What’s Next: Treatment Options in COPD

H. Ari Jaffe, MD

Ravi Kalhan, MD

Cynthia Gronkiewicz, MS, APN, AE-C

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COPD

• What is COPD?

• Diagnosis

• Classification per COPD Gold

• Management

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What is

COPD, is a common, preventable and treatable disease, is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and / or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.

2017Global Initiative for Chronic Obstructive Lung Disease

ChronicObstructive Pulmonary Disease

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Chronic Bronchitis

2017Global Initiative for Chronic Obstructive Lung Disease

Chronic productive cough for 3 months in each of two successive years in a patient in whom other causesof chronic cough have been excluded

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Emphysema on Chest X-Ray

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COPD

• What is COPD?

• Diagnosis

• Classification per COPD Gold

• Management

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SPIROMETRY required to make a diagnosis of COPD

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SPIROMETRY required to make a diagnosis of COPD

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Predicted Normal Values

Age

Height 

Gender

Ethnic Origin

Affected by:  

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COPD

• What is COPD?

• Diagnosis 

• Classification per COPD Gold

• Management

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Chronic

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isease

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G

OLD

G

OLD

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GOLD Website Address

http://www.goldcopd.org

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Assessment of COPD: Goals

To Guide Therapy Determine:• the severity of the

disease• its impact on the

patient’s health status

• the risk of exacerbations

Consider separately:

• severity of obstruction by spirometry

• patient’s current symptoms

• frequency of exacerbations

• comorbidities

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• COPD Assessment Test (CAT)

• mMRC Breathlessness scale

• Clinical COPD Questionnaire (CCQ)

Formal Assessment of Symptoms

*2017 Global Initiative for Chronic Obstructive Lung Disease14

• COPD Assessment Test (CAT)

• An 8-item measure of health status impairment in COPD

• http://catestonline.org

Formal Assessment of Symptoms

*2016 Global Initiative for Chronic Obstructive Lung Disease 15

*2016 Global Initiative for Chronic Obstructive Lung Disease

<10 Low Sx Score

> 10 High Sx Score

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• mMRC Breathlessness scale

relates well to other measures of healthstatus and predicts future mortality risk

Formal Assessment of Symptoms

*2017 Global Initiative for Chronic Obstructive Lung Disease 17

Formal Assessment of Symptoms

*2016 Global Initiative for Chronic Obstructive Lung Disease

mMRC Breathlessness scale

See Handout

0-1 Low Sx Score

>2 High Sx Score

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Assessment of COPD: GoalsTo Guide Therapy Determine:

• the severity of the disease

• its impact on the patient’s health status

• the risk of exacerbations

Consider separately:

• severity of obstruction by spirometry

• patient’s current symptoms

• frequency of exacerbations

• comorbidities

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Assessment of Risk of Exacerbations*

Low Risk:

• < 2 exacerbations in the last year

High Risk:

• > 2 exacerbations in the last year OR

• Hospitalized for exacerbation in last year

* 2017 Global Initiative for Chronic Obstructive Lung Disease20

Combined Assessment of COPD*

• Assess degree of airflow limitation using spirometry

• Assess symptoms

• Assess risk of exacerbations

Combined assessment guides optimal therapy

* 2017 Global Initiative for Chronic Obstructive Lung Disease21

Combined Assessment of COPD*

* 2017 Global Initiative for Chronic Obstructive Lung Disease22

Manage Stable COPD:Key Points Pharmacotherapy

© 2017 Global Initiative for Chronic Obstructive Lung Disease23

Questions?

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