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COPD Chronic Obstructive Pulmonary Disease

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Show Notes

Slide 1 :

COPDChronic Obstructive Pulmonary Disease Paul J. Licata, D.O. Gold Coast Pulmonary & Sleep Associates, LLC 492 Montauk Avenue 101 Airport Road New London, CT 06320 Westerly, RI 02891 (P) 1-860-443-0305 (F) 1-860-444-0823 www.goldcostpsa.com

Slide 2 :

OBJECTIVES Gain a better understanding of COPD and its pathophysiology To learn the interaction of the Pulmonary System with other systems as well as other systemic diseases. Learn about COPD and the role Asthma, Bronchitis and Emphysema play in this chronic disease. Learn about current diagnostic procedures and treatments for lung diseases.

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PULMONOLOGY A pulmonologist is a medical specialist who diagnoses and treats lung diseases. Dedicated to helping you breath better by day and night for a better tomorrow. Pulmonologists may also specialize in critical care and sleep specialties.

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LUNG DISEASE DEFINED Lung disease is any disease or disorder that impairs the function of the lungs. Lung disease may result from other insults in the environment or other organ systems (GERD airways)

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OBSTRUCTIVE LUNG DISEASE Obstructive lung disease causes a narrowing or blockage of the airways resulting in a decrease in exhaled air flow. COPD, Emphysema, Asthma, and Bronchiectasis are examples of obstructive lung diseases. Tobacco induced COPD results in Hyper- dynamic collapse of the airways due to damage of the lung tissue Both of these physiologic changes cause SOB/DOE by air trapping of the Pulmonary System

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RESTRICTIVE LUNG DISEASE Restrictive lung diseases cause one or more of the following: Loss of lung tissue Decrease in the lung's ability to expand Decrease in the lung's ability to transfer oxygen or carbon dioxide with the blood. Pulmonary Fibrosis (including Sarcoidosis), Lung Cancer, and Pneumonia are examples of restrictive lung diseases. There are other restrictive lung diseases which do not cause gas impairment despite Restrictive Physiology on PFT’s (Obesity and /or Kyphoscoliosis).

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COMMON LUNG DISEASES Acute bronchitis Allergies Alpha–1 antitrypsin deficiency (also called AAT Deficiency or Alpha-1) Asbestosis/dust diseases Asthma Avian flu Bronchiectasis Bronchitis Chronic cough Chronic obstructive pulmonary disease (COPD) Common cold Croup (Viral/RSV) Cystic fibrosis Emphysema Farmer’s lung Vocal Cord Dysfunction (VSD) Flu (influenza) Hay fever (rhinitis) Histoplasmosis / Aspergilis Interstitial lung disease Lung cancer Occupational lung diseases Pneumonia Pneumothorax Pulmonary embolus Pulmonary fibrosis Pulmonary hypertension Respiratory distress syndrome Sarcoidosis Severe acute respiratory syndrome (SARS) Obstructive sleep apnea (OSA) Sudden infant death syndrome (SIDS) Tuberculosis

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COMMON CLINICALLUNG DISEASES Asthma – Airway Disease COPD from tobacco - RBILD Infectious: Viral / Bacterial Chronic PE vs. Alternative Cardiac Etiology Allergies / Pollutants - Asbestos GERD Insult – PND Insult ILD vs. Systemic Diseases – “Ground Glass” Drug Toxicity to the Lung – ACE Cough/Amiodarone Cancer – Primary Lung vs. Mets. Disease Genetics (Alpha-1 Def. / Cystic Fibrosis) Fungus – Histoplasmosis vs. Aspergilis (ABPA)

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SYMPTOMS OF LUNG DISEASE 1) Cough 2) Dyspnea 3) Wheezing 4) Chest Pain 5) Hemoptysis 6) Cyanosis 7) GERD 8) Edema

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WHAT IS COPD? Chronic obstructive pulmonary disease (COPD) is a term referring to multiple lung diseases, chronic bronchitis, and emphysema, that are characterized by obstruction to airflow that interferes with normal breathing. Both of these conditions frequently co-exist, hence physicians prefer the term COPD. There is also some overlap between these diseases and Asthma.

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COPD IS THE 4th LEADING CAUSE OF DEATH IN U.S.A.

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Percent Change in Age-Adjusted Death Rates, U.S., 1965-1998 0 0.5 1.0 1.5 2.0 2.5 3.0 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 –59% –64% –35% +163% –7% Coronary Heart Disease Stroke Other CVD COPD All Other Causes Proportion of 1965 Rate

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COPD RELATED DEATHS HAVE THE HIGHEST INCREASE OF ANY OF THE TOP 10 DISEASES Source: Jemal A. et al. JAMA 2005

Slide 14 :

COPD FACTS COPD is the 4th leading cause of death in the United States, claiming the lives of 120,000 Americans in 2002 (106,000 in 1996). COPD is under diagnosed. 10 million adults reported physician-diagnosed COPD. 24 million adults have evidence of impaired lung function. 8 million physician and outpatient visits. 1.5 million hospital emergency visits. 726,000 hospitalizations. In 2004, the cost to the nation for COPD was approximately $37.2 billion. COPD is the #1 cause of disability in the U.S.

Slide 15 :

WHAT IS EMPHYSEMA? Emphysema begins with the destruction of air sacs (alveoli) in the lungs where oxygen from the air is exchanged for CO2 in the blood. The walls of the air sacs are thin and fragile. Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lower lungs. As air sacs are destroyed, the lungs are able to transfer less and less oxygen to the bloodstream, causing shortness of breath. The lungs also lose their elasticity, which is important to keep airways open. http://adam.about.com/encyclopedia/17055.htm

Slide 16 :

EMPHYSEMA FACTS Emphysema doesn't develop suddenly. It comes on very gradually. Years of exposure to the irritation of cigarette smoke usually precede the development of emphysema. Of the estimated 3.1 million Americans ever diagnosed with emphysema, 95 percent were 45 or older. Smoking is the primary risk factor for COPD. Approximately 80 to 90 percent of COPD deaths are caused by smoking. 54.8 percent are male and 45.2 percent are female. However, within in the past year, the prevalence rate for women has seen a 5 percent increase whereas men have seen a decrease of 10 percent. Symptoms of emphysema include: cough, shortness of breath and a limited exercise tolerance.

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WHAT IS BRONCHITIS? Chronic bronchitis is the inflammation and eventual scarring of the lining of the bronchial tubes. When the bronchi are inflamed and/or infected, less air is able to flow to and from the lungs and a heavy mucus or phlegm is coughed up.

Slide 18 :

BRONCHITIS FACTS In 2003, an estimated 8.6 million Americans were diagnosed with chronic bronchitis by a health professional. Chronic bronchitis affects people of all ages, but is higher in those over 45 years old. Females are more than twice as likely to be diagnosed with chronic bronchitis as males. In 2003, 2.7 million males had a diagnosis of chronic bronchitis compared to 5.8 million females. Symptoms of chronic bronchitis include chronic cough, increased mucus, frequent clearing of the throat and shortness of breath.

Slide 19 :

WHAT IS ASTHMA? Asthma (is an airway disease) is a breathing problem that makes it more difficult for you to get air in and out of your lungs. When you breathe in (inhale), fresh air comes in through your nose. It passes down through tubes (called bronchi) to your lungs. When you breathe out (exhale), stale air from your lungs is breathed out through the same tubes. When a person has asthma, the breathing tubes are inflamed. They may react to smoke, pollen, dust, air pollution, allergies, or other triggers. In a person with asthma, the breathing tubes may tighten, becoming inflamed and swollen. When the breathing tubes react or when they get inflamed, they become narrow. That makes it harder for you to breathe fresh air in and stale air out due to flow limitations.

Slide 20 :

ASTHMA FACTS Chronic condition occurring among both children and adults 74% increase in self-reported asthma from 1980 to 1996 85% increase in physician visits from 1980 to 1999 18 days of school or work lost due to asthma per person with asthma 75 emergency department visits and 18 hospitalizations for asthma per 10,000 population Symptoms include: wheeze, cough, mucus, shortness of breath and chest tightness.

Slide 21 :

COPD OVERLAPEmphysema, Bronchitis, Asthma In some adults, bronchitis and emphysema may seem like asthma. Or asthma may seem like bronchitis and emphysema. Heart disease may also cause breathing problems. And a person can have heart and lung disease at the same time. Emphysema Asthma Bronchitis ? ? ? ? ? ? Overlap

Slide 22 :

TRIAD OF GERD-AIRWAYS-SLEEP GERD OSA (Sleep Apnea) Asthma ? ? ? ? ? ? Overlap GERD (Gastroesophageal Reflux Disease) can be caused by paradoxical breathing from sleep apnea. This leads to day time symptoms resulting from acid in the airways that look similar to asthma. The underlying problem is a nocturnal breathing and sleep problem (Sleep Apnea) rather than Asthma.

Slide 23 :

Pulmonary Function Testing A test that measures how much air is in the lungs and how forcefully this air can be exhaled (lung function and physiology) FEV1 is and the FEV1/FVC ration are important predictors of the severity of COPD. Don’t overlook small airway disease on PFT’s/Loops which is the beginning sign of early tobacco insult-airway disease (Asthma) - (FEF75%)

Slide 24 :

Pulmonary Function Testing

Slide 25 :

Different Loop Presentations

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Different Loops on PFT

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Slide 28 :

Pulmonary Function Testing

Slide 29 :

DDx In Airway Disease Physiology in a negative w/u Bronchiectasis Reflux Induced Airway Disease Allergies Environment Small Airway Disease

Slide 30 :

CASE STUDY A 32-year-old mechanic presents with wheezing and dyspnea on exertion. He is an active smoker. His PFT findings are as follows:

Slide 31 :

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Slide 33 :

CASE STUDY

Slide 34 :

III: Severe II: Moderate I: Mild Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation Add inhaled glucocorticosteroids if repeated exacerbations Add long term oxygen if chronic respiratory failure. Consider surgical treatments IV: Very Severe Staging and Therapy for COPD

Slide 35 :

Slide 36 :

Treatment of COPD Oxygen is the only drug ever proven to extend and helps the quality of life for COPD patients. It’s very easy to qualify someone for oxygen therapy.

Slide 37 :

Exercise Oximetry 6 Minutes with a Pulse Oximeter Cost Effective Good Diagnostic Tool Criteria for Oxygen Qualification: 88% at rest 88% achieved during ambulation/exercise Must document improvement with oxygen therapy via a pulse oximeter with print out.

Slide 38 :

COPD Treatment/Management PFT results COPD Asthma (Smoker) “True” Asthma (Non-Smoker) - ? Methacholine Challenge Treat Inflammation Symptom Relief Stop Tobacco! Slow Disease Progression Improve Exercise Tolerance Prevent and Treat Exacerbations Stop Tobacco! Inhaled Corticosteroid (ICS) Long Acting Beta Agonist (LABA) Remove Environmental Insults Re-assess Pulmonary Rehabilitation Albuterol: short vs. long acting Oxygen Therapy Inhaled Corticosteroid Long Term Prednisone

Slide 39 :

Alpha-1 Antitrypsin Disease A congenital form of Emphysema. This disorder was is more prevalent in Scandinavian heritage at 1 in 1,500 to 3,000 individuals, but it is less common in Asian and black populations. In North America, alpha-1 antitrypsin deficiency affects 1 in 5,000 to 7,000 people. Testing is usually free and requires a quick blood-stick and can be done in office.

Slide 40 :

Summary of Diagnostic Procedures Pulmonary Function Tests Chest X-Rays CAT Scans Bronchoscopy / Biopsy Exercise Oximetry Ex-Ox Nocturnal Oximetry Noc-Ox Genetic Testing (disease specific) Mild COPD Severe COPD

Slide 41 :

Summary of COPD treatment options Inhalers (dry powder inhalers or metered-dose inhalers) or nebulizers containing bronchodilators or corticosteroids. Expectorants Antibiotics Oxygen Therapy Lung Transplantation Lung Reduction Surgery Natural treatments, such as N-Acetyl Cysteine and Carnitine Complementary / Integrative therapies and treatments Chest physiotherapy

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