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World COPD Day
Chronic Obstructive Pulmonary Disease
Press Conference Kyoto, Japan
November 19, 2006
Opening Remarks Yoshinosuke Fukuchi, MD, PhD
Introduction of GOLD Sonia Buist, MD
New GOLD Guidelines Suzanne Hurd, PhD Klaus F. Rabe, MD, PhD
Additional Comments Peter Calverley, MD
Comments from WONCA Chris van Weel, MD
Closing Remarks Claude Lenfant, MD
World COPD Day Press Conference
Definition of COPDDefinition of COPD
Chronic Obstructive Pulmonary Disease is a preventable and treatable disease with some significant extrapulmonary effects.
The pulmonary component is characterized by airflow limitation that is not fully reversible.
Chronic Obstructive Pulmonary Disease is a preventable and treatable disease with some significant extrapulmonary effects.
The pulmonary component is characterized by airflow limitation that is not fully reversible.
Healthy Alveolus
COPD
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
The airflow limitation in COPD is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles and gases
Severe COPD leads to respiratory failure, hospitalization and eventually death from suffocation
The airflow limitation in COPD is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles and gases
Severe COPD leads to respiratory failure, hospitalization and eventually death from suffocation
Risk Factors for COPD
NutritionNutrition
InfectionsInfections
Socio-economic Socio-economic statusstatus
Aging PopulationsAging Populations
Dr. A. Sonia Buist Introduction of
GOLD
Dr. A. Sonia Buist Introduction of
GOLDChair, GOLD Executive Committee
Portland, Oregon USA
Chair, GOLD Executive Committee
Portland, Oregon USA
lobal Initiative for Chronic
bstructive
ung
isease
lobal Initiative for Chronic
bstructive
ung
isease
G
OLD
G
OLD
November 19, 2006World COPD Day, Kyoto Japan
Why was GOLD Started?
Why was GOLD Started?
The social and economic burden of COPD is increasing rapidly in countries at all levels of economic development
COPD is under-appreciated, under-diagnosed and under-treated
Important questions about COPD are still unanswered
The social and economic burden of COPD is increasing rapidly in countries at all levels of economic development
COPD is under-appreciated, under-diagnosed and under-treated
Important questions about COPD are still unanswered
COPD is Under-appreciated and Under-diagnosedCOPD is Under-appreciated and Under-diagnosed
Example from Japan:
NICE Survey of COPD prevalence
Carried out in several regions of Japan using standardized methods
Example from Japan:
NICE Survey of COPD prevalence
Carried out in several regions of Japan using standardized methods
COPD Prevalence Rate (adjusted)* in Population 40 years
COPD Prevalence Rate (adjusted)* in Population 40 years
*Adjusted for age, sex, cluster**8.5-10.9% depending on criteria
Study
Fukuchi et al. Respirology 2004;9:458-65
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
0.3%0.3%
8.5%**8.5%**
5.3 vs 0.2M COPD patients in Japan ≥40 years5.3 vs 0.2M COPD patients in Japan ≥40 years
MHW Survey
COPD Prevalence Survey (NICE) in Japan
COPD Prevalence Survey (NICE) in Japan
91%
9%
UndiagnosedDiagnosed
Had prior diagnosis
Did not have prior diagnosis:Fukuchi et al. Respirology 2004;9:458-65
Prevalence of GOLD Stage 1+ COPD1, Guangzhou, ChinaPrevalence of GOLD Stage 1+ COPD1, Guangzhou, China
1 FEV1/FVC<0.70, post BD
MEN15.3%
WOMEN7.6%
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
COPD Mortality by Gender,U.S., 1980-2000
COPD Mortality by Gender,U.S., 1980-2000
0
10
20
30
40
50
60
70
1980 1985 1990 1995 2000
Men
Women
0
10
20
30
40
50
60
70
1980 1985 1990 1995 2000
Men
Women
Num
ber
Death
s x
100
0N
um
ber
Death
s x
100
0
19901990 20202020Ischaemic heart diseaseCerebrovascular diseaseLower resp infectionDiarrhoeal diseasePerinatal disordersCOPDTuberculosisMeaslesRoad Traffic AccidentsLung Cancer
Stomach CancerStomach CancerHIVHIVSuicideSuicide
6th6th
3rd3rd
COPD Mortality WorldwideCOPD Mortality Worldwide
Source: Murray & Lopez. Lancet 1997
Why is COPD Increasing Worldwide?
Why is COPD Increasing Worldwide?
Increase in exposure to risk factors (especially tobacco) in developing countries & in women
Changing demographics globally with more of the population, especially in the developing countries living into the COPD age range
Increase in exposure to risk factors (especially tobacco) in developing countries & in women
Changing demographics globally with more of the population, especially in the developing countries living into the COPD age range
Dr. Suzanne S. Hurd New GOLD Guidelines
Dr. Suzanne S. Hurd New GOLD Guidelines
GOLD Scientific Director
Gaithersburg, Maryland, USA
GOLD Scientific Director
Gaithersburg, Maryland, USA
GOLD ObjectivesGOLD Objectives
Increase awareness of COPD among health professionals, health authorities, and the general public
Improve diagnosis, management and prevention of COPD
Stimulate research in COPD
Increase awareness of COPD among health professionals, health authorities, and the general public
Improve diagnosis, management and prevention of COPD
Stimulate research in COPD
Global Strategy for Diagnosis, Management and Prevention of COPD
Global Strategy for Diagnosis, Management and Prevention of COPD
Definition, Classification Burden of COPD Risk factors Pathogenesis, pathology,
pathophysiology Management Practical Considerations
Definition, Classification Burden of COPD Risk factors Pathogenesis, pathology,
pathophysiology Management Practical ConsiderationsRevised 2006
MAJOR CHANGES
Global Strategy for Diagnosis,
Management and Prevention of
COPD
Revised 2006
Revised 2006
Dr. Klaus Rabe New GOLD Guidelines
Dr. Klaus Rabe New GOLD Guidelines
Chair, GOLD Science Committee
Leiden, The Netherlands
Chair, GOLD Science Committee
Leiden, The Netherlands
Global Strategy for Diagnosis, Management and Prevention of COPD
Global Strategy for Diagnosis, Management and Prevention of COPD
Definition, Classification Burden of COPD Risk factors Pathogenesis, pathology,
pathophysiology Management Practical Considerations
Definition, Classification Burden of COPD Risk factors Pathogenesis, pathology,
pathophysiology Management Practical ConsiderationsRevised 2006
Definition of COPD
Chronic Obstructive Pulmonary Disease (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.
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.
SYMPTOMScoughcough
sputumsputumshortness of breathshortness of breath
EXPOSURE TO RISKFACTORS
tobaccotobaccooccupationoccupation
indoor/outdoor pollutionindoor/outdoor pollution
SPIROMETRYSPIROMETRY
Diagnosis of COPDDiagnosis of COPD
Spirometry for COPD Diagnosis and Classification of Severity
Classification of COPD Severity by Spirometry
Stage I: Mild FEV1/FVC < 0.70 FEV1 > 80% predicted
Stage II: Moderate FEV1/FVC < 0.70 50% < FEV1 < 80% predicted
Stage III: Severe FEV1/FVC < 0.70 30% < FEV1 < 50% predicted
Stage IV: Very Severe FEV1/FVC < 0.70 FEV1 < 30% predicted or
FEV1 < 50% predicted plus chronic respiratory failure
COPD and Co-MorbiditiesCOPD and Co-Morbidities
COPD has significant extrapulmonary (systemic) effects
Weight loss, nutritional abnormalities
Skeletal muscle dysfunction
COPD has significant extrapulmonary (systemic) effects
Weight loss, nutritional abnormalities
Skeletal muscle dysfunction
COPD and Co-MorbiditiesCOPD and Co-Morbidities
COPD patients are at increased risk: • Myocardial infarction, angina
• Osteoporosis
• Respiratory infection
• Depression
• Diabetes
• COPD and lung cancer
COPD patients are at increased risk: • Myocardial infarction, angina
• Osteoporosis
• Respiratory infection
• Depression
• Diabetes
• COPD and lung cancer
Dr. Peter Calverley New GOLD Guidelines
Dr. Peter Calverley New GOLD Guidelines
GOLD Executive/Science Committee
Liverpool, England
GOLD Executive/Science Committee
Liverpool, England
Global Strategy for Diagnosis, Management and Prevention of COPD
Global Strategy for Diagnosis, Management and Prevention of COPD
Definition, Classification Burden of COPD Risk factors Pathogenesis, pathology,
pathophysiology Management Practical Considerations
Definition, Classification Burden of COPD Risk factors Pathogenesis, pathology,
pathophysiology Management Practical ConsiderationsRevised 2006
Four Components of Care
Assess and Monitor Disease
Reduce Risk Factors
Manage Stable COPD
Manage Exacerbations
• Relieve symptoms • Prevent disease progression• Improve exercise tolerance• Improve health status• Prevent and treat complications• Prevent and treat exacerbations• Reduce mortality
GOALS of COPD MANAGEMENTVARYING EMPHASIS WITH DIFFERING SEVERITY
DIAGNOSIS AND RISK FACTORS DIAGNOSIS AND RISK FACTORS
Bronchodilator testing no longer mandatory
Post-bd FEV1 still the preferred outcome Symptom assessment, e.g., MRC
dyspnoea Co-morbid pathology to be documented New therapy for smoking cessation More emphasis on indoor pollution
Bronchodilator testing no longer mandatory
Post-bd FEV1 still the preferred outcome Symptom assessment, e.g., MRC
dyspnoea Co-morbid pathology to be documented New therapy for smoking cessation More emphasis on indoor pollution
IV: Very Severe III: Severe II: Moderate I: Mild
Therapy at Each Stage of COPDTherapy at Each Stage of COPD
• FEV1/FVC < 70%
• FEV1 > 80% predicted
• FEV1/FVC < 70%
• 50% < FEV1 < 80%
predicted
• FEV1/FVC < 70%
• 30% < FEV1 < 50% predicted
FEV1/FVC < 70%
• FEV1 < 30% predicted
or FEV1 < 50% predicted plus chronic respiratory failure
Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation
Add inhaled glucocorticosteroids if repeated exacerbations
Active reduction of risk factor(s); influenza vaccinationAdd short-acting bronchodilator (when needed)
Add long term oxygen if chronic respiratory failure. Consider surgical treatments
OTHER TREATMENT OPTIONSOTHER TREATMENT OPTIONS
Less support for mucolytic and antioxidant therapy
Pneumococcal vaccination Rehabilitation remains a key intervention Oxygen therapy reviewed Surgery and COPD guidance
Less support for mucolytic and antioxidant therapy
Pneumococcal vaccination Rehabilitation remains a key intervention Oxygen therapy reviewed Surgery and COPD guidance
COPD EXACERBATIONSCOPD EXACERBATIONS
COPD exacerbations defined:
“An event in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and/or sputum that is beyond normal day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD.”
Antibiotics with specific advice NIV explained and prioritised Care at home/follow up
COPD exacerbations defined:
“An event in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and/or sputum that is beyond normal day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD.”
Antibiotics with specific advice NIV explained and prioritised Care at home/follow up
Dr. Chris van Weel Comments from
WONCA
Dr. Chris van Weel Comments from
WONCA
GOLD Executive Committee
President, World Organization of Family Physicians
Nijmegen, The Netherlands
GOLD Executive Committee
President, World Organization of Family Physicians
Nijmegen, The Netherlands
Global Strategy for Diagnosis, Management and Prevention of COPD
Global Strategy for Diagnosis, Management and Prevention of COPD
Definition, Classification Burden of COPD Risk factors Pathogenesis, pathology,
pathophysiology Management Practical Considerations
Definition, Classification Burden of COPD Risk factors Pathogenesis, pathology,
pathophysiology Management Practical ConsiderationsRevised 2006
COPD Comorbidities
Comorbid heterogeneity Common cause
Heart failure Lung cancer
Complicating Pneumonia
Coincidential Diabetes mellitus Arthritis hip/knee Depression
PATIENT – DISEASE ANOMALY
COPD – The Disease Airflow obstruction Function decline Continuous treatment Lifestyle Regular follow-up ‘Management plan’ Compliance Effects, safety treatment
Patient with COPD Social isolation Unhealthy environment Poverty Poor self-efficacy Multiple health problems Disruptive life conditions Trust & support Safety line
VERTICAL vs HORIZONTAL PROGRAMS OF CAREVERTICAL vs HORIZONTAL PROGRAMS OF CARE
HIV
AIDS
MALARIA
TB
COPD
INTEGRATED PRIMARY CAREINTEGRATED PRIMARY CARE
Practical Considerations: ConclusionsPractical Considerations: Conclusions
Link science to money
Organize special programs through primary care: Ten for 2010
Make a portion (10%) of special program money available for primary care development
Dr. Claude Lenfant Closing Comments
Dr. Claude Lenfant Closing Comments
GOLD Executive Director
Gaithersburg, Maryland, US
GOLD Executive Director
Gaithersburg, Maryland, US
COPD: An Increasing Public Health Problem Worldwide
COPD is increasing in prevalence in many countries of the world
COPD is treatable and preventable
The GOLD program offers a strategy to identify patients and to treat them according to the best medications available
COPD: An Increasing Public Health Problem Worldwide COPD can be prevented by avoidance
of risk factors, the most notable being tobacco smoke
Patients with COPD have multiple other conditions (comorbidities) that must be taken into consideration
GOLD has developed a global network to raise awareness of COPD and disseminate information on diagnosis and treatment
United StatesUnited States
United Kingdom
ArgentinaArgentina
AustraliaAustraliaBrazilBrazil Austria
Canada
CanadaCanada
Chile
Belgium
ChinaChina
DenmarkDenmark
ColumbiaColumbia
Costa Rica
CroatiaCroatia
EgyptEgypt
France
Germany
Greece
IrelandIreland
ItalyItaly
GuatemalaGuatemala
Hong Kong China
Japan
Iceland
IndiaIndia
KoreaKorea
KyrgyzstanKyrgyzstan
LatviaLatvia
LithuaniaLithuania
MexicoMexicoMoldovaMoldova
NepalNepal
Macedonia
Malta
NetherlandsNetherlands
New Zealand
PolandPoland
NorwayNorway
Portugal
Republic of GeorgiaRepublic of Georgia
RomaniaRomania
Russia
SingaporeSlovakia
Slovenia Saudi ArabiaSaudi Arabia
South AfricaSouth Africa
Tatarstan RepublicTatarstan Republic
Spain
SwedenSweden
ThailandThailand
Turkey
SwitzerlandSwitzerland
UkraineUkraine
United Arab EmiratesUnited Arab Emirates
Taiwan ROCTaiwan ROC
VenezuelaVenezuela
Vietnam
Peru
Yugoslavia
Albania
Bangladesh
World Health Organization - Global Alliance Against Chronic Respiratory
Diseases - GARD
World COPD Day
Chronic Obstructive Pulmonary Disease
Press Conference Kyoto, Japan
November 19, 2006
