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Chronic Obstructive

Pulmonary Disease

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Smoking Related Deaths

5.4 millions/year, one every 6 seconds

1.7 millions due to CVD

1 million due to COPD

850,000 due to lung cancer

443,000 deaths annually in USA; 50,000

are secondhand smokers Smokers die 10-15 year sooner than

nonsmokers

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COPD

Definitions

Epidemiology

Risk factors

Pathology

Diagnosis

Treatment

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Definition

A disease state characterized by airflow

limitation that is not fully reversible and

usually it is progressive and associated

with abnormal inflammatory response of

the lungs to noxious particles or gases. It

is a preventable and treatable disease.

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Chronic Bronchitis

The presence of cough and sputumproduction for at least 3 months

in each year for two consecutive

years

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Emphysema

Permanent airspace enlargementbeyond the terminal bronchioles

with destruction of alveolar septa

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2005 UpToDate

2005 UpToDate www.uptodate.com Contact Us

http://www.uptodate.com/http://embedded/utod/utd?type=5&displaytype=0http://embedded/utod/utd?type=5&displaytype=0http://www.uptodate.com/

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COPD in USA

12.1 million adults has COPD in 2001

11.8 million in 2008 14 million undiagnosed

126,000 deaths in 2005

3rd leading cause of death in USA (2008)

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Of the sixleading causes

of death in theUnited States,only COPD has

been increasingsteadily since1970

Source: Jemal A. et al. JAMA2005

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COPD Mortality by Gender,U.S., 1980-2000

0

10

20

30

40

50

60

70

1980 1985 1990 1995 2000

Men

Women

Numb

erDeaths

x1000

Source: US Centers for Disease Control and Prevention, 2002

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Prevalence of Smoking in Jordan

Adults above age >18 years 2007

Males 49.6%

Females 10.5%

School children 13-15 year

1999 Males 25%

Females 16%2007 Males 37%

Females 26%

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Pathology & Pathogenesis

Mucus hypersecretion, ciliary dysfunction

(cough & sputum production)

Airflow limitation & hyperinflation

(shortness of breath)

Gas exchange abnormalities, pulmonary

hypertension, and cor-pulmonale(respiratory failure)

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Diagnosis

Clinical features

Pulmonary function tests

Radiology

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Key Indicators to Consider COPD

Chronic cough

Chronic sputum production

Dyspnea

History of exposure to risk factors

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Pulmonary Function Tests

FEV1/FVC < 70

FEV1 variable

Airway resistance increased Total lung capacity increased

Residual volume increased

Diffusion capacitychronic bronchitis normal

emphysema decreased

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Classification of COPD Severityby Spirometry

Stage I: Mild FEV1/FVC < 0.70

FEV1 > 80% predicted

Stage II: Moderate FEV1/FVC < 0.7050% < FEV1 < 80% predicted

Stage III: Severe FEV1/FVC < 0.7030% < FEV1 < 50% predicted

Stage IV: V. Severe FEV1/FVC < 0.70FEV1 < 30% predicted orFEV1 < 50% predictedplus

chronic respiratory failure

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Treatment

Prevent disease progressionsmoking cessation (nicotinereplacement, antidepressants,

varinicline)vaccines

Improve pulmonary functionMedical treatment

RehabilitationSurgical treatment

Treat complications

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O i f

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Outpatient Management of

COPD

I: Mild II:Moderate III:Severe IV: V. severe

Avoidance of risk factor(s); influenza vaccination

Add short acting bronchodilator when needed

Add long acting bronchodilatorsAdd rehabilitation

Add ICS if frequent

exacerbationsAdd LTOTSurgery

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Surgical Treatment

Lung volume reduction surgery

Bullectomy

Lung transplantation

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Acute Exacerbations

Oxygen therapy

Bronchodilators

Antibiotics

Corticosteroids

Assisted ventilation

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Respiratory Failure

PaO2 < 7.3 kPa (55mmHg)

PaO2 7.3-8 kPa (55-60mmHg)+

Corpulmonale

Erythrocytosis PCV > 55%

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