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ERS-ATS COPD Guidelines Copyright © European Respiratory Society 2005 These slides can be used freely  for non-commercial purposes.
Document  authors
Document Goals and Objectives (1) ,[object Object],[object Object],[object Object],[object Object]
Document Goals and Objectives (2) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Definition of COPD ,[object Object],[object Object]
Epidemiology (1) ,[object Object],[object Object]
Epidemiology (2) ,[object Object],469,314 All other causes of death 24,936 Chronic liver disease 26,265 Nephritis 29,264 Suicide 64,574 Diabetes 93,207 Pneumonia and influenza 94,828 Accidents 114,381 Respiratory diseases (COPD) 158,060 Cerebrovascular disease (stroke) 538,947 Cancer 724,269 Heart disease Number Leading causes of death in the USA, 1998
Epidemiology (3) ,[object Object],[object Object],[object Object],Smoking Socio-economic status Occupation Environmental pollution Perinatal events and childhood illness Recurrent bronchopulmonary infections Diet Genetic factors  Sex  Airway hyperreactivity, IgE and asthma Exposures Host factors
Pathogenesis and Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis of COPD (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis of COPD (2) Spirometry ,[object Object],[object Object],<30  0.7 Very severe COPD 30 – 50  0.7 Severe COPD 50 – 80  0.7 Moderate COPD  80  0.7 Mild COPD  80 >0.7 ,[object Object],[object Object],[object Object],[object Object],[object Object],FEV 1  % pred Postbrochodilator FEV 1 /FVC Severity
Diagnosis of COPD (3) BMI and dyspnoea ,[object Object],[object Object],[object Object],Too breathless to leave the house or breathless when dressing or undressing. 4 Stops for breath after walking about 100 m or after a few minutes on the level. 3 Walks slower than people of the same age due to breathlessness or has to stop for breath when walking at own pace on the level. 2 Troubled by shortness of breath when hurrying or walking up a slight hill. 1 Not troubled with breathlessness except with strenuous exercise. 0
Diagnosis of COPD (4)
Smoking cessation (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],Schedule follow-up contact Arrange Help the patient with a quit plan, provide practical counselling, treatment and social support, recommend the use of approved pharmacotherapy Assist Determine willingness to make a quit attempt Assess Strongly urge all tobacco users to quit Advise Identify all tobacco users at every visit Ask
Smoking cessation (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Smoking cessation (3) ,[object Object],[object Object],[object Object],[object Object]
Management of stable COPD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management of stable COPD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacological therapy (1) ,[object Object],[object Object],[object Object],[object Object]
Pharmacological therapy (2) ,[object Object],[object Object],[object Object]
Pharmacological therapy (3)   Bronchodilators LA-BD: long-acting bronchodilator; ICS: inhaled corticosteroid. Assess effectiveness by treatment response criteria. If forced expiratory volume <50% predicted and exacerbations of COPD requiring a course of oral corticosteroid or antibiotic occurred at least once within the last year, consider adding regular ICS. Always ensure the patient can use an inhaled device effectively and understands its purpose. If an ICS and a long-acting β-agonist are used, prescribe a combination inhaler.
Pharmacological therapy (4)     Bronchodilators ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacological therapy (5)     Glucocorticoids ,[object Object],[object Object]
Pharmacological Therapy (6) Effects on commonly used medications on important clinical outcomes in COPD
Management of stable COPD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Long-term oxygen therapy (1) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Long-term oxygen therapy (2) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Long-term oxygen therapy (3)   Home treatment ,[object Object]
Management of stable COPD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pulmonary rehabilitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management of stable COPD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nutrition ,[object Object],[object Object],[object Object],[object Object],[object Object],BMI   30 kg · m -2 Obese  BMI <30 kg · m -2 Overweight BMI <21 – 25 kg · m -2 Normal weight BMI <21 kg · m -2 ;age >50 yrs Underweight
Management of stable COPD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surgery in COPD (1) ,[object Object],[object Object],[object Object],[object Object]
Surgery in COPD (2) ,[object Object]
Surgery for COPD (1) ,[object Object],[object Object]
Surgery for COPD (2) Bullectomy CXR: chest radiography; CT: computed tomography; FVC: forced vital capacity; FEV 1 : forced expiratory volume in one second;  D L,CO: carbon monoxide diffusing capacity of the lung; Pa,O2; arterial oxygen tension;  P a,CO 2 ; arterial carbon dioxide tension
Surgery for COPD (3)   Lung Volume Reduction Surgery PA: alveolar pressure; RV: residual volume; TLC: total lung capacity;  P a,O 2 : arterial oxygen tension;  P a,CO 2 : arterial carbon dioxide tension; FEV 1 : forced expiratory volume in one second;  D L,CO: carbon dioxide diffusing capacity of the lung.  # : confirmed recommendations using NETT data or expert opinion.
Surgery for COPD (4)   Lung Volume Reduction Surgery ,[object Object]
Management of stable COPD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sleep ,[object Object],[object Object],[object Object],[object Object],[object Object]
Management of stable COPD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Air travel ,[object Object],[object Object],[object Object],[object Object],[object Object]
Exacerbation of COPD ,[object Object],[object Object],[object Object]
Exacerbation of COPD ,[object Object],[object Object],[object Object]
Definition, evaluation and  treatment (1) ,[object Object],[object Object],[object Object]
Definition, evaluation and  treatment (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Definition, evaluation and  treatment (3) ,[object Object],+: unlikely to be present; ++: likely to be present; +++: very likely to be present Yes Yes Yes Yes If applicable Yes Yes Yes Yes Yes Yes If applicable Yes  Yes Yes No No No If applicable No No ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stable/unstable +++ +++ Stable ++ ++ Stable Not present No ,[object Object],[object Object],[object Object],[object Object],+++ +++ Severe +++ +++ Moderate/severe + + Mild/moderate ,[object Object],[object Object],[object Object],[object Object],Level III Level II Level I
Definition, evaluation and  treatment (4) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Definition, evaluation and  treatment (5) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Supplemental oxygen  (if saturation <90% ) ,[object Object],[object Object],[object Object]
Definition, evaluation and  treatment (6) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Supplemental oxygen  Ventilatory support
Exacerbation of COPD ,[object Object],[object Object],[object Object]
In-patient oxygen therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
In-patient oxygen therapy (2) ,[object Object]
Exacerbation of COPD ,[object Object],[object Object],[object Object]
Assisted ventilation (1) ,[object Object],[object Object],[object Object],[object Object]
Assisted ventilation (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Assisted ventilation (3) ,[object Object]
Ethical and palliative care  issues in COPD ,[object Object],[object Object],[object Object],[object Object]
Patient section
Patient section ,[object Object],[object Object],[object Object],[object Object],[object Object]
www.ersnet.org/copd Eur Respir J  2004; 23: 932 – 946 ERS-ATS COPD Guidelines Website Address

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Ers Ats Copd Guidelines

  • 1. ERS-ATS COPD Guidelines Copyright © European Respiratory Society 2005 These slides can be used freely for non-commercial purposes.
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  • 21. Pharmacological therapy (3) Bronchodilators LA-BD: long-acting bronchodilator; ICS: inhaled corticosteroid. Assess effectiveness by treatment response criteria. If forced expiratory volume <50% predicted and exacerbations of COPD requiring a course of oral corticosteroid or antibiotic occurred at least once within the last year, consider adding regular ICS. Always ensure the patient can use an inhaled device effectively and understands its purpose. If an ICS and a long-acting β-agonist are used, prescribe a combination inhaler.
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  • 24. Pharmacological Therapy (6) Effects on commonly used medications on important clinical outcomes in COPD
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  • 37. Surgery for COPD (2) Bullectomy CXR: chest radiography; CT: computed tomography; FVC: forced vital capacity; FEV 1 : forced expiratory volume in one second; D L,CO: carbon monoxide diffusing capacity of the lung; Pa,O2; arterial oxygen tension; P a,CO 2 ; arterial carbon dioxide tension
  • 38. Surgery for COPD (3) Lung Volume Reduction Surgery PA: alveolar pressure; RV: residual volume; TLC: total lung capacity; P a,O 2 : arterial oxygen tension; P a,CO 2 : arterial carbon dioxide tension; FEV 1 : forced expiratory volume in one second; D L,CO: carbon dioxide diffusing capacity of the lung. # : confirmed recommendations using NETT data or expert opinion.
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  • 62. www.ersnet.org/copd Eur Respir J 2004; 23: 932 – 946 ERS-ATS COPD Guidelines Website Address