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How should be the therapeutical approach to COPD patient?

How should be the therapeutical approach to COPD patient?. Nikos Siafakas MD, PhD, FCCP Professor of Thoracic Medicine University of Crete, Greece President of ERS 2009-2010 TTC April 2009. Before starting the therapeutic approach we need.

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How should be the therapeutical approach to COPD patient?

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  1. How should be the therapeutical approach to COPD patient? Nikos Siafakas MD, PhD, FCCP Professor of Thoracic Medicine University of Crete, Greece President of ERS 2009-2010 TTC April 2009

  2. Before starting the therapeutic approach we need • Proper Diagnosis (Differential Diagnosis) • Staging of Severity of Disease

  3. Proper diagnosis • History (Smoking environmental/exposure) b. Symptoms (cough, phlegm, dyspnea) c. SPIROMETRY

  4. Severity of disease Spirometric staging  [FEV1]  ATS/ERS stages of severity

  5. 2004 ERS/ATS guidelines for management of COPD

  6. Non-pharmacological interventions in COPD • Smoking cessation • Mechanical ventilation • Surgery for COPD • Rehabilitation • LTOT ????

  7. Management of Stable COPD Reduce Risk Factors: Smoking Cessation • Counseling delivered by physicians and other health professionals significantly increases quit rates over self-initiated strategies. Even a brief (3-minute) period of counseling to urge a smoker to quit results in smoking cessation rates of 5-10%. .

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

  9. Vicious circle of COPD lack of exercise COPD Dyspnea immobility (deconditioning) Depression social isolation

  10. Pulmonary RehabilitationDefinition • PUL-REHAB is a multidisciplinary program of care for patients with COPD that is individually tailored and designed to optimize physical and social performance and autonomy

  11. Pulmonary rehabilitation: multidisciplinary • Exercise training • Nutrition interventions • Sleep interventions • Education • Psychological and social considerations

  12. Rehabilitation: Exercise • Bicycle ergometer • Treadmill • Walking (6-20 min) • Upper limbs • Respiratory muscles (insp/exp) • Others (NMES)

  13. Pulmonary Rehabilitation • COPD of all stages benefit from exercise training programs • Minimum duration at least 4 weeks (best 4-10 weeks) • Benefits wane after the end but sustained above pre –rehab levels for long time (even a year) • Repeated or home training sustain benefits

  14. Nutrition • Assess : • BMI less than 21 Kg/m2 underweighted • BMI : 25-30 Kg/m2 over weighted • BMI more than 30 Kg/m2 obese • Estimation of weight loss: • more than 10% last 6 months or 5% the • last month

  15. Nutrition • Nutritional interventions are effective in combination with exercise and/or other anabolic stimuli

  16. Interventions during SLEEP • In COPD sleep is significantly impaired a) as part of the course of the disease ( marked desaturation) • b) co-existing sleep apnea syndromes • CPAP or O2 improves QoL

  17. Education: topics • Breathing strategies • Proper use of medications/O2 • Bronchial hygiene • Benefits of physical activities • Energy conservation techniques • Nutritional strategies • Prevention and copying with exacerbations • Travel leisure sexuality • End-of-life planning • Anxiety stress and panic management /relaxation techniques

  18. ATS/ERS statement : concluded ARRDCC 2006:173.1390-1413 • Pul- rehab must be available to all COPD patients who need it • More research is needed to optimize effectiveness • Develop better ways to maintain benefits • Evaluate the effects of REHAB on SURVIVAL

  19. Meta-analysis :Lancet 1996Cochrane database 2002 • Rehab relieves dyspnea , fatigue and enchances patient’s sense of control over their condition. Although the average improvement in exercise was modest. Rehab forms an important component of the management of COPD

  20. Pulmonary Rehabilitation: is cost effective ? • British study shows that Rehab is effective to reduce overall cost in health services • Canadian study =cost is 11597 CDN /person

  21. Effects of Home-based Pul-Rehab in COPD • Canadian study: Maltais et al: Ann Inter Med 2008 (16) 869-78 • Home rehab is a useful equivalent alternative to outpatient rehab in COPD

  22. CONCLUSION • In COPD the non-Pharmacological interventions are at least as important and effective as the pharmacological ones and should be provided to all patients

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