Prof Dr Guy JOOS Dept Respiratory Medicine Ghent University Hospital

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

2. Noncommunicable Diseases (NCDs) Responsible for up to 60% of all deaths, 80% are in low- and middle-income countries Major noncommunicable diseases: Cardiovascular disease Cancer Chronic Respiratory disease Diabetes Shared preventable risk factors: Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol Cancer Chronic Respiratory Diseases Diabetes Cardiovascular Disease Other NCDs Physical inactivity Unhealthy diets Obesity Smoking Harmful use of alcohol

3. GARD (September 2007) • Everyone in the world is exposed to • CRD risk factors • often common with other NCDs • Co-morbidities • paramount importance • often common with other NCDs Global Alliance against Chronic Respiratory Diseases www.who.int/respiratory/gard

4. Definition of COPD • COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. • Its pulmonary component is characterized by airflow limitation that is not fully reversible. • The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. GOLD 2006

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

6. Risk Factors for COPD Nutrition Infections Socio-economic status Aging Populations

8. Fabbri et al., Eur Respir J, 2008, 31, 204-212

9. COPD and Co-Morbidities COPD patients are at increased risk for: Myocardial infarction, angina Osteoporosis Respiratory infection Depression Diabetes Lung cancer

10. COPD and Co-Morbidities COPD has significant extrapulmonary (systemic) effects including: Weight loss Nutritional abnormalities Skeletal muscle dysfunction

13. L e g e n d < 0 . 6 2 7 5 6 . 2 7 5 - 9 . 6 5 8 9 . 6 5 9 - 1 5 . 6 8 7 1 5 . 6 8 8 - 1 8 . 1 4 5 1 8 . 1 4 6 - 1 9 . 8 8 9 1 9 . 8 9 - 2 2 . 1 1 6 2 2 . 1 1 7 - 3 5 . 5 4 8 3 5 . 5 4 9 - 3 8 . 1 7 7 > 3 8 . 1 7 8 N o D a t a COPD - Deaths / 1000 1990 Data projected to 2000

14. Mortality related to COPD 6th leading cause of death worldwide 2.2 million deaths Global Burden of Disease Study 1999

15. 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 Stomach cancer HIV Suicide Murray & Lopez 1997

16. Causes of death in patients with COPD Rabe, N Engl J Med, 2007, 356, 851-854

17. Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee McGarvey et al., Thorax, 2007, 62, 411-415

18. Chronic obstructive pulmonary disease

19. Chronic overlooked pulmonary disease

20. Diagnosis of COPD EXPOSURE TO RISK FACTORS SYMPTOMS cough tobacco sputum occupation shortness of breath indoor/outdoor pollution è è è SPIROMETRY

21. GOALS of COPD MANAGEMENT VARYING EMPHASIS WITH DIFFERING SEVERITY • Relieve symptoms • Prevent disease progression • Improve exercise tolerance • Improve health status • Prevent and treat complications • Prevent and treat exacerbations • Reduce mortality

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

23. Global Initiative for Chronic Obstructive Lung Disease www.goldcopd.com

24. Active reduction of risk factor(s); influenza vaccination Addshort-acting bronchodilator (when needed) I: Mild II: Moderate III: Severe IV: Very Severe Addregular treatment with one or more long-acting bronchodilators (when needed); Addrehabilitation Addinhaled glucocorticosteroids if repeated exacerbations Addlong term oxygenif chronic respiratory failure. Considersurgical treatments