Prof Dr Guy JOOS

Dept Respiratory Diseases

Ghent University Hospital

COPDGOLD guidelines

COPD

• Chronic Obstructive Pulmonary Disease

• Causes: cigarette smoking, indoor cooking/heating

• Symptoms: cough, sputum production, dyspnea

• Small airways and lung parenchyma

• Chronic bronchitis and emphysema

Lung Pathology in COPDSmall airways and lung parenchyma

Chronic bronchitis Emphysema

Global Initiative for ChronicObstructiveLung Disease

www.goldcopd.com

United StatesUnited States

United Kingdom

ArgentinaArgentina

AustraliaAustraliaBrazilBrazil Austria

CanadaCanada

Chile

Belgium

ChinaChina

DenmarkDenmark

ColumbiaColumbia

CroatiaCroatia

EgyptEgypt

Germany

Greece

IrelandIreland

ItalyItaly

SyriaSyria

Hong Kong ROC

Japan

IcelandIndiaIndia

KoreaKorea

KyrgyzstanUruguayUruguay

MoldovaMoldova

NepalNepal

Macedonia

Malta

Netherlands

New Zealand

PolandPoland

NorwayNorway

Portugal

GeorgiaGeorgia

Romania

Russia

SingaporeSlovakia

Slovenia Saudi ArabiaSaudi Arabia

South AfricaSouth Africa

Spain

SwedenSweden

ThailandThailand

SwitzerlandSwitzerland

UkraineUkraine

United Arab EmiratesUnited Arab Emirates

Taiwan ROC

VenezuelaVenezuela

Vietnam

Peru

Yugoslavia

Albania

Bangladesh

France

Mexico

Turkey Czech Republic

Pakistan

Israel

GOLD National Leaders

Philippines

6th leading cause of death worldwide 2.2 million deaths

Mortality related to COPD

Global Burden of Disease Study 1999

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

COPD is the only one of the major causes of death that has increased significantly in recent

years

3.0

Percentage change in age-adjusted death rates in USA, from 1965 to 1998

1.0

2.0

0

Proportion of 1965 rate

2.5

1.5

0.5

Coronaryheart

disease

Stroke OtherCVD

COPD All othercauses

–59% –64% –35% +163% –7%

CVD = cerebrovascular disease

www.copdgold.com

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

COPD Mortality by Gender,U.S., 1980-2000

0

10

20

30

40

50

60

70

1980 1985 1990 1995 2000

Men

Women

Num

ber

Death

s x

100

0N

um

ber

Death

s x

100

0

Source: US Centers for Disease Control and Prevention, 2002

NOXIOUS AGENTS(tobacco smoke, indoor air pollution,

occupational agents)

Genetic factors

Respiratory infections

Other

COPD

Pathogenesis of COPD

European Lung White Book

SYMPTOMScoughcough

sputumsputumshortness of breathshortness of breath

EXPOSURE TO RISKFACTORS

tobaccotobaccooccupationoccupation

indoor/outdoor pollutionindoor/outdoor pollution

SPIROMETRYSPIROMETRY

Diagnosis of COPDDiagnosis of COPD

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

COPD

• Underrecognized• Underdiagnosis• Undertreatment• Insufficiently prevented

WHO: GARD (Global Alliance against Chronic Respiratory Diseases) – may 2005

Chronic obstructive pulmonary disease

Chronic overlooked pulmonary disease

GOLD Website Address

http://www.goldcopd.org