1. lobal Initiative for Chronic bstructive ung isease G O L D

2. Description of Levels of Evidence Evidence Category Sources of Evidence A Randomized controlled trials (RCTs). Rich body of data B Randomized controlled trials (RCTs). Limited body of data C Nonrandomized trials Observational studies. D Panel consensus judgment

3. United States United Kingdom Argentina Australia Brazil Austria Canada Chile Belgium China Denmark Columbia Croatia Egypt Germany Greece Ireland Italy Syria Hong Kong ROC Japan Iceland India Korea Kyrgyzstan Uruguay Moldova Nepal Macedonia Malta Netherlands New Zealand Poland Norway Portugal Georgia Romania Russia Singapore Slovakia Slovenia Saudi Arabia South Africa Spain Sweden Thailand Switzerland Ukraine United Arab Emirates Taiwan ROC Venezuela Vietnam Peru Yugoslavia Albania Bangladesh France Mexico Turkey Czech Republic Pakistan Israel GOLD National Leaders Philippines

7. Classification of COPD Severity by Spirometry Stage I: Mild FEV 1 /FVC < 0.70 FEV 1 > 80% predicted Stage II: Moderate FEV 1 /FVC < 0.70 50% < FEV 1 < 80% predicted Stage III: Severe FEV 1 /FVC < 0.70 30% < FEV 1 < 50% predicted Stage IV: Very Severe FEV 1 /FVC < 0.70 FEV 1 < 30% predicted or FEV 1 < 50% predicted plus chronic respiratory failure

13. Percent Change in Age-Adjusted Death Rates, U.S., 1965-1998 0 0.5 1.0 1.5 2.0 2.5 3.0 Proportion of 1965 Rate 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 – 59% – 64% – 35% +163% – 7% Coronary Heart Disease Stroke Other CVD COPD All Other Causes Source : NHLBI/NIH/DHHS

14. COPD Mortality by Gender, U.S., 1980-2000 Number Deaths x 1000 Source: US Centers for Disease Control and Prevention, 2002

17. Risk Factors for COPD Nutrition Infections Socio-economic status Aging Populations

20. LUNG INFLAMMATION COPD PATHOLOGY Oxidative stress Proteinases Repair mechanisms Anti-proteinases Anti-oxidants Host factors Amplifying mechanisms Cigarette smoke Biomass particles Particulates Source : Peter J. Barnes, MD Pathogenesis of COPD

21. Alveolar wall destruction Loss of elasticity Destruction of pulmonary capillary bed ↑ Inflammatory cells macrophages, CD8 + lymphocytes Source : Peter J. Barnes, MD Changes in Lung Parenchyma in COPD

22. Chronic hypoxia Pulmonary vasoconstriction Muscularization Intimal hyperplasia Fibrosis Obliteration Pulmonary hypertension Cor pulmonale Death Edema Pulmonary Hypertension in COPD Source : Peter J. Barnes, MD

23. Mast cell CD4+ cell (Th2) Eosinophil Allergens Ep cells ASTHMA Bronchoconstriction AHR Reversible Irreversible Airflow Limitation Source : Peter J. Barnes, MD Y Y Y Alv macrophage Ep cells CD8+ cell (Tc1) Neutrophil Cigarette smoke Small airway narrowing Alveolar destruction COPD

29. SYMPTOMS cough sputum shortness of breath EXPOSURE TO RISK FACTORS tobacco occupation indoor/outdoor pollution SPIROMETRY Diagnosis of COPD   

31. Spirometry: Normal and Patients with COPD

58. WORLD COPD DAY November 14, 2007 Raising COPD Awareness Worldwide

59. THANK YOU