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
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)


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
O bstructive
L ung
D isease
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, underdiagnosed 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
15.3%
1 FEV
WOMEN
7.6%
1/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
Number Deaths x 1000
COPD Mortality by Gender,
U.S., 1980-2000
70
60
Men
50
40
Women
30
20
10
0
1980
1985
1990
1995
2000
COPD Mortality Worldwide
1990
Ischaemic heart disease
Cerebrovascular disease
Lower resp infection
Diarrhoeal disease
Perinatal disorders
COPD
2020
3rd
6th
Tuberculosis
Measles
Road Traffic Accidents
Lung Cancer
Stomach Cancer
HIV
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





Revised 2006

Definition, Classification
Burden of COPD
Risk factors
Pathogenesis, pathology,
pathophysiology
Management
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





Revised 2006

Definition, Classification
Burden of COPD
Risk factors
Pathogenesis, pathology,
pathophysiology
Management
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
SYMPTOMS
cough
sputum
shortness of breath
EXPOSURE TO RISK
FACTORS
tobacco
occupation
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
chronic respiratory failure
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





Revised 2006

Definition, Classification
Burden of COPD
Risk factors
Pathogenesis, pathology,
pathophysiology
Management
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
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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/FVC < 70%
• FEV1/FVC < 70%
• FEV1 > 80%
predicted
• 50% < FEV1 <
80%
predicted
• FEV1 < 30%
predicted
• FEV1/FVC < 70% or FEV < 50%
1
predicted plus
• 30% < FEV1 <
chronic
50% predicted
respiratory failure
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


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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





Revised 2006

Definition, Classification
Burden of COPD
Risk factors
Pathogenesis, pathology,
pathophysiology
Management
Practical Considerations
COPD Comorbidities

Comorbid heterogeneity

Common cause
 Heart failure
 Lung cancer
Complicating



Pneumonia
Coincidential



Diabetes mellitus
Arthritis hip/knee
Depression
PATIENT – DISEASE ANOMALY

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COPD – The Disease
Airflow obstruction
Function decline
Continuous treatment
Lifestyle
Regular follow-up
‘Management plan’
Compliance
Effects, safety treatment

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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
I
V
A
I
D
S
M
A
L
A
R
I
A
T
B
C
O
P
D
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
Yugoslavia Croatia
Turkey Australia Brazil Canada
Austria Taiwan ROC
United States
Thailand Portugal
Moldova Norway
Greece Mexico China Malta
Guatemala
South Africa
United Kingdom
Hong Kong China
Italy
New Zealand
Argentina France
United Arab Emirates
Poland
Korea
Costa Rica
Latvia
Tatarstan Republic
Nepal
Chile
Japan
Peru
Egypt Netherlands
Venezuela
Russia
Republic of Georgia
Switzerland
Macedonia
Canada Iceland
Denmark
Lithuania
Belgium
Slovakia
Romania
Singapore Spain
Ukraine
Columbia
India
Sweden
Kyrgyzstan Vietnam
Albania
World Health Organization - Global Alliance
Against Chronic Respiratory Diseases - GARD
World COPD Day
Chronic Obstructive
Pulmonary Disease
Press Conference
Kyoto, Japan
November 19, 2006