This document discusses chronic obstructive pulmonary disease (COPD). It defines COPD as a preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation. The main causes of COPD are tobacco smoking, exposure to indoor and outdoor air pollution, and occupational dusts and chemicals. Spirometry is used to diagnose COPD by demonstrating airflow limitation. The assessment of COPD involves evaluating symptoms, degree of airflow limitation, risk of exacerbations, and comorbidities. Treatment involves smoking cessation, pulmonary rehabilitation, pharmacotherapy including bronchodilators and corticosteroids, oxygen therapy, and vaccination.

1. JORGE GUERRERO
Residente 1er año
MedicinaFalimiaryComunitaria
FarmacologíaClínica

2. Focus on both the short-term and
longterm impact of COPD on our patients.

3. EPIDEMIOLOGY
14.78% (2005-2008)
ClinGastroenterolHepatol. 2011 Jun;9(6):524-530.e1; quiz e60. doi: 10.1016/j.cgh.2011.03.020. Epub 2011 Mar 25

4. DEFINITION CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
 Preventable
PERSISTENT
 Treatable
Chronic
Response not Reversible

5. DEFINITION CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
 This definition does not use the terms
chronicbronchitis and emphysema and excludes
asthma (reversible airflow limitation).
Chronic bronchitis, defined as the presence
of cough and sputum production for at least
3 months in each of 2 consecutive years, is
not necessarily associated with airflow
limitation.
Emphysema, defined as destruction
of the alveoli.

6. SYNTOMS OF COPD

7. CARDINAL SYNTOMS

8. WHAT CAUSE COPD ?
 TABACCO SMOKERS

9. WHAT CAUSE COPD ?
 INDOOR AIR POLLUTION
Biomass fuel used for cooking and heating in poorly vented
dwellings, a risk factor that particularly affects

10. WHAT CAUSE COPD ?
 OCCUPATIONAL DUST AND CHEMICALS

11. WHAT CAUSE COPD ?
 OUTDOOR AIR POLLUTION
Total burden of inhaled particles

12. DIAGNOSIS OF COPD

14. DIAGNOSIS OF COPD
+ SPIROMETRY (Air flow limitation)
Simple test to measure the amount of air a person
can breathe out, and the amount of time taken to
do so.
 FVC (Forced Vital Capacity): maximum volume of air that
can be exhaled during a forced maneuver.
 FEV1 (Forced Expired Volume in one second): volume
expired in the first second of maximal expiration after a maximal
inspiration. This is a measure of how quickly the lungs can be
emptied.
 FEV1/FVC: FEV1 expressed as a proportion of the FVC, gives a
clinically useful index of airflow limitation.

15. WHY DO SPIROMETRY FOR COPD?
 Spirometry is needed to make a clinical
diagnosis of COPD.
 A normal value for spirometry effectively
excludes the diagnosis of clinically relevant
COPD.
 Together with the presence of symptoms,
spirometry helps gauge COPD severity and
can be a guide to specific treatment steps.

17. ASSESMENT OF COPD
• Symptoms (impact on patient’s health status)
• Degree of airflow limitation
(using spirometry)
• Risk of exacerbations
• Comorbidities

18. ASSESS SYMTOMS
CAT COPD Assessment Test
Modified British Medical Research
mMRC Council breathlessness scale
measures of health status91 and predicts future mortality risk
CCQ Clinical COPD Questionnaire
measure clinical control self administered

20. ASSESMENT OF COPD
• Symptoms (impact on patient’s health status)
• Degree of airflow limitation
• Risk of exacerbations
• Comorbidities

21. DEGREE OF AIR FLOW LIMITATION

22. ASSESMENT OF COPD
• Symptoms (impact on patient’s health status)
• Degree of airflow limitation
• Risk of exacerbations
• Comorbidities

23. ASSESSMENT OF RISK OF
EXACERBATIONS
 CONCEPT.
 Acute event.
 Worsening of the patient’s respiratory symptoms.
 leads to a change in medication.
The best predictor of having frequent
exacerbations
=
Previous Exacerbations

24. ASSESMENT OF COPD
• Symptoms (impact on patient’s health status)
• Degree of airflow limitation
• Risk of exacerbations
• Comorbidities

25. ASSESSMENT OF COMORBIDITIES

26. ASSESMENT OF COPD
• Symptoms (impact on patient’s health status)
• Degree of airflow limitation
• Risk of exacerbations
• Comorbidities

27. COMBINED COPD ASSESMENT
• Symptoms (impact on patient’s health status)
• Degree of airflow limitation
• Risk of exacerbations
• Comorbidities

28. COMBINED COPD ASSESMENT
When assessing risk, choose the highest risk according to GOLD
grade or exacerbation history. (One or more hospitalizations for
COPD exacerbations should be considered high risk.

29.  Patient Group A – Low Risk, Less Symptoms
Typically GOLD 1 or GOLD 2 (Mild or Moderate
airflow limitation) and/or 0-1 exacerbation per year
and mMRC grade 0-1 or CAT score < 10
 Patient Group B – Low Risk, More Symptoms
Typically GOLD 1 or GOLD 2 (Mild or Moderate
airflow limitation) and/or 0-1 exacerbation per year
and mMRC grade ≥ 2 or CAT score ≥ 10

30.  Patient Group C – High Risk, Less Symptoms
Typically GOLD 3 or GOLD 4 (Severe or Very Severe
airflow limitation) and/or ≥ 2 exacerbations per year
and mMRC grade 0-1 or CAT score < 10
 Patient Group D – High Risk, More Symptoms
Typically GOLD 3 or GOLD 4 (Severe or Very Severe
airflow limitation) and/or ≥ 2 exacerbations per year
and mMRC grade ≥ 2 or CAT score ≥ 10

31.  Example: Imagine a patient with a CAT score of 18,
FEV1 of 55% of predicted, and a history of 3
exacerbations within the last 12 months.

32.  Example: Imagine a patient with a CAT score of 18,
FEV1 of 55% of predicted, and a history of 3
exacerbations within the last 12 months.

34. TO BE CONTINUED…

36. ABANDONO DEL TABAQUISMO
 Mayor capacidad de intervencion en la historia
natural del EPOC.
Vareniclina

38. EJERCICIO CARDIOVASCULAR

39. TRATAMIENTO
FARMACOLOGICO
Reducir los sintomas.
Reduce la frecuenciayseveridad
de lasexacerbaciones.
Controla la toleranciapara el inicio
del ejercicio.

40. TRATAMIENTO
FARMACOLOGICO
 TerapiaIndividualizada.
 Disponibilidad
del medicamento.
 Costo del medicamento
 Respuestapor parte del paciente

41. TRATAMIENTO FARMACOLOGICO
BRONCODILATADORES
 Fundamental para el CONTROL de SÍNTOMAS
 Se prefiereporvíaInhalada
 La escogencia entre: beta-2-agonists, anticolinergicos,
teofilinaoterapiacombinada…’
 Los de largaacción, producen mayor tiempo, libre de
síntomas.
 Combinacion de broncodilatadoresde
clasefarmacológicadiferentedisminuye el riesgo de
efectossecundarios.

42. TRATAMIENTO FARMACOLOGICO
CORTICOIDES INHALADOS
 Pacientes con FEV1<60%.
 Tratamiento regular: Disminuye los
síntomas.
 Relacionados con aumentoIncidencia de
Neumonía.
 NO usar en monoterapia.

43. TRATAMIENTO FARMACOLOGICO
CORTICOIDES ORALES
Nousar tratamiento a largo plazo
con corticosteroide oral.

44. TRATAMIENTO FARMACOLOGICO
METILXANTINAS (Bloqueo R Adenosina)
 Menos efectivas y toleradas que los
broncodilatadores de larga acción.
 La adición de Teofilina con Salmeterol,
aumento en el VEF1 yalivio de la disnea.
 Bajasdosis de Teofilinadisminuye los
síntomas, mas no la funciónpulmonar.

45. TRATAMIENTO FARMACOLOGICO
INHIBIDORES 4-P-DIESTERASA (AMPc)
 Reduce lasexacerbaciones en sinergismo
con los
corticoidesoralesobroncodilatadores de
largaacción.

46. TRATAMIENTO FARMACOLOGICO
AGENTES MUCOLÍTICOS
 Pacientes con esputo viscoso, se
benefician, sin embargo los beneficios son
leves.

47. TRATAMIENTO FARMACOLOGICO
AGENTES ANTITUSIVOS

48.  Example: Imagine a patient with a CAT score of 18,
FEV1 of 55% of predicted, and a history of 3
exacerbations within the last 12 months.

49. TRATAMIENTO FARMACOLOGICO

50. TRATAMIENTO FARMACOLOGICO

51. OTROS TRATAMIENTOS
 USO DE VACUNAS

52. OTROS TRATAMIENTOS
PaO2menor (55 mmHg) or SaO288%,
con o sin hipercapniaconfirmada dos
veces en un periodo de 3 semanas.
PaO2entre (55 mmHg)y (60 mmHg), o
SaO2of 88%, con evidencia de HTP,
edema perifericosugestivo de ICC,
opolicitemia(hematocrito> 55%).

54. Oxigeno Terapia (88 – 92%)
B2 agonista de Acción corta
Corticoide Oral (30-40mg
c/dia por 10 - 14 dias)
Inicio de Antibioticos?
Dx diferenciales y
necesidad de Hx?