page 1

1

5

3

2

4

COPD Management

A hand draws on the titles.

The hand draws on the planet. VOChronic Obstructive Pulmonary Disease or COPD affects about 210 million people worldwide

Pan down.

page 2

6

10

8

7

9

COPD Management

Gravestones are drawn all over the planet VOnd is a leading cause of morbidity and mortality.1 By 2030, COPD will be the 3rd largest killer in the world.

Pan across to an empty area.

The circling illustrations are erased. VOThe good news is that most of the causes of COPD are preventable

Small Illustrations of causes of COPD are drawn circling the globe. VOThe burden of COPD is estimated to increase in coming decades, due to continued exposure to COPD risk factors and the aging of the worlds population. COPD is also associated with significant economic burden.

page 3

11

15

13

12

14

COPD ManagementThe hand draws on a doctor listening to the chest of a coughing patient. He looks at a graph with a red line on it. VOand COPD management has made significant changes over the last few years. Until now, management primarily involved short-term here-and-now goals, targeting immediate patient benefit and focusing on the reduction of daily symptoms.

The hand draws the word RISK on to the See-saw. (Symptoms is already there.) VOHowever, treating symptoms is only half the battle

Pan down to a drawing of a playground background

The hand draws on another doctor offering an inhaler VODoctors have successfully prescribed treatments to reduce shortness of breath, chronic cough and sputum, thus improving the patients' exercise tolerance and their health status.

page 4

16

20

18

17

19

COPD Management

The See-saw levels out.

Pan upwards as the hand draws a weight above the patients head. VOIn 2011, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) emphasised the need for clinicians to maintain a focus on both the short

The patient is drawn on standing straight and looking happier.a blue line is drawn onto the graph and the red line is erased.

Pan back to the patient.

VOan equally important objective of COPD management is the stabilisation of patients and the reduction of future risk such as reducing flare-ups (or exacerbations), disease progression and mortality.

page 5

21

25

23

22

24

COPD Management

A second weight is drawn along side the first. VOand long-term impact of COPD on their patients

A doctor is drawn on about to vaccinate the woman. VOWhen appropriate, influenza and pneumococcal vaccination should be offered, depending on local guidelines. Appropriate pharmacologic therapy can reduce COPD symptoms, reduce the frequency and severity of exacerbations, and improve health status and exercise tolerance.

The cigarette is erased and the camera pulls back as the rest of the woman is drawn walking a dog. VOHealthcare professionals should encourage all patients who smoke to quit. Furthermore, COPD patients benefit from regular physical activity and should repeatedly be encouraged to remain active.

An old fashioned balance is drawn, connecting the weights. VOby dividing the treatment objectives into two groups of equal importance: reducing symptoms and reducing risk. The new focus on these two groups represents a shifting paradigm in COPD Management.

Pan across and zoom to an empty space. A womans head smoking a cigarette is drawn on. VOSo what options do we currently have in managing COPD? Smoking cessation certainly has the greatest capacity to influence the natural history of COPD.

PDE4INHIBITOR

page 6

26

30

28

27

29

COPD Management

VOThe most common pharmacologic treatment options consist of: bronchodilators, inhaled corticosteroids (or a combination of both), and Phosphodiesterase-4 inhibitors.

Zoom in and the hand draws on the needles onto the dials as they are mentioned. VOFrequent exacerbations can lead to a more rapid disease progression, worse quality of life, increased mortality and subsequently increased economic cost

The hand draws on the control console VOThese exacerbations can have very severe consequences.

Pan down and pull out as the hand starts drawing the patient gasping for breath. VOIn COPD patients at increased future risk (with severe to very severe airflow limitation and a history of exacerbations) the PDE4 inhibitor roflumilast is a new treatment option shown to further reduce exacerbations and help stabilising the disease

Pull back as the patient fades out to reveal the machine beneath. VOMany COPD patients experience exacerbations acute periodic worsening of their symptoms beyond normal day-to-day variations. Exacerbations are associated with an increased airway inflammation.

page 7

31

35

33

32

34

COPD Management

pan up and left.

pan down. The hand starts to draw an ill looking patient in bed one side of a brick wall. VOPatients who had previous exacerbations are more likely to have exacerbations in the future. It is not uncommon for patients in my practice to have an exacerbation around Halloween,

The woman is erased and re drawn reaching for a tissue rather than the phone. VOso often patients dont always immediately reach out to their physician when they experience an exacerbation.

A patient is drawn sitting at a table next to a hot drink, box of tissues and phone. She is coughing. VOReducing the number of exacerbations experienced by patients is still a major unmet need in COPD. The main problem is that up to half of the exacerbations are not reported by the patients.

The hand writes on the caption. VOAn exacerbation is often mistaken for a bad chest cold or a chest infection by patients and not linked to their COPD,

page 8

36

40

38

37

39

COPD Management

The patients family are drawn on the other side of the wall having a pick-nick and hunting for Easter eggs. VOanother at New Year and a further around Easter.

The clouds move out of frame to reveal a healthier looking patient with a doctor standing behind him. They are standing on the planet from earlier in the film only this time without the grave stones.

The clouds fill the screenVO because every exacerbation counts.

VOThey end up with about six months of chronic ill health,

Dark clouds animate into frame. VObut most importantly, the long term damage these episodes may cause to the lungs is irreversible. It is extremely important to stabilise these patients and prevent further exacerbations with appropriate treatment

page 9

41

43

42

44

COPD Management

Pull out to reveal...

The drawing in its entirety.

Fade to white and then the hansd writes on the end credits.

Et non, exercitation aliquip nisi elit eu, aliqua est culpa dolor mollit exercitation deserunt eiusmod deserunt occaecat, incididunt qui. Anim cupidatat veniam dolor proident commodo minim nulla dolor ullamco dolore ad minim veniam duis. Ullamco officia dolor deserunt aute, voluptate eiusmod magna. Veniam magna, reprehenderit, eu lorem reprehenderit irure tempor ea. Velit aute ipsum, dolor adipisicing elit ad eiusmod elit eiusmod, eu esse eiusmod id, consectetur sit nostrud et in.