Dr. Danny Galdermans

Dept Respiratory Medicine

ZNA Middelheim Antwerp

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 Prevalence

Asthma 300 million

COPD 210 million

Allergic rhinitis 400 million

Sleep apnea >100 million

Others >50 million

Everyone in the world is exposed to

CRD 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-MorbiditiesCOPD and Co-Morbidities

COPD patients are at increased risk for: • Myocardial infarction, angina

• Osteoporosis

• Respiratory infection

• Depression

• Diabetes

• Lung cancer

COPD patients are at increased risk for: • Myocardial infarction, angina

• Osteoporosis

• Respiratory infection

• Depression

• Diabetes

• Lung cancer

COPD and Co-MorbiditiesCOPD and Co-Morbidities

COPD has significant extrapulmonary

(systemic) effects including:

• Weight loss

• Nutritional abnormalities

• Skeletal muscle dysfunction

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 disease

CVD disease

Lower respiratory infection

Diarrhoeal disease

Perinatal disorders

COPD

Tuberculosis

Measles

Road traffic accident

Lung cancer

Stomach cancer

HIV

Suicide

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

SYMPTOMScoughcough

sputumsputumshortness of breathshortness of breath

EXPOSURE TO RISKFACTORS

tobaccotobaccooccupationoccupation

indoor/outdoor pollutionindoor/outdoor pollution

SPIROMETRYSPIROMETRY

Diagnosis of COPDDiagnosis 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

Management

Four Components of COPD

Management

1. Assess and monitor disease

2. Reduce risk factors

3. Manage stable COPD Education Pharmacologic Non-pharmacologic

4. Manage exacerbations

1. Assess and monitor disease

2. Reduce risk factors

3. Manage stable COPD Education Pharmacologic Non-pharmacologic

4. Manage exacerbations

IV: Very Severe III: Severe II: Moderate I: Mild

Therapy 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

Global Initiative for ChronicObstructiveLung Disease

www.goldcopd.com