Chronic Obstructive

Pulmonary Disease

What is COPD?
Disorder characterized by expiratory
airflow limitation that is not fully
reversible
Airflow limitation is often progressive
2 entities:
Emphysema
Chronic bronchitis

Etiology/Pathophysiology
Attributable to cigarette smoking
Environmental and occupational
dusts, fumes, gases and chemicals

Prevention
Abstinence from smoking is the
most effective means for
preventing COPD

Clinical Presentation

Dyspnea on exertion
Cough
Sputum production
Wheezing
Weight loss

Diagnosis and Classification

Treatment

Asthma

What is Asthma?
Airway disease characterized by
chronic inflammation and airway
hyperresponsiveness and is
reversible
Patients have paroxysms of cough,
dyspnea, chest tightness and
wheezing
Chronic disease with episodic acute
exacerbations that are interspersed
with symptom-free periods

Risk Factors

Pathophysiology
Airway obstruction
Hyperinflation
Airflow limitation

Clinical Presentation
Recurring episodes of cough,
dyspnea, chest tightness and
wheezing are suggestive
Symptoms occur most often at night
or early morning, in the presence of
potential triggers and/or in a
seasonal pattern
Personal or family history of atopy

Pulmonary Function Tests

Demonstrate an obstructive pattern on
pulmonary function tests which is a decrease
in expiratory flow rates
Decreased FEV1
Decreased FEV1/FVC ratio

Clinical diagnosis of asthma is supported by

an obstructive pattern that improves after
bronchodilator therapy
Improvement is defined as an increase in
FEV1 of > 12% and 200ml after 2 to 4 puffs
of a short-acting bronchodilator

Diagnosis
1. A history of variable respiratory symptoms
Wheeze, shortness of breath, chest tightness, cough
People with asthma generally have more than one of
these symptoms
Symptoms occur variably over time and vary in
intensity
The symptoms often occur or are worse at night or on
waking
Symptoms are often triggered by exercise, laughter,
allergens or cold air
Symptoms often occur with or worsen with viral
infection

Diagnosis
2. Evidence of variable expiratory airflow limitation
At least once during the diagnostic process when FEV1 is low, document
that the FEV1/FVC ratio is reduced
Document that variation in lung function is greater than in healthy people
FEV1 increases by more than 12% and 200ml after inhaling a bronchodilator
Average daily diurnal PEF variability is > 10% (in children > 13%)
FEV1 increases by more than 12% and 200ml from baseline after 4 weeks of antiinflammatory treatment (outside respiratory infections)

The greater the variation the more times excess variation is seen, the more
confident can you be of the diagnosis
Testing may needed to be repeated during symptoms, in the early morning,
or after witholding bronchodilator medications
Bronchodilator reversibility may be absent during severe exacerbations or
viral infections. If bronchodilator reversibility is not present when it is first
tested, the next step depends on the clinical urgency and availability of the
other tests
For other tests to assist in diagnosis, including bronchial challenge tests

Diagnosing Asthma in Special

Populations
Cough as the only respiratory
symptoms
Occupational asthma and workaggravated asthma
Pregnant women
The elderly
Smokers and ex-smokers

Control-Based Asthma Management

Initial Controller Treatment

Before initiating controller treatment
Record evidence for the diagnosis of
asthma, if possible
Document symptom control and risk
factors
Assess lung function, when possible
Train the patient to use the inhaler
correctly, and check their technique
Schedule follow-up accordingly

Initial Controller Treatment

Regular low-dose ICS is recommended for
patients with any of the following:
Asthma symptoms more than twice a month
Waking due to asthma more than once a month
Any asthma symptoms plus any risk factors for
exacerbations

Consider starting at a higher step if the patient

has troublesome asthma symptoms on most
days; or is waking from asthma once or more a
week, especially if there are any risk factors for
exacerbations

Initial Controller Treatment

If the initial asthma presentation is
with severely uncontrolled asthma,
or with an acute exacerbation, give a
short course of oral OCS and start
regular controller treatment
After starting initial controller
treatment
Review response after 2-3 months, or
according to clinical urgency
Consider step down when asthma has

Reviewing response and adjusting

treatment
How often should patients with
asthma be reviewed?
Stepping up treatment
Stepping down treatment

THANK YOU