COPD Consensus GOLD Global Initiative for chronic Obstructive Lung Disease

1
COPD Consensus GOLDGlobal Initiative for chronic
Obstructive Lung Disease

• Habib GHEDIRA, MD, Prof.
• Medical Faculty of Tunis

2
Percent Change in Age-Adjusted Death Rates, U.S.,
1965-1998
Proportion of 1965 Rate
3.0
Coronary Heart Disease
Stroke
Other CVD
COPD
All Other Causes
2.5
2.0
1.5
1.0
0.5
59
64
35
163
7
0
1965 - 1998
1965 - 1998
1965 - 1998
1965 - 1998
1965 - 1998
Source NHLBI/NIH/DHHS
3
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.

4
Risk Factors for COPD

• Genes
• Exposure to particles
• Tobacco smoke
• Occupational dusts, organic and inorganic
• Indoor air pollution from heating and cooking
  with biomass in poorly ventilated dwellings
• Outdoor air pollution

• Lung growth and development
• Oxidative stress
• Gender
• Age
• Respiratory infections
• Socioeconomic status
• Nutrition
• Comorbidities

5
COPD Pathology
ASTHMA
Allergens
Mast cell
Ep cells
CD4 cell (Th2)
Eosinophil
Bronchoconstriction AHR
Airflow Limitation
Reversible
Irreversible
Source Peter J. Barnes, MD
6
Changes in Large Airways of COPD Patients
Mucus hypersecretion
Neutrophils in sputum
Squamous metaplasia of epithelium
No basement membrane thickening
Goblet cell hyperplasia
? Macrophages
? CD8 lymphocytes
Mucus gland hyperplasia
Little increase in airway smooth muscle
Source Peter J. Barnes, MD
7
Changes in Small Airways in COPD Patients
Inflammatory exudate in lumen
Disrupted alveolar attachments
Thickened wall with inflammatory cells -
macrophages, CD8 cells, fibroblasts
Peribronchial fibrosis
Lymphoid follicle
Source Peter J. Barnes, MD
8
Changes in the Lung Parenchyma in COPD Patients
Alveolar wall destruction
Loss of elasticity
Destruction of pulmonary capillary bed
? Inflammatory cells macrophages, CD8
lymphocytes
Source Peter J. Barnes, MD
9
Diagnosis of COPD
EXPOSURE TO RISK FACTORS
SYMPTOMS
cough
tobacco
sputum
occupation
shortness of breath
indoor/outdoor pollution
è
è
è
SPIROMETRY
10
Spirometry Normal and Patients with COPD
11
Classification of COPD Severity by Spirometry

• Stage I Mild FEV1/FVC lt 0.70
• FEV1 gt 80 predicted
• Stage II Moderate FEV1/FVC lt 0.70
• 50 lt FEV1 lt
  80 predicted
• Stage III Severe FEV1/FVC lt 0.70
• 30 lt FEV1 lt
  50 predicted
• Stage IV Very Severe FEV1/FVC lt 0.70
• FEV1 lt 30 predicted or
• FEV1 lt 50 predicted plus chronic
  respiratory failure

12
Therapy at Each Stage of COPD
IV Very Severe
III Severe
II Moderate
I Mild
50
80
30
FEV1
Add long term oxygen if chronic respiratory
failure. Consider surgery
Add inhaled glucocorticosteroids if repeated
exacerbations
Active reduction of risk factor(s) influenza
vaccination Add short-acting bronchodilator
(when needed)
13
Questions ? Réponses !