Prof Dr Guy JOOS Dept Respiratory Medicine Ghent University Hospital COPD GOLD guidelines Prof Dr Guy JOOS Dept Respiratory Medicine Ghent University Hospital

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 Cancer Chronic Respiratory Diseases Diabetes Cardiovascular Disease Other NCDs 60% of all global deaths. About 80% of the global deaths due to NCDs occur in low and middle income countries. The global strategy for NCD prevention and control focuses on four groups of disease: Cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes which represent the overwhelming proportion of the NCD burden and mortality. These four groups of diseases are largely caused by shared preventable risk factors, mainly tobacco use, unhealthy diet, physical inactivity, and the harmful use of alcohol. Physical inactivity Unhealthy diets Obesity Smoking Harmful use of alcohol 2

Global Alliance against Chronic Respiratory Diseases GARD (September 2007) Disease Prevalence Asthma 300 million COPD 210 million Allergic rhinitis 400 million Sleep apnea >100 million Others >50 million Everyone in the world is exposed to CRD risk factors often common with other NCDs Co-morbidities paramount importance Global Alliance against Chronic Respiratory Diseases www.who.int/respiratory/gard 3

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

Small airways and lung parenchyma Lung Pathology in COPD Small airways and lung parenchyma Chronic bronchitis Emphysema

Risk Factors for COPD Aging Populations Nutrition Infections Socio-economic status Aging Populations 6

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

Voor België betekent dit 100 x 2 a 5000 ttz 500.000 mensen met COPD

Voor BelgiE betekent dit 100x 25 a 50 = 2500 tot 5000

COPD - Deaths / 1000 1990 Data projected to 2000 L e g n d < . 6 2 . 6 2 7 5 - 9 8 1 4 3 > N o D a t

Mortality related to COPD 6th leading cause of death worldwide 2.2 million deaths Global Burden of Disease study 1999 Dia Hansel and Barnes Global Burden of Disease Study 1999

COPD is projected to be the third biggest killer by 2020 1990 2020 Ischemic heart disease CVD disease Lower respiratory infection Diarrhoeal disease Perinatal disorders COPD Tuberculosis Measles Road traffic accident Lung cancer 3rd 6th As part of the Global Burden of Disease Study, Murray and Lopez1 projected future mortality rates based on the most common causes of death in 1990. The top 10 most important causes of death are presented in this slide. The majority of these leading causes of deaths are projected to remain stable or decline. Notably, COPD is expected to rise from the sixth biggest killer in 1990 to the third in 2020. Of the top 10 leading causes of death in 1990, only deaths caused by COPD, lung cancer and road traffic accidents are projected to rise. Reference Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997;349:1498–504. Stomach cancer HIV Suicide Murray & Lopez 1997

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

indoor/outdoor pollution Diagnosis of COPD EXPOSURE TO RISK FACTORS SYMPTOMS cough tobacco sputum occupation shortness of breath indoor/outdoor pollution A diagnosis of COPD should be considered in any patient who has cough, sputum production, or dyspnea and/or a history of exposure to risk factors. The diagnosis is confirmed by spirometry. To help identify individuals earlier in the course of disease, spirometry should be performed for patients who have chronic cough and sputum production even if they do not have dyspnea. Spirometry is the best way to diagnose COPD and to monitor its progression and health care workers to care for COPD patients should have assess to spirometry. è è è SPIROMETRY

GOALS of COPD MANAGEMENT VARYING EMPHASIS WITH DIFFERING SEVERITY Relieve symptoms Prevent disease progression Improve exercise tolerance Improve health status Prevent and treat complications Prevent and treat exacerbations Reduce mortality

Four Components of COPD Management Assess and monitor disease Reduce risk factors Manage stable COPD Education Pharmacologic Non-pharmacologic Manage exacerbations

Global Initiative for Chronic Obstructive Lung Disease www.goldcopd.com

Therapy at Each Stage of COPD I: Mild II: Moderate III: Severe IV: Very Severe FEV1/FVC < 70% FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure FEV1/FVC < 70% 30% < FEV1 < 50% predicted FEV1/FVC < 70% 50% < FEV1 < 80% predicted FEV1/FVC < 70% FEV1 > 80% predicted Active reduction of risk factor(s); influenza vaccination Add short-acting bronchodilator (when needed) This provides a summary of the recommended treatment at each stage of COPD. 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. Consider surgical treatments 24