Presentation by Dr David Pierson, faculty of Pulmonary Medicine Update Course, Egypt. Knowledge resources at Scribe : www.scribeofegypt.com

1. State-of-the-Art Overview of COPD and its Management David J Pierson MD Professor of Medicine University of Washington Seattle, WA, USA December, 2008

5. Consensus Standards and Practice Guidelines for COPD Management GOLD : Respir Care . 2001 Aug;46(8):798-825; Updated Eur Respir J . 2003 Jul;22(1):1-2. www.goldcopd.com American Thoracic Society - European Thoracic Society : Eur Respir J . 2004 Jun;23(6):932-46. www.thoracic.org (Other national guidelines from Australia–New Zealand, Canada, Finland, France, Germany, India, Malaysia, South Africa, Switzerland, the UK, and others) Review and comparison of current guidelines: Pierson DJ, Respir Care 2006 (Mar);51(3):277-288.

8. Change in Age-Adjusted US Death Rates, 1965-1998* *www.goldcopd.com Percentage of 1965 Rate 50 100 150 200 250 Coronary Heart Disease Stroke Other CVD All Other Causes COPD -59% -64% -35% +163% -7%

9. Deaths from COPD in the US *Mannino DM, Respir Care 2003;48(12):1185-91

13. Diagnosing COPD with Spirometry* *www.goldcopd.com

14. Use of Spirometry to Diagnose COPD* *Global Initiative for Obstructive Lung Disease Guideline (2007 Revision); www.goldcopd.org

15. Should the General Public Be Screened for COPD with Spirometry?

18. GOLD Staging System for COPD* *www.goldcopd.com

21. Prognostic Value of Spirometry in COPD Survival among patients with COPD as a function of FEV 1 when first enrolled in cohort *  = FEV 1 > 1.25 L  = FEV 1 1.25-0.75 L  = FEV 1 < 0.75 L (Correspond approximately to 2003 GOLD Stages II/III/IV) *Diener CF, Burrows B. Am Rev Respir Dis 1975;111:719-24

22. Natural History of COPD

27. Using More Different Smoking Cessation Formats Increases the Success Rate *Marlow SP,Stoller JK, Respir Care 2003;48(12):1238-54

28. More Individual Smoking Cessation Sessions Increase the Success Rate *Marlow SP,Stoller JK, Respir Care 2003;48(12):1238-54

29. More Contact Time Increases the Likelihood of Success *Marlow SP,Stoller JK, Respir Care 2003;48(12):1238-54

32. Sutherland & Cherniack, NEJM 2004;350:2689-97

33. *Sutherland & Cherniack, NEJM 2004;350:2689-97 Lung Hyperinflation in COPD*

34. Effect of Long-Acting Beta 2 -Agonists on COPD Exacerbations* *Sin DD et al, JAMA 2003;290:2301-12 Meta-analysis of 9 clinical trials (4198 patients)

35. Effect of Tiotropium on COPD Exacerbations* *Sin DD et al, JAMA 2003;290:2301-12 Meta-analysis of 5 clinical trials (3574 patients)

36. Relationship Between FEV 1 and Effect of Inhaled Corticosteroids in Preventing COPD Exacerbations* Greater Effect in More Severely Obstructed Patients *Sin DD et al, JAMA 2003;290:2301-12

44. Effect of Pulmonary Rehabilitation on Health-Related Quality of Life in COPD* *Sin DD et al, JAMA 2003;290:2301-12 Meta-analysis of 6 clinical trials (491 patients) SGRQ, St George’s Respiratory Questionnaire

45. Effects of Pulmonary Rehabilitation on Functional Exercise Capacity* *Lacasse Y et al, Cochrane Database Syst Rev 2006;Oct 18(4):CD007793

46. Effects of Pulmonary Rehabilitation on Dyspnea* *Lacasse Y et al, Cochrane Database Syst Rev 2006;Oct 18(4):CD007793

47. Effects of Pulmonary Rehabilitation on St Georges Respiratory Questionnaire (Total)* *Lacasse Y et al, Cochrane Database Syst Rev 2006;Oct 18(4):CD007793

54. Apical Bullae in COPD* *Dunnill MS. Pulmonary Pathology. Edinburgh, Churchill Livingstone, 1987:115

56. GOLD Guidelines for Stepwise COPD Management

60. Cost of Managing COPD According to Current Guidelines (Pierson DJ, Respir Care 2006;51(3):277-288) Monthly Cost ($) add LTOT add ICS add LABD SABD as needed 0 100 200 300 400 500 600 700 800 Mild (GOLD I) Moderate (GOLD II) Severe (GOLD III) Very Severe (GOLD IV)

65. Language Barriers to Health Care in the US* *Data from US Census Bureau; Flores G, NEJM 2006;355(3):229-31 *

66. * Prose Literacy Levels Among US Adults in 2003. Marcus EN, NEJM 2006;355(4):339-41 Barriers to Effective Health Care: Literacy in the US*