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COPD PowerPoint Presentation

COPD

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COPD

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  1. COPD Review Oct. 16, 2014 Cathy Vakil

  2. Key messages 1) Suspect COPD - prolonged or recurrent cough, dyspnea, or decreased exercise tolerance, smoking history 2) PFTs for confirmation and to document disease progression 3) Encourage smoking cessation 4) Vaccinations

  3. 5) Meds 6) Referral – respirologist, pulm. rehab. 7) Rule out co-morbidities (e.g. MI, congestive heart failure, systemic infections, anemia). 8) If end-stage COPD, discuss, document, and periodically re-evaluate wishes about aggressive treatment interventions.

  4. Global Initiative for Chronic Obstructive Lung Disease - GOLD

  5. COPD • Treatable • Preventable • Underdiagnosed

  6. Family Physicians’ role • Early detection through targeted screening and prevention by smoking cessation counselling • Optimize symptom control through appropriate pharmacological and non-pharmacological therapy • Prevention; management of acute exacerbations

  7. COPD • Tobacco smoke/air pollution – *chronic lung inflammation* (persists after removal of toxin) • Air trapping, luminal plugs, airflow limitation • Mucous production (“chronic bronchitis”) • Tissue destruction, small airway fibrosis (emphysema)

  8. Leads to: • hypoxia • Pulmonary hypertension, RVH • Inflammatory mediators - cachexia, worsening of heart disease, DM, osteoporosis, anemia

  9. Types of COPD • Emphysema • Chronic bronchitis • Asthma-COPD Overlap Syndrome (ACOS)

  10. Emphysema • Toxin – lung inflammation – narrowing of small airways and destruction of lung parenchyma – reduction of elastic recoil – reduction of ability of airways to remain open during expiration – air trapping • Destruction of gas-exchanging surfaces of the lung (alveoli) • hypoxia

  11. Chronic Bronchitis • Presence of cough and sputum production for at least 3 months in 2 consecutive years • Independent disease entity, can occur in normal spirometry • Usually present in COPD along with emphysema

  12. ACOS • Features of both • History of asthma, then develop COPD • Chronic inflammation of asthma untreated – COPD • Usually over 40 years old • More rapid decline, higher mortality than either alone • Specific treatment limitations

  13. Causes of COPD • Total burden of inhaled particles • Smoking, second-hand smoke • Air pollution (indoor, outdoor) • Occupational – dust (silica, grain), chemicals, fumes, cadmium, agriculture • Cumulative exposure over decades

  14. Other factors • Alpha 1-antritrypsin deficiency • Aging, low SES, co-morbidities • Childhood infections, low birth weight • Family history of COPD • Gene/environment interaction • Significant morbidity, mortality, social, economic burden