1. Prof Dr Guy JOOS Dept Respiratory Diseases Ghent University Hospital
COPD
GOLD guidelines
Prof Dr Guy JOOS
Dept Respiratory Diseases
Ghent University Hospital

2. COPD Chronic Obstructive Pulmonary Disease
Causes: cigarette smoking, indoor cooking/heating
Symptoms: cough, sputum production, dyspnea
Small airways and lung parenchyma
Chronic bronchitis and emphysema

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

5. Global Initiative for Chronic Obstructive Lung Disease

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7. 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

8. 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

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

10. COPD is the only one of the major causes of death that has increased significantly in recent years
Proportion of 1965 rate
3.0
Coronary heart
disease
Stroke
Other CVD
COPD
All other causes
2.5
2.0
1.5
1.0
These data from the USA, collected from 1965 to 1998, show a 163% increase in age-adjusted death rates from COPD. While the death rate is declining from diseases such as coronary heart disease (a 59% decrease) and cerebrovascular disease (a 35% decrease), the death rate from COPD is increasing markedly. All other causes of age-adjusted US deaths also saw a decline of 7%.
The Global Burden of Disease (GBD) study attributed more than 2.2 million deaths to COPD in 1990 (4.4% of worldwide deaths), ranking COPD as the sixth most serious cause of worldwide mortality.1 Furthermore, the 2002 World Health Organization (WHO) report indicated that COPD deaths are on the increase, with over 2.7 million deaths (5%) in Even more concerning, COPD deaths are projected to rise to third place in the worldwide ranking with 4.5 million deaths in
The 2004 American Lung Association Report estimated approximately 120,000 deaths in the USA in
The European Lung White Book, the first comprehensive survey on respiratory health in Europe, estimated annual COPD mortality in Europe as 200,000–300,000.4
References
Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997;349:1498–504.
World Health Organization. The World Health Report: Reducing Risks, Promoting Healthy Life
American Lung Association Epidemiology and Statistics Unit Research and Scientific Affairs. Trends in Chronic Bronchitis and Emphysema: Morbidity and Mortality. November 2004.
European Lung White Book: The First Comprehensive Survey on Respiratory Health in Europe. Editor in chief R Loddenkemper. ERSJ Ltd. 200;34–43.
0.5
–59%
–64%
–35%
+163%
–7%
Percentage change in age-adjusted death rates in USA, from 1965 to 1998
CVD = cerebrovascular disease

11. 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 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 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

12. COPD Mortality by Gender, U.S., 1980-2000
Number Deaths x 1000
Source: US Centers for Disease Control and Prevention, 2002

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

14. COPD Pathogenesis of COPD
NOXIOUS AGENTS (tobacco smoke, indoor air pollution, occupational agents)
Genetic factors
Respiratory infections
Other
COPD

16. European Lung White Book

17. 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

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

19. COPD Underrecognized Underdiagnosis Undertreatment
Insufficiently prevented
 WHO: GARD (Global Alliance against Chronic Respiratory Diseases) – may 2005

20. Chronic obstructive pulmonary disease

21. Chronic overlooked pulmonary disease

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