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

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

3. 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

4. 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

5. 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

6. 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.

7. 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.

8. 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.