COPD Consensus GOLD
Global Initiative for chronic Obstructive
Lung Disease
Habib GHEDIRA, MD, Prof.
Medical Faculty of Tunis
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Percent Change in Age-Adjusted Death Rates, U.S., 19651998
Proportion of 1965 Rate
3.0
3.0
2.5
2.5
Coronary
Heart
Disease
Stroke
Other CVD
COPD
All Other
Causes
–59%
–64%
–35%
+163%
–7%
2.0
2.0
1.5
1.5
1.0
1.0
0.5
0.5
0.0 0
1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998
Source: NHLBI/NIH/DHHS
2
Definition of COPD
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.
3
Risk Factors for COPD
Genes
Exposure to particles
Tobacco smoke
Occupational dusts,
organic and
inorganic
 Indoor air pollution
from heating and
cooking with biomass
in poorly ventilated
dwellings
 Outdoor air pollution




4
 Lung growth and
development
 Oxidative stress
 Gender
 Age
 Respiratory
infections
 Socioeconomic
status
 Nutrition
 Comorbidities
COPD : Pathology
COPD
ASTHMA
Cigarette smoke
Allergens
Ep cells
Mast cell
CD4+ cell
(Th2)
Eosinophil
Bronchoconstriction
AHR
Reversible
5
Alv macrophage Ep cells
CD8+ cell
(Tc1)
Neutrophil
Small airway narrowing
Alveolar destruction
Airflow Limitation
Source: Peter J. Barnes, MD
Irreversible
Changes in Large Airways of COPD Patients
Mucus hypersecretion
Neutrophils in sputum
Squamous metaplasia of epithelium
No basement membrane thickening
Goblet cell
hyperplasia
↑ Macrophages
↑ CD8+ lymphocytes
Mucus gland hyperplasia
Little increase in
airway smooth muscle
Source: Peter J. Barnes, MD
6
Changes in Small Airways in COPD Patients
Inflammatory exudate in lumen
Disrupted alveolar attachments
Thickened wall with inflammatory cells
- macrophages, CD8+ cells, fibroblasts
Peribronchial fibrosis
Lymphoid follicle
Source: Peter J. Barnes, MD
7
Changes in the Lung Parenchyma in COPD Patients
Alveolar wall destruction
Loss of elasticity
Destruction of pulmonary
capillary bed
↑ Inflammatory cells
macrophages, CD8+ lymphocytes
8
Source: Peter J. Barnes, MD
Diagnosis of COPD
SYMPTOMS
cough
sputum
shortness of breath
EXPOSURE TO RISK
FACTORS
tobacco
occupation
indoor/outdoor pollution

SPIROMETRY
9
Spirometry: Normal and
Patients with COPD
10
Classification of COPD Severity
by Spirometry
11
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
Therapy at Each Stage of COPD
I: Mild
II: Moderate
III: Severe
IV: Very Severe
Add long term
oxygen if chronic
respiratory failure.
Consider surgery
Add inhaled glucocorticosteroids
if repeated exacerbations
Add regular treatment with one or more long-acting
bronchodilators* (when needed);
Add rehabilitation
Active reduction of risk factor(s); influenza vaccination
Add short-acting bronchodilator (when needed)
* ß212
agonists, anticholinergics and methylxanthines
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