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Chronic Obstructive Pulmonary Disease

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.

Chronic Bronchitis
The presence of cough and sputum production for at least 3 months in each year for two consecutive years

Emphysema
Permanent airspace enlargement beyond the terminal bronchioles with destruction of alveolar septa

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2005 UpToDate

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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 six leading causes of death in the United States, only COPD has been increasing steadily since 1970
Source: Jemal A. et al. JAMA 2005
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COPD Mortality by Gender,

U.S., 1980-2000
Number Deaths x 1000
70 60 50 40 Women 30 20 10 0 1980 1985 1990 1995 2000
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Men

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 FEV1 Airway resistance Total lung capacity Residual volume Diffusion capacity chronic bronchitis emphysema < 70 variable increased increased increased normal decreased
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Classification of COPD Severity by Spirometry

Stage I: Mild FEV1/FVC < 0.70 FEV1 > 80% predicted FEV1/FVC < 0.70 50% < FEV1 < 80% predicted FEV1/FVC < 0.70 30% < FEV1 < 50% predicted FEV1/FVC < 0.70 FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure

Stage II: Moderate Stage III: Severe Stage IV: V. Severe

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Treatment
Prevent disease progression smoking cessation (nicotine replacement, antidepressants, varinicline) vaccines Improve pulmonary function Medical treatment Rehabilitation Surgical treatment Treat complications
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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 bronchodilators Add rehabilitation Add ICS if frequent exacerbations Add LTOT Surgery

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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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