WELCOME TO THE CME ON “CURRENT CONCEPTS IN THE MANAGEMENT OF COPD”

WORLDWIDE MORTALITY Hansel TT, Barnes PJ in ‘An Atlas of Chronic Obstructive Pulmonary Disease’; Parthenon Publishers 2004

GLOBAL MORTALITY 2004 2020 COPD Ischaemic heart disease Cerebrovascular disease Lower respiratory infection Diarrhoeal disease Perinatal disorders COPD Tuberculosis Measles Road traffic accidents Lung cancer Murray & Lopez: World Bank Global Predictions Nat Med 1998 6th

PREDICTIONS FOR DISABILITY 1990 TO 2020 2004 2020 1. Lower respiratory infections 2. Diarrhoeal diseases 3. Perinatal conditions 4. Unipolar major depression 5. Ischaemic heart disease 6. Cerebrovascular disease 7. Tuberculosis 8. Measles 9. Road traffic accidents 10. Congenital anomalies 11. Malaria 12. COPD disability- adjusted life-years Murray & Lopez: WHO Global Predictions Nat Med 1997

CONFUSING TERMINOLOGY Chronic Bronchitis Emphysema Fixed Asthma Blue bloater Pink puffer COPD/ COAD/COLD COPD as a disease was recognized not long back but in 1960s. The terms Chronic bronchitis and emphysema remained in use for long time. The use of terms pink puffer and blue bloater kept on confusing everyone. Thankfully all the variants of the disease have now been brought under one umbrella and termed as COPD or chronic obstructive pulmonary disease. The other two terms COAD and COLD are also being used at some places but are to be discouraged. The current GOLD guidelines clearly talk about the pathophysiology, morbidity and management which remains same regardless the clinical variants of the COPD

MAKING A DIAGNOSIS History and clinical examination Radiological findings Spirometry History of smoking makes the doctor think of COPD but we need to be careful. Asthmatics may smoke. On the other side, non-smoking COPD is being increasingly recognized. Radiologically, finding increased broncho-vascular markings should not be reported as COPD, especially chronic bronchitis because it essentially remains a clinical definition. Reporting emphysema also leads to confusion between pathological emphysema, compensatory emphysema and senile emphysema in the minds of the inexperienced doctors. When it comes to spirometry, there are again lots of confusions in understanding the bronchodilator reversibility So all these need to be combined to arrive at the diagnosis.

DIFFERENTIATING FROM ASTHMA IS MUST !! I have routinely seen COPD patients who have been labeled and treated as bronchial asthma. And I occasionally came across referrals where asthma was labeled as COPD. This differentiation is must since despite the simillarity of symptoms there are major differences in the etiology, pathology, treatment and prognosis of these two diseases. If I have to give an example, Tumors look alike but it is most important to differentiate between the benign and malignant tumour.

BREATHLESS BUT NOT HELPLESS The revised definition of COPD stresses on this point. A disease that was once considered as a relentlessly progressive disease is now called as a preventable and treatable diseases. With better understanding of the disease and new advances in pharmacology, it is now possible to give longer as well as better quality of life to these patients.