Professional Documents
Culture Documents
Sub-Saharan Africa
India
0 2 4 6 8 10 12
Adapted from the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for
Chronic Obstructive Lung Disease (GOLD) 2005.
COPD Misdiagnosis Is Common in Women
Hypothetical Male Patient With
COPD Symptoms
Diagnosed as COPD by
65% of physicians
65%
49%
Hypothetical Female Patient
With COPD Symptoms
Diagnosed as COPD by
49% of physicians
Cerebrovascular disease 2 2
HIV/AIDS 4 3
COPD 5 4
Perinatal conditions 6 9
Diarrhoeal diseases 7 16
Tuberculosis 8 23
Inhaled substances +
Genetic susceptibility
Epithelial cells
Chronic inflammation
Structural changes
Systemic Bronchoconstriction, Acute
inflammation oedema, mucus, exacerbation
emphysema
Airflow
limitation
Adapted from Barnes PJ, in Stockley, et al (editors), Chronic Obstructive Pulmonary Disease. Oxford, England: Blackwell Publishing; 2007:860.
NYC/DAXAS/10/012
COPD inflammation is different from asthma inflammation
COPD Asthma
Noxious agent Onset Sensitising agent
Not fully
Airflow limitation Reversible
reversible
From the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for
Chronic Obstructive Lung Disease (GOLD) 2009. Available from: http://www.goldcopd.org.
NYC/DAXAS/10/012
Airway Inflammation occurs from COPD onset and increases
with disease severity
100
Airways with measurable cells (%)
GOLD Stage I
60
40
20
NYC/DAXAS/10/012
COPD is diagnosed based on symptoms,
risk factors and spirometry
Spirometry
From the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for
Chronic Obstructive Lung Disease (GOLD) 2009. Available from: http://www.goldcopd.org.
NYC/DAXAS/10/012
Classification of
cough
Cough is classified into acute and chronic
and
Clinically subdivided into productive and
dry cough.
Productive cough
is present at an expectoration rate of
30 ml/24 hours,
Classification of
cough
Acute cough is defined as one lasting less
than three weeks
Pulse rate < 100 / min 100 120 / min > 120 / min
Relieve symptoms
Improve exercise tolerance Improve current
Improve health status control
Death Stopped at 65
0
25 50 75
Adapted from Fletcher C and Peto R , 1977.
Age (years)
NYC/DAXAS/10/012
What are exacerbations ?
NYC/DAXAS/10/012
What are exacerbations?
Global Initiative for Chronic Obstructive Lung Disease
(GOLD) defines an exacerbation as:
an event in the natural course of the disease
characterized by a change in the patients baseline
dyspnea, cough, and/or sputum that is beyond normal
day-to-day variations, is acute in onset and may
warrant a change in regular medication1
May be mild, moderate or severe in nature. More severe
exacerbations can require hospitalisation and are associated
with a prolonged recovery period2
Commonly caused by bacterial/viral infections of the lungs
and airways1
Associated with increases in markers of inflammation3,4
Distressing for patients and their loved ones
frequent exacerbations drive disease progression
Number of exacerbations
Chronic
3
inflammation
Chronic cough 2
and sputum
p<0.0001
1
Frequent exacerbations
0
Patients WITH Patients WITHOUT
chronic cough and chronic cough and
sputum sputum
Adapted from Burgel PR et al, 2009.
NYC/DAXAS/10/012
Definitions of Exacerbations
Sputum retention
Bronchospasm
Infection
Pneumothorax
Large bullae
Uncontrolled O2 - administration
Pulmonary embolism
Left-ventricular failure
End-stage disease
PATHO- PHYSIOLOGY.
Mucosal edema
Hypertrophy of mucosa
Increased secretions
Increased bronchospasm
incr. Airway tortuosity
More airway turbulance
Loss of lung recoil
PATHO-PHYSIOLOGY.contd
AIR-FLOW OBSTRUCTION
PROLONGED EXPIRATION
PULMONARY HYPERINFLATION
DUE TO AIR-TRAPPING
DYSPNOEA
PATH-PHYSIO..CONTD
ALVEOLAR DISTORTION
AND DESTRUCTION
PULMONARY HYPERTENSION
COR-PULMONALE
Pharmacological treatments should be added stepwise as copd
progresses
Stage IV:
Stage III: Very Severe
Stage II: Severe FEV1/FVC<0.70
Stage I: Moderate
Mild FEV1 <30%
FEV1/FVC<0.70 FEV1/FVC<0.70 predicted or
FEV1/FVC<0.70 FEV1 <50%
50% FEV1 <80% 30% FEV1
FEV1 80% <50% predicted plus
predicted
predicted predicted chronic respiratory
failure
Active reduction of risk factor(s); influenza vaccination
Add short-acting bronchodilator (when needed)
Add regular treatment with one or more long-acting
bronchodilators (when needed); Add rehabilitation
Add inhaled glucocorticosteroids if
repeated exacerbations
Add long-term
oxygen if chronic
respiratory failure
From the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Consider surgical
Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2009. Available from: http://www.goldcopd.org.
NYC/DAXAS/10/012
procedures
MANAGEMENT NONINVASIVE
# BRONCHODILATORS
ROUTINELY GIVEN
HELP RESIDUAL BRONCHODILATION
AND MUCO-CILIARY CLEARANCE
CONTD
CONSERVATIVE MANAGEMENT .contd
# ANTIBIOTICS
# STEROIDS AVOID IN ARF DUE TO INFECTION
# OTHER
* STEAM / PHYSIOTHERAPY / ENCOURAGE COUGH
* GENERAL HYDRATION
* DIURETICS / LOW DIGOXIN IF LVF
* HEPARIN S /C FOR D V T / PULM EMBOLISM
* NUTRITION
* RESPIRATORY STIMULANTS
MANAGEMENT - NON CONSERVATIVE.
1. INVASIVE TECHNIQUES FOR SPUTUM CLEARANCE
OROPHARYNGEAL / NASOPHARYNGEAL SUCTION
NASO-PHARYNGEAL AIR-WAY
THERAPEUTIC AND DIAGNOSTIC F O B
MINI TRACHEOSTOMY/ CRICOTHYROTOMY FOR SUCTION
ENDOTRACHEAL INTUBATION
* FOR BETTER ACCESS
* FOR VENTILATORY SUPPORT
TRACHEOSTOMY
* IF VERY THICK SECRETIONS
* INTUBATION > SEVEN DAYS
Emphysema
The fourth leading cause of death in the US
34 million people in the US suffer from emphysema
Current treatment is limited in efficacy
Bronchoscopic Lung Volume
Reduction for Emphysema
DEATH
From the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic
Obstructive Lung Disease (GOLD) 2008. Available from: http://www.goldcopd.org.
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