This document outlines 11 guidelines and 11 myths related to COPD. It discusses the evolution of COPD guidelines over time from 1959 to 2011, with 11 major guidelines listed. The guidelines generally agree that COPD is a progressive lung disease involving airflow obstruction. They provide definitions of COPD and discuss diagnosis, manifestations, and treatment. The document then discusses 11 myths related to excessive influence of the philosophy of science on COPD concepts and guidelines. It questions aspects of past COPD guidelines and concepts regarding their consideration of smoking and other risk factors.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
It contains :
- The new GOLD classification of severity
- The new GOLD treatment guidelines for the treatment of
COPD
Do Not Forget To Visit Our Pages On Facebook on the following Links:
https://www.facebook.com/groups/569435236444761/
AND
https://www.facebook.com/groups/690331650977113/
CTMT Quốc gia phòng chống bệnh phổi tắc nghẽn mạn tính và hen phế quản http://benhphoitacnghen.com.vn/
Chuyên trang bệnh hô hấp mãn tính: http://benhkhotho.vn/
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
It contains :
- The new GOLD classification of severity
- The new GOLD treatment guidelines for the treatment of
COPD
Do Not Forget To Visit Our Pages On Facebook on the following Links:
https://www.facebook.com/groups/569435236444761/
AND
https://www.facebook.com/groups/690331650977113/
CTMT Quốc gia phòng chống bệnh phổi tắc nghẽn mạn tính và hen phế quản http://benhphoitacnghen.com.vn/
Chuyên trang bệnh hô hấp mãn tính: http://benhkhotho.vn/
A presentation by Jon Henrik Laake at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
APA format 2 pages 3 references 2 from walden university library. brockdebroah
APA format 2 pages 3 references 2 from walden university library.
As a registered nurse working as a case manager within the home health care setting, I have had the opportunity to provide care to patients diagnosed with various respiratory disorders. A majority of the patients I have worked with were diagnosed with chronic obstructive pulmonary disease (COPD). COPD is defined as a common preventable and treatable disease 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 (Huether, 2017). Two important facts regarding this respiratory disorder include the following:
COPD is the third leading cause of death in the United States accounting for 138,080 deaths in 2010.
In 2010, the cost of COPD in the United States was estimated to be nearly $50 billion, including nearly $30 billion in direct health care expenditures.
These figures detail the staggering numbers of patients living with COPD and the significant impact on patients, families, communities and the health care system.
During the time that I worked with COPD patients, one of the respiratory disorders of particular interest was emphysema. I wanted to make sure I understood the disease process so I could provide the most appropriate care and teaching to my patients, families and caregivers. Emphysema is abnormal permanent enlargement of gas-exchange airways (acini) accompanied by destruction of alveolar walls without obvious fibrosis (Huether, 2017). Furthermore, the American Lung Association defined emphysema as the gradual damage of lung tissue, specifically thinning and destruction of the alveoli or air sacs (
www.lung.org
). I often used this definition with patients to help them understand how this respiratory disorder effects the body. The pathophysiology of emphysema includes the following:
Air sacs are destroyed in emphysema, making it progressively difficult to breathe.
Emphysema is usually accompanied by chronic bronchitis, with almost-daily or daily cough and phlegm.
Cigarette smoking is the major cause of emphysema.
People with emphysema experience shortness of breath with activities
It is not curable, but there are treatments that can help you manage the disease (www.lung.org).
Medication management of emphysema varies depending upon severity of the disease. Initial drug therapy selection depends on COPD severity, symptoms, and exacerbation risk. In addition, medication therapy may be based upon Global Obstructive Lung Disease (GOLD) guidelines which categorized COPD into four groups (A, B, C, D) ranging from low risk, less symptoms to high risk, high symptoms (Arcangelo, 2017). Medications may include the following:
Short-acting beta2 agonists, short-acting anticholinergics, combination of short-acting anticholinergic and short-acting beta2-adrenergic agonists, long-acting beta2-agonists, l ...
Select one (1) peer-reviewed research article that you used in you.docxzenobiakeeney
Select one (1) peer-reviewed research article that you used in your research paper to share with the class.
Do not discuss en editorial or letter to editor.
After reading your selected article, post the following information:
1. Why is the research question significant to your research paper?
2. What was the purpose of the study?
3. What was the study design?
4. Who was in the study population(s)/sample(s)?
5. What was the outcome and was it consistent with the researcher(s)' original research question?
6. What recommendation(s) did the researcher offer for future studies?
7. How do you know this article was peer-reviewed?
OBSTRUCTIVE PULMONARY
DI
SEASE (COPD)
1
Chronic Obstructive Pulmonary Disease (
COPD
)
Name
Course
Tutor
Date
Chronic Obstructive Pulmonary Disease (
COPD
)
Abstract
A chronic obstructive pulmonary disease (COPD) is one of the current killers in the world. It is a preventable disease that makes it difficult for the affected individual to empty air out of the lungs otherwise referred to as airflow obstruction. The difficulties in breathing that is brought about by this condition leaves one feeling tired because they use
much
energy to
breathe
than required.
The c
hronic
obstructive pulmonary disease is a term that is used to include other types of pulmonary diseases that include chronic bronchitis, emphysema or both. Although asthma is a health condition that results in difficulties in breathing it is not included among the chronic obstructive pulmonary disease.
The effects of the disease are not instant but rather evolve at a slower rate inhibiting the breathing system of a patient.
However,
the
most important thing to note is that the disease can
be prevented
and it is relatively easier when it
is detected
in its earlier stages than in advanced stage.
In the United States, between 10 % and 20% of the chronic obstructive pulmonary disease is said to have been caused by occupational or exposure to chemical vapors,
irritants
,
and fumes which are very much contaminated. A
large
percentage of patients who are suffering from COPD are said to be
smokers
,
but a recent research indicated that 25 % of patients with COPD have never smoked in the United States. This paper provides an in-depth analysis into chronic obstructive pulmonary diseases including the historical perspective,
symptoms, and causes
of COPD,
method of spread, how it can
be contained
, and its implication on the economy,
treatment
,
and efforts being put in place to ensure that the disease is
contained
.
Keywords
COPD,
Chronic, Obstructive. Bronchodilators,
Pulmonary,
Prevalence, Mortality
.
History of the diseases
The c
hronic
obstructive pulmonary disease has been in existence for the last 200
years;
the only difference is that its prevalence back in the day was much lower mainly because of
the
lower
presence of risk factors than they are currently.
The disease
was recognized
by the.
Dr Kishore Kumar Ubrangala, MD
Professor, Dept. of Medicine,
Yenepoya Medical College,
Yenepoya (Deemed to be) University, Mangalore, India.
sankish@gmail.com
Ponencia donde se hace una revisión superficial comparativa entre la TBC y la Covid 19.
Se describen los aspectos cronológicos, con las fechas mas resaltables que marcaron la evolución de ambas enfermedades.
Se citan también los datos epidemiológicos globales mediante mapas mundiales actualizados donde visualizamos la incidencia de ambas patologías.
Se sintetizan los costes económicos destinados a luchar contra ambas patologías o bien en forma de ayudas directas previstas como objetivo como es en la TBC, o bien como inyección monetaria al sistema económico, concluyendo que es vital la
concienciación de los gobiernos y las administraciones y la solidaridad de todos, para afrontar severa crisis sanitaria y humanitaria actual.
Se repasa la influencia de ambas enfermedades en la sociedad, en los estilos de vida, en el pensamiento, y en las manifestaciones artísticas, en el caso de la TBC referida al siglo XIX.
Enfermedades respiratorias relacionadas con la asbestosis (català)Dr. Josep Morera Prat
Causas y efectos del amianto en la Salud, diferentes enfermedades respiratorias relacionadas y la fibrosis pulmonar provocada por asbestosis. Presentación efectuada en la Jornada " El amianto y su impacto en la Salud", realizada en Parc Científic de Barcelona, 15-N-2019
Teoria higienista en la prevención de enfermedades respiratorias alérgicas.
Posición de defensa de la Teoría Higienista, en debate realizado durante la Jornada de Patología Respiratoria celebrado en el COMB, Noviembre 2019
Obesidad i asma ( coincidència o causalitat) - actualització Novembre 2019 ( ...Dr. Josep Morera Prat
presentació actualitzada del document relatiu a la relació asma bronquial i obesitat, presentat a la Jornada de Patologia Respiratoria, realitzat al COMB, el 8/11/2019
Conferencia realizada en la jornada de Fenotipos del Asma, el pasado 18 de Noviembre 2018, en el COMB.
Una visión de la magnitud del problema, causalidad vs coincidencia y los fenotipos, clínica y tratamiento.
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!
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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 Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
6. Índice
Índice
1) Las 11 Guías
2) Los 11 Mitos
3) Conclusiones
7. Las 11 Guías
Las 11 Guías
1. Terminology, Definitions, and Classification of Chronic Pulmonary Emphysema and
Related Conditions: A Report of the Conclusions of a Ciba Guest Symposium Thorax
1959;14:286-299)
2. Standards for the diagnosis and care of patients with chronic obstructive pulmonary
disease (COPD) and asthma. This official statement of the American Thoracic Society
was adopted by the ATS Board of Directors, November 1986. Am Rev Respir Dis. 1987
Jul;136(1):225-44.
3. Siafakas NM, Vermeire P, Pride NB, Paoletti P, Gibson J, Howard P, Yernault JC,
Decramer M, Higenbottam T, Postma DS, et al. Optimal assessment and management
of chronic obstructive pulmonary disease (COPD). The European Respiratory
Society Task Force. Eur Respir J. 1995 Aug;8(8):1398-420.
4. Montemayor T, Alfajeme I, Escudero C, Morera J, Sánchez Agudo L. [Guidelines on the
diagnosis and treatment of chronic obstructive lung disease. The SEPAR Working
Group. The Spanish Society of Pneumology and Thoracic Surgery]. Arch
Bronconeumol. 1996 Jun-Jul; 32 (6): 285-301.
5. BTS guidelines for the management of chronic obstructive pulmonary disease. The
COPD Guidelines Group of the Standards of Care Committee of the BTS. Thorax. 1997
Dec;52 Suppl 5:S1-28.
8. Las 11 Guías
Las 11 Guías
6. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS; GOLD Scientific Committee.
Global strategy for the diagnosis, management, and prevention of chronic obstructive
pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease
(GOLD) Workshop summary. Am J Respir Crit Care Med. 2001 Apr;163(5):1256-76.
7. Barberà JA, Peces-Barba G, Agustí AG, Izquierdo JL, Monsó E, Montemayor T, Viejo JL;
Sociedad Española de Neumología y Cirugía Torácica (SEPAR). [Clinical guidelines for
the diagnosis and treatment of chronic obstructive pulmonary disease]. Arch
Bronconeumol. 2001 Jun;37(6):297-316.
8. Celli BR, MacNee W; ATS/ERS Task Force. Standards for the diagnosis and treatment of
patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004
Jun;23(6):932-46.
9. Halpin D. NICE guidance for COPD. Thorax. 2004 Mar;59(3):181-2.
10. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C,
Rodriguez-Roisin R, van Weel C, Zielinski J; Global Initiative for Chronic Obstructive
Lung Disease. Global strategy for the diagnosis, management, and prevention of
chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit
Care Med. 2007 Sep 15;176(6):532-55.
9. Las 11 Guías
Las 11 Guías
11. Peces-Barba G, Barberà JA, Agustí A, Casanova C, Casas A, Izquierdo JL, Jardim J,
López Varela V, Monsó E, Montemayor T, Viejo JL. [Diagnosis and management of
chronic obstructive pulmonary disease: joint guidelines of the Spanish Society of
Pulmonology and Thoracic Surgery (SEPAR) and the Latin American Thoracic Society
(ALAT)]. Arch Bronconeumol. 2008 May;44(5):271-81.
Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, Criner G, van der Molen T, Marciniuk DD,
Denberg T, Schünemann H, Wedzicha W, MacDonald R, Shekelle P; American College of
Physicians; American College of Chest Physicians; American Thoracic Society; European
Respiratory Society. Diagnosis and management of stable chronic obstructive pulmonary
disease: a clinical practice guideline update from the American College of Physicians,
American College of Chest Physicians, American Thoracic Society, and European
Respiratory Society. Ann Intern Med. 2011 Aug 2;155(3):179-91.
Grupo de Trabajo de GESEPOC. [Moving towards a new focus on COPD. The Spanish COPD
Guidelines (GESEPOC)]. Arch Bronconeumol. 2011 Aug;47(8):379-81.
10. Las 11 Guías
Las 11 Guías
Chronic obstructive pulmonary disease (COPD) is a slowly progressive disease involving the airways or
pulmonary parenchyma (or both) that results in airflow obstruction. Manifestations of COPD range
from dyspnea, poor exercise tolerance, chronic cough with or without sputum production, and wheezing to
respiratory failure or cor pulmonale. Exacerbations of symptoms and concomitant chronic diseases may
contribute to the severity of COPD in individual patients. A diagnosis of COPD is confirmed when a
patient who has symptoms of COPD is found to have airflow obstruction (generally defined as a
postbronchodilator FEV1–FVC ratio less than 0.70, but taking into account that age-associated
decreases in FEV1–FVC ratio may lead to overdiagnosis in elderly persons) in the absence of an
alternative explanation for the symptoms (for example, left ventricular failure or deconditioning) or the
airflow obstruction (for example, asthma). Clinicians should be careful to avoid attributing symptoms to
COPD when common comorbid conditions, such as heart failure, are associated with the same
symptoms…
Ann Intern Med. 2011;155:179-191.
11. Las 11 Guías
Las 11 Guías
br ar
n om
de
Chronic obstructive pulmonary disease (COPD) is a slowly progressive disease involving the airways or
es
pulmonary parenchyma (or both) that results in airflow obstruction. Manifestations of COPD range
nt
from dyspnea, poor exercise tolerance, chronic cough with or without sputum production, and wheezing to
s a co
respiratory failure or cor pulmonale. Exacerbations of symptoms and concomitant chronic diseases may
r a ba
a b ta
contribute to the severity of COPD in individual patients. A diagnosis of COPD is confirmed when a
al
patient who has symptoms of COPD is found to have airflow obstruction (generally defined as a
p
postbronchodilator FEV1–FVC ratio less than 0.70, but taking into account that age-associated
4 49
decreases in FEV1–FVC ratio may lead to overdiagnosis in elderly persons) in the absence of an
alternative explanation for the symptoms (for example, left ventricular failure or deconditioning) or the
airflow obstruction (for example, asthma). Clinicians should be careful to avoid attributing symptoms to
COPD when common comorbid conditions, such as heart failure, are associated with the same
symptoms…
Ann Intern Med. 2011;155:179-191.
12. Las 11 Guías
Las 11 Guías
GOLD’2001
No menciona tabaquismo en definición.
No menciona que el efecto del tabaco es dosis/efecto.
No se menciona la palabra “Smoke” hasta después de
688 palabras y 2 tablas, y 688 palabras más hasta
repetirla.
No definen si en ensayos clínicos deben excluirse los
no fumadores / ex.
Clasificación de severidad confusa / discutible
13. Las 11 Guías
Las 11 Guías
RISK FACTORS
• Host Factors
– Genes
– Airway Hyperresponsiveness
– Lung Growth
• Exposures
– Tobacco Smoke
– Occupational Dust and Chemicals
– Outdoor and Indoor Air Pollution
– Infections
– Socioeconomic Status
14. Índice
Índice
1) Las 11 Guías
2) Los 11 Mitos
3) Conclusiones
15. Los 11 Mitos
EXCESIVA INFLUENCIA DE LA FILOSOFIA DE LA CIENCIA
Filosofía de la Ciencia: Método
inductivo Vs método Refutacionista
Epidemiology: an introduction. Kenneth J. Rothman.
KJ Rothman - Oxford University Press
What is Causation?. Cap. 2
16. Los 11 Mitos
VS POSITIVISTAS / NOMINALISTES
La navaja de Occam (navaja de Ockham o principio de economía o de parsimonia) hace referencia a un tipo de
razonamiento basado en una premisa muy simple: en igualdad de condiciones la solución más sencilla es
probablemente la correcta. El postulado es entia non sunt multiplicanda praeter necessitatem, o «no ha de presumirse la
existencia de más cosas que las absolutamente necesarias».
17. Los 11 Mitos
PRINCIPIS DE HILL
1. Human experiments
2. Strength of association
3. Consistency of association
4. Temporal relationship
5. Dose-response gradient
6. Biological plausibility
7. Epidemiological plausibility
8. Specificity
9. Analogy
Coultas D.B & Samet J.M. Cigarrette Smoking. Ch 7 de Clinical epidemiology of COPD. M. Decker,
N.Y. 1989, pp 109-138.
18. Los 11 Mitos
Martin J. Tobin. Chest. 2008 May;
133(5):1071-4; discussion 1074-7.
19. Los 11 Mitos
DEFINICIÓN Y CATEGORIZACIÓN CLÍNICA
ENFERMEDAD
4 Causa - Etiología
S Desorden Funcional
Í 3 Característico
N
D Lesión Anatómica
R 2 Característica
O
M
E 1 Descripción Clínica
Basado en J. G. Scadding.
Principles of definition in medicione. Lancet, 1959; 1: 323-325 .
Meaning of diagnostic terms in bronchopulmonary disease. BMJ, 1963; 2: 1425-1430.
The semantics of medical diagnosis. Niomed. Comput, 1972; 3: 83-90.
Helath and disease: what can medicine do for philosophy?. J. Med. Ethics, 1988; 14: 118-124.
Definition on asthma. In: Bronchial asthma, mechanisms and therapeutics, 3erd ed. Boston: Litle Brown; 1993. p.1-13.
20. Los 11 Mitos
EPOC: NOSOLOGÍA
1. Miravitlles M, Morera J. It's time for an aetiology-based
definition of chronic obstructive pulmonary disease.
Respirology. 2007 May;12(3):317-9.
2. Morera J, Miravitlles M. [Chronic obstructive pulmonary disease:
disease or Zugzwang's syndrome?] Med Clin (Barc). 2008 May
10;130(17):655-6.
3. Snider GL. Nosology for our day: its application to chronic
obstructive pulmonary disease. Am J Respir Crit Care Med.
2003 Mar 1;167(5):678-83.
21. Los 11 Mitos
R. Pellegrino, V. Brusasco, G. Viegi, R.O. Crapo, F. Burgos, R. Casaburie, A.
Coates, C.P.M. van der Grinten, P. Gustafsson, J. Hankinson, R. Jensen, D.C.
Johnson, N. MacIntyreee, R. McKay***, M.R. Miller, D. Navajas, O.F. Pedersen
and J. Wanger.
23. Los 11 Mitos
¿Y LOS SÍNTOMAS?
Can Global Initiative for Chronic Obstructive Lung Disease Stage 0
Provide Prognostic Information on Long-term Mortality in Men?
Stavem K, et al. Chest, 2006; 130: 318-25
24. Los 11 Mitos
http://www.goldcopd.com.
BODE: Celli BR, Cote CG, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic
obstructive pulmonary disease. N Engl J Med. 2004 Mar 4;350(10):1005-12.
ADO: Puhan MA, Garcia-Aymerich J, et al. Expansion of the prognostic assessment of patients with chronic obstructive
pulmonary disease: the updated BODE index and the ADO index. Lancet. 2009 Aug 29;374(9691):704-11.
DOSE: Jones RC, Donaldson GC, et al.. Derivation and Validation of a Composite Index of Severity in Chronic Obstructive
Pulmonary Disease - The DOSE Index. Am J Respir Crit Care Med. 2009 Sep 24.
25. Los 11 Mitos
¿Y LOS SÍNTOMAS?
GOLD – DIAGNÓSTICO DIFERENCIAL
Asma
Insuficiencia cardíaca
Bronquiectasias
Tuberculosis
Bronquiolitis obliterante
Panbronquiolitis difusa
Global Strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.
Update 2003 (GOLD). http://www.goldcopd.com.
34. Los 11 Mitos
Clinical Bronchiolitis Obliterans in Workers at a Microwave-Popcorn Plant
Kreiss K, et al. NEJM, 2002; 347: 330-338
100 Volatile Organic Compounds
Diacetyl (2,3-butanedione)
35. Los 11 Mitos
Does Distinction
Between Asthma
and COPD Matter?
Kraft M. AJRCCM, 2006; 174: 238-
244.
36. Los 11 Mitos
CONFUSIÓN
… Potentially, the common mechanism by which major risk
… Potentially, the common mechanism by which major risk
factors such as smoking, hyperlipidaemia, obesity, and
factors such as smoking, hyperlipidaemia, obesity, and
hypertension lead to chronic disease is systemic
hypertension lead to chronic disease is systemic
inflammation…
inflammation…
Lancet. 2007 Sep 1;370(9589):797-9.
44. Los 11 Mitos
COPD: the dangerous underestimate of 15%.
Rennard SI, Vestbo J.
Decline in FEV1 and airfl ow limitation related to
occupational exposures in men of an urban community.
Humerfelt S, Gulsvik A, Skjaerven R, et al. Eur Respir J 1993; 6: 1095–103.
Lancet. 2006 Apr 15;367(9518):1216-9.
45. Los 11 Mitos
COPD: the dangerous underestimate of 15%.
Rennard SI, Vestbo J.
Lancet. 2006 Apr 15;367(9518):1216-9.
46. Los 11 Mitos
COPD: the dangerous underestimate of 15%.
Rennard SI, Vestbo J.
Decline in FEV1 and airfl ow limitation related to
occupational exposures in men of an urban community.
Humerfelt S, Gulsvik A, Skjaerven R, et al. Eur Respir J 1993; 6: 1095–103.
Lancet. 2006 Apr 15;367(9518):1216-9.
47. Los 11 Mitos
Proc Am Thorac Soc. 2006;3(1):58-65.
A homeopathic remedy for early COPD
Enright P. Respir Med. 2011 Nov;105(11):1573-5.
Enright P. Prim Care Respir J. 2011 Mar;20(1):6-8.
52. Los 11 Mitos
FENOTIPOS
El fenotipo está determinado fundamentalmente por el genotipo, o por la identidad de
los alelos, los cuales, individualmente, cargan una o más posiciones en los cromosomas.
Algunos fenotipos están determinados por los múltiples genes, y además influidos por
factores del medio. De esta manera, la identidad de uno, o de unos pocos alelos
conocidos, no siempre permite una predicción del fenotipo. En este sentido, la
interacción entre el genotipo y el fenotipo ha sido descrita usando la simple ecuación
que se expone a continuación:
Ambiente + Genotipo + Ambiente* Genotipo = Fenotipo
En conclusión, el fenotipo es cualquier característica detectable de un organismo
(estructural, bioquímico, fisiológico o conductual) determinado por una interacción
entre su genotipo y su medio.
El conjunto de la variabilidad fenotípica recibe el nombre de polifasia o polifenismo.
http://es.wikipedia.org/wiki/Fenotipo
53. Los 11 Mitos
Phenotype classically refers to any observable characteristic of
an organism, and up until now, multiple disease characteristics
have been termed COPD phenotypes. We, however, propose the
following variation on this definition: ‘‘a single or combination of
disease attributes that describe differences between individuals
with COPD as they relate to clinically meaningful outcomes
(symptoms, exacerbations, response to therapy, rate of disease
progression, or death).’’
Am J Respir Crit Care Med 2010; 182: 589–604.
66. Los 11 Mitos
DIAGNÓSTICO Y PRONÓSTICO: CUADRO CLÍNICO (DIFICULTADES)
Previamente catalogados de EPOC (leves / moderados)
Enfisema precede ≈5 años a fibrosis
Espirometría poco reveladora
Efecto “joven/vieja”
TAC (no siempre fácil de interpretar)
(No hacemos ni TAC ni difusión = guías)
No sabíamos que el humo del cigarrillo producía fibrosis pulmonar !!!???
67. Los 11 Mitos
DIAGNÓSTICO Y PRONÓSTICO
Combined pulmonary fibrosis and emphysema: a distinct underrecognised
entity.
Cottin V, Nunes H, Brillet PY, Delaval P, Devouassoux G, Tillie-Leblond I, Israel-Biet D,
Court-Fortune I, Valeyre D, Cordier JF; Groupe d'Etude et de Recherche sur les
Maladies Orphelines Pulmonaires (GERM O P).
Eur Respir J. 2005 Oct;26(4):586-93.
68. Los 11 Mitos
LECCIONES PASADAS DE LA HISTORIA
¿Coincidente o relación causal?
¿Cita o encuentro?
Humo de cigarrillo
The spectrum of smoking-related interstitial lung disorders: the
never-ending story of smoke and disease.
Selman M. Chest. 2003 Oct;124(4):1185-7.
Smoking: an injury with many lung manifestations.
Flaherty KR, Hunninghake GG. Am J Respir Crit Care Med. 2005 Nov 1;172(9):1070-1.
69. Los 11 Mitos
LECCIONES PASADAS DE LA HISTORIA: AVISOS
Relation of smoking and age to findings in lung parenchyma: a microscopic study.
Auerbach O, Garfinkel L, Hammond EC. Chest. 1974 Jan;65(1):29-35.
Smoking Habits And Age In Relation To Pulmonary Changes. Rupture Of Alveolar
Septums, Fibrosis And Thickening Of Walls Of Small Arteries And Arterioles.
Auerbach O, Stout Ap, Hammond Ec, Garfinkel L. N Engl J Med. 1963 Nov
14;269:1045-54.
J Occup Med. 1988 Jan;30(1):33-9).
70. Los 11 Mitos
LECCIONES PASADAS DE LA HISTORIA: AVISOS
93,3
<60 60-69 70+ 90,7 90,6
100 82,5
Age
Severe Pulmonary Fibrosis %
80
Relation of smoking and age to findings in lung parenchyma: a microscopic study.
62,7
Auerbach O, Garfinkel L, Hammond EC. Chest. 1974 Jan;65(1):29-35.
50
60
39,1
32,7
40
Smoking Habits 20 Age In Relation To Pulmonary Changes. Rupture Of Alveolar
And 1,9
6,9
Septums, Fibrosis And Thickening Of Walls Of Small Arteries And Arterioles.
Auerbach0O, Stout Ap, Hammond Ec, Garfinkel L. N Engl J Med. 1963 Nov
No. In group 36 52 32 87 87 38 205 200 43 83 96 15
0 <1 1_2 2+
14;269:1045-54.
Cigarettes – Packs/Day
J Occup Med. 1988 Jan;30(1):33-9).
71. Los 11 Mitos
ÚLTIMAS NOTICIAS
Diagnosis of usual interstitial pneumonia and distinction from other
fibrosing interstitial lung diseases.
Katzenstein AL, Mukhopadhyay S, Myers JL.
23 piezas lobectomía por tumor pulmonar
20 fumadores
Examen histológico: fibrosis >25% slides. En 12/20
(60%) fumadores 0 en no fumadores
Describe SRIF (Smoking-Related Fibrosis Disease)
Hum Pathol. 2008 Sep;39(9):1275-94.
72. Los 11 Mitos
ÚLTIMAS NOTICIAS
Idiopathic pulmonary fibrosis and emphysema: decreased survival associated
with severe pulmonary arterial hypertension.
Mejía M, Carrillo G, Rojas-Serrano J, Estrada A, Suárez T, Alonso D, Barrientos E,
Gaxiola M, Navarro C, Selman M.
30% !!! Chest. 2009 Jul;136(1):10-5.
73. Los 11 Mitos
ÚLTIMAS NOTICIAS
The rising incidence of idiopathic pulmonary fibrosis in the U.K.
Navaratnam V, Fleming KM, West J, Smith CJ, Jenkins RG, Fogarty A, Hubbard RB.
↑ 5% por año
5.000 nuevos casos por año (UK) =
[≈ 4.000 en España ?!]
5.000 +/a
>+ que por cáncer ovárico, linfoma,
leucemia, hipernefroma o mesotelioma.
YA NO ES HUÉRFANA…
Thorax. 2011 Jun;66(6):462-7.
80. Los 11 Mitos
Even more effective tobacco legislation, including prevention of passive smoking
exposure for children in cars and at home. Legislation works17dor, if it does not,
let us prorogue parliament at once!
Recognition that airborne pollution is a human rights issuedif you live in a
Western city you cannot avoid air pollution.
The roots of much disease are in povertydand yet it is not only low and middle
income countries that are affected. All major Western countries still have
substantial poverty affecting children.
Finally, invest in research to understand early lung development, and devise
interventions to operate before the lungs are shot to pieces.
Thorax. 2011 Aug;66(8):645-6.
81. Índice
Índice
1) Las 11 Guías
2) Los 11 Mitos
3) Conclusiones
82. Conclusiones
Conclusiones
MITOS
1) Factor de Riesgo o Causa
2) Cociente Fijo
3) Es Fácil de Diagnosticar
4) El Gran Síndrome Inflamatorio
5) La Irreversibilidad
6) La Comorbilidad
83. Conclusiones
Conclusiones
MITOS
7) La Suscetibilidad
8) La Importancia de los Genes
9) Envejecimiento
10) Los Fenotipos
11) El Cigarrillo no Produce Fibrosis