Prof Dr Guy JOOSDept Respiratory MedicineGhent University Hospital

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 PrevalenceAsthma 300 millionCOPD 210 millionAllergic rhinitis 400 million

Sleep apnea >100 millionOthers >50 million

Everyone in the world is exposed toCRD 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-Morbidities

COPD patients are at increased risk for: • Myocardial infarction, angina• Osteoporosis• Respiratory infection• Depression• Diabetes• Lung cancer

COPD and Co-Morbidities

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 diseaseCVD diseaseLower respiratory infectionDiarrhoeal diseasePerinatal disordersCOPDTuberculosisMeaslesRoad traffic accidentLung cancer

Stomach cancerHIVSuicide

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

SYMPTOMScough

sputumshortness of breath

EXPOSURE TO RISKFACTORS

tobaccooccupation

indoor/outdoor pollution

SPIROMETRY

Diagnosis 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

Management1. Assess and monitor

disease

2. Reduce risk factors

3. Manage stable COPD Education Pharmacologic Non-pharmacologic

4. Manage exacerbations

Global Initiative for ChronicObstructiveLung Disease

www.goldcopd.com

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