1. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11 بسم الله الرحمن الرحیم با سلام

2. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11 Chronic Obstructive Pulmonary Disease Dr A. Asadian

3. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11 Occupational Respiratory Diseases

4. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11 تعریف  COPD is defined as a disease state characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema.

5. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11  airflow limitation that is not fully reversible Accessed September 19, 2008, at http://www.goldcopd.com/.)http://www.goldcopd.com/ N Engl J Med Volume 359:1616-1618 October 9, 2008October 9, 2008

7. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11

9. Key Indicators for COPD Diagnosis Chronic coughPresent intermittently or every day often present throughout the day; seldom only nocturnal Chronic sputum productionPresent for many years, worst in winters. Initially mucoid – becomes purulent with exacerbation Dyspnoea that isProgressive (worsens over time) Persistent (present every day) Worse on exercise Worse during respiratory infections Acute bronchitisRepeated episodes History of exposure to risk factors Tobacco smoke occupational dusts and chemical smoke from home cooking and heating fuel

10. Disease Trajectory of a Patients with COPD Symptoms Exacerbations Deterioration End of Life

11. Physical signs  Large barrel shaped chest (hyperinflation)  Prominent accessory respiratory muscles in neck and use of accessory muscle in respiration  Low, flat diaphragm  Diminished breath sound

13. Emphysema

14. Normal versus Diseased Bronchi

17. COPD classification based on spirometry GOLD 2003. Severity Postbronchodilat or FEV 1 /FVC Postbronchodilator FEV 1 % predicted At risk>0.7>80 Mild COPD<0.7>80 Moderate COPD <0.750-80 Severe COPD<0.730-50 Very severe COPD <0.7<30

18. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11 Cardiac Disease in Chronic Obstructive Pulmonary Disease  The cardiac manifestations of chronic obstructive pulmonary disease (COPD) are numerous. right ventricular dysfunction and pulmonary vascular disease are well known to complicate the clinical course of COPD and correlate inversely with survival.

19. Spirometry  Diagnosis  Assessing severity  Assessing prognosis  Monitoring progression

20. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11

21. Spirometry  FEV 1 – Forced expired volume in the first second  FVC – Total volume of air that can be exhaled from maximal inhalation to maximal exhalation  FEV 1 /FVC% - The ratio of FEV 1 to FVC, expressed as a percentage.

22. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11

24. COPD:   Beyond FEV1

25. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11 Systemic Effects  weight loss, Circulating concentrations of interleukin-6 acute-phase proteins, such CRP levels of leptin

27. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11

28. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11 CXY in COPD

31. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11

32. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11

35. comorbidities of COPD  The most common that are possibly related to the systemic effects of smoking are CHF, arrhythmias, hypertension, peripheral and coronary artery diseases, diabetes and metabolic syndrome, osteoporosis, cancer (particularly lung cancer), pulmonary vascular abnormalities, psychiatric disorders, cachexia, skeletal muscle abnormalities, and infections

36. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11 Airflow Limitation in Smokers Is Associated with Subclinical Atherosclerosis  Conclusions: Smokers with airflow limitation had exaggerated subclinical atherosclerosis.. American Journal of Respiratory and Critical Care Medicine Vol 179. pp. 35-40, 2009

37. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11

38. Post- bronchodilator FEV1 (% predicted) Management based on GOLD

40. What medications are used to prevent complications?  Annual flu vaccine Reduces risk of flu and its complications  Pneumonia vaccine Reduces risk of common cause of pneumonia

42. Algorithm for the management of COPD Short acting bronchodilator – as required Tiotropium Tiotropium+LABA Long acting beta agonist LABA + tiotropium Add -Inhaled steroids -Theophylline Mild Severe assess with symptoms and spirometry

43. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11 Chicken or egg: physical activity in COPD Eur Respir J 2009; 33:227-229 Copyright ©ERS Journals Ltd 2009ERS Journals Ltd

45. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11

48. خسته نباشید

50. يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11 QUESTIONS?