Coincides with BB presentation: use script from original Tobacco 101

presentation
If you add smoking and SHS, it equals 438,000. If you add up all the non
tobacco-related causes, it equals of the people from tobacco-related. Given
these numbers, helping people quit or reduce SHS exposure needs to be a
health priority. Half of all teens who start to smoke will die of tobacco-related
disease.
There are over 4,000 chemicals in cigarette smoke. These chemicals irritate the throat and cause cancer, lung and heart disease. Chemicals are added to:
Make tobacco burn smoothly; Make the paper burn evenly
Enhance the flavor; Boost the nicotine (ammonia); Kill the tobacco slugs
Make sure the cigarette doesnt go out in the ashtray when not puffing on it.
Other chemicals found in tobacco include:

Benzene: found in moth balls

Denatured alcohol: used to keep cigarettes burning
Toluene: now illegal to put in top coat solution for polishing your nails.
DDT: Insecticides
Arsenic: found in rat poison
Formaldehyde: dead body preserver
Tar: a pack a day smoker would accumulate 1 quart of
tar a year In their lungs. Contains most of the cancer-
Both smokers and non-smokers experience eye irritation, sore throats, headaches, nausea, and dizziness
when exposed to cigarette smoke. Exposure to secondhand smoke can also cause nonsmokers to experience
the same devastating health effects as smokers- including cardiovascular disease, lung cancer, and COPD.
Secondhand smoke contains twice as much tar and nicotine as that which is inhaled by the smoker and is
responsible for over 63,000 deaths among nonsmokers every year in the United States. One of the most
significant actions we can take to reduce the consequences from second hand smoke exposure is to set up
rules to not allow smoking in our homes or in our cars.
Discussion:
How many people here have family or friends who allow smoking in their home or their car?
How many people have family or friends who allow smoking around children?
NATIONAL HEART LUNG BLOOD INSTITUTE/ NATIONAL INSTITUTE
OF HEALTH/ DEPARTMENT OF HEALTH AND HUMAN SERVICES -
METODA CAPTURE-RECAPTURE
The theoretical model used in rehabilitation is the international classification of
impairment, disability and handicap .

Impairment is the loss of physiological or psychological function - such as a

reduced FEV1.

Disability is a restriction in activity, for example, a decreased exercise capacity.

Handicap is a limitation in the fulfilment of a normal role, such as the inability to

., Irwin DE , Fenn P , Gray A , Anderson P , Lovering A ,
MacGowan A . The excess cost of acute exacerbations of
chronic bronchitis in patients aged 45 and older in England and
Wales . Value Health 4 ( 5 ) , 2001 .
Health burden
Financial burden
In the UK, total costs to the NHS for COPD have been estimated somewhere
between 486 million ( = 719 million) (Calverley and Sondhi 1998; Britton
2003) and 848 million ( = 1255 million ) (Guest 1999; Sullivan et al 2000)
per year. Additionally, including some societal costs, most notably productivity
costs (costs arising from loss of income through inability or absence from
work), pushes total costs for COPD up to 982 million ( = 1453 million) per
Exacerbations
Exacerbations are the leading driver of cost in COPD. A serious exacerbation
will lead to hospitalization; indeed an exacerbation is the main reason why a
COPD patient would attend hospital. COPD has been found to be the cause of
approximately 90,000 hospital admissions within the UK alone and around 1
million hospital bed days per year (Lung and Asthma Information Agency
2003). The cost of exacerbations has been found to increase in line with the
severity of exacerbations; a Swedish study reports: SEK 120 ( = 13) for a mild,
SEK 354 ( = 38) for mild/moderate, SEK 2111 ( = 225) moderate and SEK
21,852 ( = 2326) for a severe exacerbation.

Claes-Goran Lofdahl, A. Ericsson, K. Svensson, E. Andreasson 2005

Imaginea stanga - evaluarea combinata a BPOC:
evaluarea care combina 1) scorul simptomelor (folosind scala mMRC sau CAT:
mMRC 2 sau CAT 10 indicand un nivel inalt al simptomelor)
2) scorul de risc, prin una din cele 2 metode: a)
clasificarea spirometrica a limitarii de flux aerian (neschimbata fata de GOLD
2010) si/sau
b) Istoricul exacerbarilor (numar exacerbari in ultimele
12 luni)
Folosind acesti 3 parametrii, pacientul va fi incadrat intr-unul din cele 4
grupuri de pacienti: A, B, C sau D
Cat COPD ASSESSMENT TOOL : TED.TALIDE TUSE EXPECTORATIE
DISPNEE TENSIUNE ACTIVITATE LIMITARE INCREDERE DORM
ENERGIE
Prima evaluare de la care trebuie pornita incadrarea pacientului intr-un grup
este evaluarea simptomelor, prin evaluare mMRC sau CAT; pacientul va fi
incadrat intr-unul din cele 4 grupuri.
Urmatoarea este evaluarea riscului, fie prin clasificarea spirometrica fie prin
evaluarea exacerbarilor din istoricul pacientului. La unii pacienti, aceste doua
metode de evaluarea a riscului pot conduce la un rezultat diferit; in aceste
cazuri, se va lua in considerare varianta care indica riscul cel mai mare,
Ceci devient vident quand on voit le spirale infernale dans la quelle se
trouve nos patients
Management of COPD
The GOLD guidelines recommend several goals for the effective management of COPD.
These goals aim to enable patients to achieve daily control of symptoms and to avoid
exacerbations, allowing them to enjoy a good quality of life and to reduce the risk of
future exacerbations.
Pharmacological treatments can control symptoms, improve exercise tolerance and
reduce exacerbations, thus leading to improvements in health status.
These goals should be reached with minimal side effects from treatment.
The best pharmacological treatment is one that achieves most of these COPD
management goals with the least side effects.
Frequently, as the disease progresses, more than one treatment approach is often
required to achieve these goals.