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INTRODUCTION

DEFINITION:

COPD-a common preventable and treatable disease, characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.

Burden of COPD:

Morbidity: Living with COPD can pose serious challenges most especially those in developing and underdeveloped countries. These include physician visits, EU visits and hospitalization. Morbidity increases with age and the management can be impacted by comorbidities such as DM, HPT etc…

Mortality: The accuracy of mortality data is affected by underrecognition and underdiagnosis, despite this COPD is still the 3^rd leading cause of mortality. The high mortality is mainly due to the expanding epidemic of smoking and aging of the world population.

Socioeconomic: COPD is associated with significant socioeconomic burden, making it difficult to effectively manage the disease. The cost of care goes hand in hand with the severity of the disease. The allocated budget for health care costs is never enough to handle the socioeconomic burden associated with COPD.

DR MACHABE 17 FEB 2022

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FACTORS THAT INFLUENCE DEVELOPMENT AND PROGRESSION OF COPD

Cigarrete smoking and other tobacco types, and marijuana
Environmental tobacco smoke i.e. passive smoking
Biomass gases, e.g. usage of paraffin stoves in our townships
Occupational exposures e.g. working in coal mines
Genetics
Lung development abnormalities
Aging
Bronchial hyperreactivity
Socioeconomic status

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DIAGNOSIS OF COPD

HISTORY

Clinical diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough and/or sputum production, comorbidities and a history of exposure to risk factors for the disease.

INVESTIGATIONS

Spirometry

Saturation(Oximetry)

Arterial blood gas

Α1-antitrypsin deficiency(contextual)

Grading

The goals of COPD assessment are to determine: (1) the impact of the disease on the patient’s health status, (2) the severity of airflow limitation, and (3) the risk of future events (such as exacerbations, hospital admissions, or death), to, eventually, guide

therapy.

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DIAGNOSIS OF COPD�

Patient group A—low risk, less symptoms

GOLD 1–2 (mild or moderate airflow limitation)

and 0–1 exacerbation per year and mMRC grade 0–1 or CAT score , 10

Patient group B—low risk, more symptoms

GOLD 1–2 (mild or moderate airflow limitation)

and 0–1 exacerbation per year and mMRC grade > 2 or

CAT score > 10

Patient group C—high risk, less symptoms

GOLD 3–4 (severe or very severe airflow limitation)

and/or > 2 exacerbations per year and/or > 1 hospitalized

exacerbation per year and mMRC grade 0–1 or CAT score , 10

Patient group D—high risk, more symptoms

GOLD 3–4 (severe or very severe airflow limitation)

and/or > 2 exacerbations per year / > 1 hospitalized exacerbation

per year and mMRC grade > 2 or CAT score > 10

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MANAGEMENT OF COPD

Stable COPD

Prevention: Early identification and reduction of exposure to risk factors significantly improves the prevention and treatment of COPD.

Assessment: Comprehensive individualized assessment of symptoms and future risk of exacerbation should also be incorporated into the management strategy for stable COPD.

Non-pharmacological management:

Physical activity: Regular physical activity is recommended for all patients with COPD.
Rehabilitation: Patient with COPD appear to benefit from rehabilitation and maintenance of physical activity, improving their exercise tolerance and experiencing decreased dyspnea and fatigue.
Vaccination: Decisions about vaccination in patients with COPD depend on local policies, availability, and affordability.

Pharmacological management:

used to reduce symptoms, reduce frequency and severity of exacerbations, andimprove health status and exercise tolerance.

The choice of drugs to use is largely dependent on the severity of the disease based on the grading score.

e.g. Group A-Short acting bronchodilators

Group C- Long-acting anticholinergic or a combination of inhaled corticosteroid/long-acting b2 agonist is recommended.

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MANAGEMENT OF COPD CONT…

Acute Exacerbation of COPD:

Definition: An exacerbation of COPD is an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication.

Precipitating factors: Viral upper respiratory tract infections and infection of the tracheobronchial tree are the most common precipitants.

Diagnosis: Is based on clinical presentation of the patient (baseline dyspnea, cough, and/or sputum production)

Treatment: The goal of treatment in COPD exacerbations is to minimize the impact of the current exacerbation and to prevent the development of subsequent exacerbations.

And this can mainly be achieved by:

Smoking cessation
Influenza and pneumococcal vaccination
Knowledge of current therapy including inhaler technique
Appropriate treatment

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COPD & COMORBIDITIES

COPD can coexist with other conditions that may worsen the prognosis. Comorbidities often affects the accuracy of the diagnosis of COPD. Comorbidities must be treated as though patient doesn’t have COPD

Common COPD comorbidities:

Cardiovascular- IHD

CCF

HPT

Respiratory- Lung cancer

Asthma

Musculoskeletal- Osteoporosis

Endocrine- DM

Metabolic syndrome

Mental- Anxiety

Depression

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CONCLUSION

Respiratory diseases have high mortality rate, COPD being the 3^rd leading cause of death worldwide. However COPD is preventable and treatable. Applying the approach of the levels of prevention immensely improves the prognosis despite the limited resources in the public health sector. Understanding the goal of treatment in COPD can help alleviate the burden it comes with.

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