World COPD Day

Chronic Obstructive
Pulmonary Disease

Press Conference
Kyoto, Japan
November 19, 2006
 World COPD Day Press
Conference

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

 Definition of COPD

 Chronic Obstructive Pulmonary

Disease is a preventable and Healthy
Alveolus
treatable disease with some
significant extrapulmonary
effects.
 The pulmonary component is
characterized by airflow limitation COPD
that is not fully reversible.
 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
Risk Factors for COPD

Nutrition

Infections

Socio-economic
status

Aging Populations
 Dr. A. Sonia Buist
Introduction of
GOLD
Chair, GOLD Executive Committee
Portland, Oregon USA
G lobal Initiative for Chronic
bstructive
O ung
L isease
D
November 19, 2006
World COPD Day, Kyoto Japan
 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
 COPD is Under-appreciated and
Under-diagnosed

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

10.00% 8.5%**

8.00%

6.00%

4.00%

2.00%
0.3%
0.00%
Study MHW Survey

5.3 vs 0.2M COPD patients in Japan ≥40 years

*Adjusted for age, sex, cluster
**8.5-10.9% depending on criteria Fukuchi et al. Respirology 2004;9:458-65
 COPD Prevalence Survey (NICE)
in Japan

9% Had prior diagnosis

Undiagnosed
Diagnosed

Did not have prior diagnosis: 91%

Fukuchi et al. Respirology 2004;9:458-65
Prevalence of GOLD Stage 1+
COPD1, Guangzhou, China

MEN WOMEN
15.3% 7.6%
1
FEV1/FVC<0.70, post BD
 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
Number Deaths x 1000

70

60

50 Men

40
Women
30

20

10

0
1980 1985 1990 1995 2000
 COPD Mortality Worldwide
1990 2020
Ischaemic heart disease
Cerebrovascular disease
Lower resp infection 3rd
Diarrhoeal disease
Perinatal disorders
COPD 6th
Tuberculosis
Measles Stomach Cancer
Road Traffic Accidents HIV
Lung Cancer Suicide

Source: Murray & Lopez. Lancet 1997

 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
Dr. Suzanne S. Hurd
New GOLD
Guidelines
GOLD Scientific Director
Gaithersburg, Maryland, USA
 GOLD 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
 Global Strategy for Diagnosis,
Management and Prevention of COPD

 Definition, Classification
 Burden of COPD
 Risk factors
 Pathogenesis, pathology,
pathophysiology
 Management
Revised 2006
 Practical Considerations
 MAJOR CHANGES
Revised 2006

Global Strategy for

Diagnosis,
Management and
Prevention of COPD
Revised 2006
 Dr. Klaus Rabe
New GOLD
Guidelines
Chair, GOLD Science Committee
Leiden, The Netherlands
 Global Strategy for Diagnosis,
Management and Prevention of COPD

 Definition, Classification
 Burden of COPD
 Risk factors
 Pathogenesis, pathology,
pathophysiology
 Management
Revised 2006
 Practical Considerations
 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.
 The airflow limitation is usually progressive
and associated with an abnormal inflammatory
response of the lung to noxious particles or gases.
 Diagnosis of COPD
EXPOSURE TO RISK
SYMPTOMS FACTORS
cough tobacco
sputum occupation
shortness of breath
indoor/outdoor pollution


SPIROMETRY
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
 COPD and Co-Morbidities

 COPD has significant extrapulmonary

(systemic) effects
 Weight loss, nutritional abnormalities
 Skeletal muscle dysfunction
 COPD and Co-Morbidities
 COPD patients are at increased risk:
• Myocardial infarction, angina
• Osteoporosis
• Respiratory infection
• Depression
• Diabetes
• COPD and lung cancer
 Dr. Peter Calverley
New GOLD Guidelines
GOLD Executive/Science Committee
Liverpool, England
 Global Strategy for Diagnosis,
Management and Prevention of COPD

 Definition, Classification
 Burden of COPD
 Risk factors
 Pathogenesis, pathology,
pathophysiology
 Management
Revised 2006
 Practical Considerations
 Four Components of Care

 Assess and Monitor Disease

 Reduce Risk Factors
 Manage Stable COPD
 Manage Exacerbations
 GOALS of COPD MANAGEMENT
VARYING EMPHASIS WITH DIFFERING SEVERITY

• Relieve symptoms
• Prevent disease progression
• Improve exercise tolerance
• Improve health status
• Prevent and treat complications
• Prevent and treat exacerbations
• Reduce mortality
 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
 Therapy at Each Stage of COPD
I: Mild II: Moderate III: Severe IV: Very Severe

FEV1/FVC < 70%

• FEV1 < 30%

predicted
• FEV1/FVC < 70% • FEV1/FVC < 70%
or FEV1 < 50%
• FEV1/FVC < 70% predicted plus
• 50% < FEV1 < • 30% < FEV1 <
chronic respiratory
80% 50% predicted
• FEV1 > 80% failure
predicted
predicted
Active reduction of risk factor(s); influenza vaccination
Add short-acting bronchodilator (when needed)
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
 OTHER TREATMENT OPTIONS

 Less support for mucolytic and

antioxidant therapy
 Pneumococcal vaccination
 Rehabilitation remains a key intervention
 Oxygen therapy reviewed
 Surgery and COPD guidance
 COPD 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
 Dr. Chris van Weel
Comments from
WONCA
GOLD Executive Committee
President, World Organization of Family
Physicians
Nijmegen, The Netherlands
 Global Strategy for Diagnosis,
Management and Prevention of COPD

 Definition, Classification
 Burden of COPD
 Risk factors
 Pathogenesis, pathology,
pathophysiology
 Management
Revised 2006
 Practical Considerations
 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 CARE
H
M
I
A C
V
L
A
T O
A B
I
R P
I D
D
A
S

INTEGRATED PRIMARY CARE

Practical 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
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
 Saudi Arabia Bangladesh
Slovenia Germany Ireland
Turkey Australia Brazil Canada Yugoslavia Croatia
Austria Taiwan ROC
United States
Thailand Portugal
Moldova Norway Greece Mexico China Malta
Guatemala
South Africa
United Kingdom
Hong Kong China
Italy New Zealand
Tatarstan Republic
Argentina France
Nepal Chile
United Arab Emirates
Japan
Peru
Poland Korea
Latvia Egypt Netherlands
Costa Rica
Venezuela
Switzerland Russia Republic of Georgia
Canada Iceland
Macedonia
Lithuania Denmark
Slovakia Belgium
Romania
Columbia Ukraine Singapore Spain
India
Sweden Albania Kyrgyzstan Vietnam
 World Health Organization - Global Alliance
Against Chronic Respiratory Diseases - GARD
World COPD Day
Chronic Obstructive
Pulmonary Disease

Press Conference
Kyoto, Japan
November 19, 2006