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
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