prof dr guy joos dept respiratory medicine ghent university hospital
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Prof Dr Guy JOOS Dept Respiratory Medicine Ghent University Hospital. COPD GOLD guidelines. Noncommunicable Diseases (NCDs). Responsible for up to 60% of all deaths, 80% are in low- and middle-income countries Major noncommunicable diseases: Cardiovascular disease Cancer - PowerPoint PPT PresentationTRANSCRIPT
Prof Dr Guy JOOSDept Respiratory MedicineGhent University Hospital
COPDGOLD guidelines
Noncommunicable Diseases (NCDs)• Responsible for up to 60% of all deaths, 80% are in low- and middle-income
countries
• Major noncommunicable diseases: – Cardiovascular disease– Cancer– Chronic Respiratory disease– Diabetes
• Shared preventable risk factors: – Tobacco use– Unhealthy diet– Physical inactivity – Harmful use of alcohol
Chronic
RespiratoryDiseases
CardiovascularDisease
Diabetes Cancer
Physical inactivity
Obesity
Unhealthy diets
Smoking Harmful use of alcohol
Other NCDs
Global Alliance against Chronic Respiratory Diseaseswww.who.int/respiratory/gard
Disease PrevalenceAsthma 300 millionCOPD 210 millionAllergic rhinitis 400 million
Sleep apnea >100 millionOthers >50 million
Everyone in the world is exposed toCRD risk factors often common with other NCDs
Co-morbidities- paramount importance- often common with other NCDs
GARD (September 2007)GARD (September 2007)
Definition of COPD COPD is a preventable and treatable disease
with some significant extrapulmonary effects that may contribute to the severity in individual patients.
Its pulmonary component is characterized by airflow limitation that is not fully reversible.
The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.GOLD 2006
Lung Pathology in COPDSmall airways and lung parenchyma
Chronic bronchitis Emphysema
Risk Factors for COPD
NutritionNutrition
InfectionsInfections
Socio-economic Socio-economic statusstatus
Aging PopulationsAging Populations
Fabbri et al., Eur Respir J, 2008, 31, 204-212
COPD and Co-Morbidities
COPD patients are at increased risk for: • Myocardial infarction, angina• Osteoporosis• Respiratory infection• Depression• Diabetes• Lung cancer
COPD and Co-Morbidities
COPD has significant extrapulmonary(systemic) effects including:
• Weight loss• Nutritional abnormalities• Skeletal muscle dysfunction
COPD - Deaths / 10001990 Data projected to 2000
Legend<0.62756.275 - 9.6589.659 - 15.68715.688 - 18.14518.146 - 19.88919.89 - 22.11622.117 - 35.54835.549 - 38.177>38.178No Data
6th leading cause of death worldwide 2.2 million deaths
Mortality related to COPD
Global Burden of Disease Study 1999
COPD is projected to be the third biggest killer by 2020
Murray & Lopez 1997
Ischemic heart diseaseCVD diseaseLower respiratory infectionDiarrhoeal diseasePerinatal disordersCOPDTuberculosisMeaslesRoad traffic accidentLung cancer
Stomach cancerHIVSuicide
1990 2020
3rd
6th
Causes of death in patients with COPD
Rabe, N Engl J Med, 2007, 356, 851-854
Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical
Endpoint Committee
McGarvey et al., Thorax, 2007, 62, 411-415
Chronic obstructive pulmonary disease
Chronic overlooked pulmonary disease
SYMPTOMScough
sputumshortness of breath
EXPOSURE TO RISKFACTORS
tobaccooccupation
indoor/outdoor pollution
SPIROMETRY
Diagnosis of COPD
• Relieve symptoms • Prevent disease progression• Improve exercise tolerance• Improve health status• Prevent and treat complications• Prevent and treat exacerbations• Reduce mortality
GOALS of COPD MANAGEMENTVARYING EMPHASIS WITH DIFFERING SEVERITY
Four Components of COPD
Management1. Assess and monitor
disease
2. Reduce risk factors
3. Manage stable COPD Education Pharmacologic Non-pharmacologic
4. Manage exacerbations
Global Initiative for ChronicObstructiveLung Disease
www.goldcopd.com
IV: Very Severe III: Severe II: Moderate I: MildTherapy at Each Stage of COPD
FEV1/FVC < 70%
FEV1 > 80% predicted
FEV1/FVC < 70%
50% < FEV1 < 80%
predicted
FEV1/FVC < 70%
30% < FEV1 < 50% predicted
FEV1/FVC < 70%
FEV1 < 30% predicted
or FEV1 < 50% predicted plus chronic respiratory failure
Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation
Add inhaled glucocorticosteroids if repeated exacerbations
Active reduction of risk factor(s); influenza vaccinationAdd short-acting bronchodilator (when needed)
Add long term oxygen if chronic respiratory failure. Consider surgical treatments