsen over time
 Many doctors and researchers consider
terms such as chronic bronchitis and
emphysema as forms of COPD
 The major cause of COPD is smoking

4. Asthma
 It is a respiratory condition
marked by spasms of the
bronchi, due to inflamed
and narrowed
 It causes difficulty in
breathing that often results
from an allergic reaction
 Asthma usually causes
recurring periods of
shortness of breath,
wheezing and/or chest
tightness

5. Similarities between
COPD vs. asthma
 Coughing
 Shortness of breath
 Chest tightness
 Exercise intolerance
 Wheezing
 Anxiety with increased heart rate may
occur in both diseases.

6. Differences between
COPD vs. asthma
 In asthma, breathing can return to normal between attacks,
while breathing with COPD usually does not return to normal.
 The symptoms of COPD gradually become more severe
 COPD produces more mucus and phlegm compared to asthma
 Chronic cough is common with COPD
 People with COPD often have chronic blueness to fingernail
beds and/or lips
 Asthma can occur in a person of almost any age, while COPD
usually occurs in those over age 40

7. Asthma - COPD Overlap (ACO)
Feature ACO
Age of onset Usually age ≥40 years, but may have had symptoms in childhood or early adulthood
Pattern of respiratory
Symptoms
Respiratory symptoms including exertional dyspnea are persistent but variability may
be prominent
Lung function Airflow limitation not fully reversible, but often with current or historical variability
Lung function between
symptoms
Persistent airflow limitation
Past history or family
history
Frequently a history of doctor-diagnosed asthma (current or previous), allergies and
a family history of asthma, and/or a history of noxious exposures
Time course Symptoms are partly but significantly reduced by treatment. Progression is
usual and treatment needs are high
Chest X-ray Similar to COPD
Typical airway
inflammation
Eosinophils and/or neutrophils in sputum

8. Classification of 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

9. The redefined ABCD
assessment tool
Grade FEV1
(%predicted)
GOLD 1 > 80
GOLD 2 50-79
GOLD 3 30-49
GOLD 4 <30
C D
A B
Spirometrically
Confirmed diagnosis
Assessment of
Airflow Limitation
Assessment of
Symptoms/Risk of
Execerbation
> >
Post Bronchodilator
FEV1/FVC <0.7
Moderate or Severe
Exacerbation History
> 2 or > 1
Leading to hospital
admission
0 or 1
(not leading to
hospital
admission)
mMRC 0-1 mMRC≥2
CAT<10 CAT ≥10
Symptoms

11. Pharmacological Therapy for
Stable COPD
 Bronchodilators
 Anti-Muscarinic drugs
 Methylxanthines
 Combination of bronchodilator therapy
(LABA/LAMA)
 Anti-Inflammatory agents
 ICS
 Oral Glucocorticosteroids
 PDE4 inhibitor
 Antibiotics
 Mucoregulators and anti-oxidatns
 Other anti-inflammatory agents
 Triple therapy (LABA/LAMA/ICS)

12. Other Pharmacological Treatment
Alpha-1 Antitrypsin Augmentation Therapy
 Intravenous augmentation therapy may slow down the progression of
emphysema
Antitussives
 There is no conclusive evidence of a beneficial role of antitussives in patient with
COPD
Vasodilators
 Vasodilators do not improve outcomes and may worsen oxygenation

13. Oxygen therapy and Ventilator
support in Stable COPD
 NPPV may improve hospitalization-free survival in selected patients
after recent hospitalization, particularly in those with pronounced
daytime persistant hypercapnia (PaCO2 > 52 mmHg)
 Long term administration of oxygen increases survival in patients
with severe chronic resting arterial hypoxemia
 In patient with stable COPD and moderate resting or exercise-
induced arterial desaturation, prescription of long-term oxygen
does not lengthen time to death

14. Initial Pharmacological treatment
> 2 moderate
exacerbations or > 1
Leading to hospital
admission
Group C
LAMA
Group D
LAMA or
LAMA+LABA* or
ICS+LABA**
*consider if highly symptomatic
** consider if eos > 300
0 or 1
(not leading to hospital
admission)
Group A
A Bronchodilator
Group B
A Long Acting Bronchodilator
(LABA or LAMA)

15. Pulmonary rehabilitation, self-management
and integrative care in COPD
Pulmonary
Rehabilitation
Education and
Self-
Management
Integrated care
programs
 Pulmonary Rehabilitation improves dyspnea, health status and exercise
tolerance in stable patients
 Pulmonary Rehabilitation reduces hospitalization among patients who have
had a recent exacerbation (<4weeks from prior hospitalization)
 Pulmonary Rehabilitation leads to a reduction in symptoms of anxiety and
depression
 Education alone has not been shown to be effective
 Self-management intervention with communication with professional improves
health status and decrease hospitalizations and emergency department visits
 Integrative care and telehealth have no demonstrated benefit at this time

16. Non-pharmacological management of
COPD Patient
group
Essential Recommended Depending on
local guidelines
A Smoking cessation
(can include
pharmacological
treatment)
Physical Activity  Flu vaccination
 Pneumococcal
vaccination
 Pertussis
vaccination
B, C &
D
 Smoking
cessation
 (can include
pharmacological
treatment)
 Pulmonary
Rehabilitation
Physical activity  Flu vaccination
 Pneumococcal
vaccination
 Pertussis
vaccination