copd英文课87页PPT
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CELLULAR MECHANISMS OF COPD
CD8+
?
lymphocyte
Cigarette smoke
Alveolar macrophage
MCP-1
Neutrophil chemotactic factors Cytokines (IL-8) Mediators (LTB4)
Neutrophil
Chronic Bronchitis
Clinical manifestation
Character: chronic onset, recurrent attack and long
course of disease Main symptoms: cough: chronic, long term, repeatedly expectoration: mucoid sputum, purulent
Alpha1-antitrypsin deficiency Others: Poor nutrition of alveoli or respiratory
bronchiole due to decreased blood supply because of oppression of high airway pressure
Definition
Emphysema is characterized by enlargement and destruction of respiratory bronchioles and /or alveoli in the lungs.
Etiology
Environment Factors Cigarette smoking Occupational dusts and chemicals Infections Host Factors Genes: Alpha1-antitrypsin deficiency
【COPD英文精品课件】 Obstructive Lung Diseases
• Centriacinar (centrilobular) • Panacinar (panlobular) • Paraseptal (distal acinar) • Irregular
I will only discuss Centriacinar and Panacinar Emphysema
Diffuse Enlargement of Acinus
Pathogenesis Emphysema
Emphysema- clinical
-The clinical manifestations of emphysema do not appear until at least one third of the functioning pulmonary parenchyma is damaged
Emphysema
Centriacinar Emphysema
-In this type of emphysema the central or proximal parts of the acini, formed by respiratory bronchioles, are affected, whereas distal alveoli are spared
-The prefix “pan” refers to the entire acinus but not to the entire lung.
-In contrast to centriacinar emphysema, panacinar emphysema tends to occur more commonly in the lower zones and in the anterior margins of the lung, and it is usually most severe at the bases.
I will only discuss Centriacinar and Panacinar Emphysema
Diffuse Enlargement of Acinus
Pathogenesis Emphysema
Emphysema- clinical
-The clinical manifestations of emphysema do not appear until at least one third of the functioning pulmonary parenchyma is damaged
Emphysema
Centriacinar Emphysema
-In this type of emphysema the central or proximal parts of the acini, formed by respiratory bronchioles, are affected, whereas distal alveoli are spared
-The prefix “pan” refers to the entire acinus but not to the entire lung.
-In contrast to centriacinar emphysema, panacinar emphysema tends to occur more commonly in the lower zones and in the anterior margins of the lung, and it is usually most severe at the bases.
《copd英文课》课件
Relationship of COPD and Chronic bronchitis, Asthma or Emphysema
Chronic Bronchitis
Chronic Bronchitis
Definition: Chronic and unspecific inflammation of bronchi and the surrounding tissue.
3.30.0 2.25.5
Coronary Heart
Disease
Stroke
2.20.0
Other CVD
COPD
All Other Causes
1.15.5
1.10.0
0.05.5
0.0 0
–59%
–64%
–35%
+163%
–7%
1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998
Sputum examination: bacterial culture guide antibiotic treatment
Diagnosis
Chronic cough and sputum production for 3 consecutive months in at least 2 successive years（≥3m/yⅹ2y）, excluding other chronic lung diseases (TB, Bronchiectasis )
The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.
【COPD英文PPT课件】Chronic obstructive pulmonary disease (COPD)_
Evidence guiding health care
Methodology:
• Fiscal year 2006/07 • Cohort = Ontarians (derived from the Registered Persons
Database [RPDB]) • EDC algorithm applied to Canadian Institute for Health
• Prevalence rates for other chronic conditions (diabetes, asthma, cancer, congestive heart failure and hypertension) not reported using the ACG System already being measured, or will be measured in the near future, using validated algorithms developed by ICES and Cancer Care Ontario.
• Exclusions: Persons less than 20 years of age (less than 35 years of age for calculation of COPD rates) Out-of-province residents Records with missing/invalid age, sex, and/or LHIN information Individuals who died or whose date of last contact with the health care system was greater than 5 years
Methodology:
• Fiscal year 2006/07 • Cohort = Ontarians (derived from the Registered Persons
Database [RPDB]) • EDC algorithm applied to Canadian Institute for Health
• Prevalence rates for other chronic conditions (diabetes, asthma, cancer, congestive heart failure and hypertension) not reported using the ACG System already being measured, or will be measured in the near future, using validated algorithms developed by ICES and Cancer Care Ontario.
• Exclusions: Persons less than 20 years of age (less than 35 years of age for calculation of COPD rates) Out-of-province residents Records with missing/invalid age, sex, and/or LHIN information Individuals who died or whose date of last contact with the health care system was greater than 5 years
【COPD英文精品课件】OBSTRUCTIVE PULMONARY DISEASE
The only two available treatment options that have been proven to achieve the aims of treatment are smoking cessation and long-term oxygen therapy in severe COPD
and expensive treatments are often needed. The indirect economic costs of COPD are also significant and include
lost years of life, disability, loss of working capacity, and reduction in
The main aim of COPD management is to achieve and maintain control of the disease. This includes improving
symptoms and quality of life and reducing COPD exacerbations; to improving lung
symptoms of chronic cough & sputum, and pulmonary emphysema with the specific symptoms of dyspnea. Asthma = acute obstructive pulmonary disease?
COPD can be defined as a chronic, irreversible, slowly progressive disorder characterized by airflow
【COPD英文PPT课件】epidemiological significance of Chronic Obstructive Pulmonary Disease (COPD)_
4 7 0 ,0 0 0 6 ,0 0 0 6.2 billion
COPD Y es
< 10% 14-30 m illion
14 m illion 5 0 0 ,0 0 0 1 0 0 ,0 0 0 24 billion
Clinical Characteristics of Emphysema vs Chronic Bronchitis
m ild rare d e c re a se d
P red o m in an t C h ro n ic B ro n ch itis
50s o b ese M ild E arly (b efo re d y sp n ea) C o p io u s- p u ru le n t F requent R ep etativ e B ro n ch o v ascu lar m ark s 4 5 -6 0 5 0 -6 0 5 0 -6 0 M o d erate-sev ere Com m on S lig h t d ecrease
» asbestos, silica dust, cotton dust, grain dust, household cleaners, toluene, mining, glass or ceramics
Genetic (1- AT) Search for other genetic variants -
A ge W eig h t D yspnea C ough S p u tu m B ro n ch ial In fectio n R esp failu re ep iso d e CXR PaO 2 PaC O 2 H em ato crit P u lm o n ary H T N C o r-P u lm o n ale D iffu sio n C ap acity
COPD Y es
< 10% 14-30 m illion
14 m illion 5 0 0 ,0 0 0 1 0 0 ,0 0 0 24 billion
Clinical Characteristics of Emphysema vs Chronic Bronchitis
m ild rare d e c re a se d
P red o m in an t C h ro n ic B ro n ch itis
50s o b ese M ild E arly (b efo re d y sp n ea) C o p io u s- p u ru le n t F requent R ep etativ e B ro n ch o v ascu lar m ark s 4 5 -6 0 5 0 -6 0 5 0 -6 0 M o d erate-sev ere Com m on S lig h t d ecrease
» asbestos, silica dust, cotton dust, grain dust, household cleaners, toluene, mining, glass or ceramics
Genetic (1- AT) Search for other genetic variants -
A ge W eig h t D yspnea C ough S p u tu m B ro n ch ial In fectio n R esp failu re ep iso d e CXR PaO 2 PaC O 2 H em ato crit P u lm o n ary H T N C o r-P u lm o n ale D iffu sio n C ap acity
【COPD英文精品课件】Chronic Obstructive Pulmonary Disease (COPD)_
Number Deaths x 1000
70
60
50
Men
40 Women
30
20
10
0 1980
1985
1990
1995
2000
Source: US Centers for Disease Control and Prevention, 2002 – cited in GOLD 2007
Risk Factors for COPD
Disrupted alveolar attachments
Thickened wall with inflammatory cells - macrophages, CD8+ cells, fibroblasts
Peribronchial fibrosis
Changes in Lung Parenchyma in COPD
Obliteration
Death
Edema
Source: GOLD 2007
Diagnosis and Assessment of COPD
Patient LG
【COPD英文精品课件】 Chronic Obstructive Pulmonary
Disease (COPD)
Definition of COPD*
➢COPD is a preventable and treatable chronic lung disease 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.
【COPD英文PPT课件】Pulmonary - Allergy Drugs Advisory Committee Meeting
Pulmonary - Allergy Drugs Advisory Committee Meeting
ADVAIR DISKUS® NDA 21-077
A1
A2
A3
Patient Burden of COPD
• Poor physical functioning • Significant symptoms • Social isolation • Fear of exacerbations • Frequent hospitalizations • Increased mortality
• Advair Diskus 500/50 addresses some of the
unmet needs for patients with COPD
– Exacerbations – Survival
A8
Proposed Indication
“ADVAIR DISKUS 500/50 is indicated for the
A4
COPD Is The Only Major Cause Of Death That Has Increased Significantly In Recent Years
Change in age-adjusted death rate in USA, from 1970 to 2002 (%)
and to increase survival and reduce exacerbations in patients with forced expiratory volume in 1 second (FEV1) <60% of
predicted.”
A9
Order of GSK Presentation
ADVAIR DISKUS® NDA 21-077
A1
A2
A3
Patient Burden of COPD
• Poor physical functioning • Significant symptoms • Social isolation • Fear of exacerbations • Frequent hospitalizations • Increased mortality
• Advair Diskus 500/50 addresses some of the
unmet needs for patients with COPD
– Exacerbations – Survival
A8
Proposed Indication
“ADVAIR DISKUS 500/50 is indicated for the
A4
COPD Is The Only Major Cause Of Death That Has Increased Significantly In Recent Years
Change in age-adjusted death rate in USA, from 1970 to 2002 (%)
and to increase survival and reduce exacerbations in patients with forced expiratory volume in 1 second (FEV1) <60% of
predicted.”
A9
Order of GSK Presentation
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Chronic Bronchitis
Clinical manifestation
Character: ➢ chronic onset, recurrent attack and long
course of disease Main symptoms: ➢ cough: chronic, long term, repeatedly ➢ expectoration: mucoid sputum, purulent
Sputum examination: bacterial culture guide antibiotic treatment
Diagnosis
Chronic cough and sputum production for 3 consecutive months in at least 2 successive years（≥3m/yⅹ2y）, excluding other chronic lung diseases (TB, Bronchiectasis )
Examination Chest x-ray imaging
Examination
Pulmonary function test: maybe normal in early stage. Gradually obstructive airway function appeared.
Blood routine: elevated neutrophil or eosinophil
Relationship of COPD and Chronic bronchitis, Asthma or Emphysema
Chronic Bronchitis
Chronic Bronchitis
Definition: Chronic and unspecific inflammation of bronchi and the surrounding tissue.
Percent Change in Age-Adjusted Death Rates, U.S., 1965-2019
Proportion of 1965 Rate
3.30.0 2.25.5
Coronary Heart
Disease
Stroke
2.20.0
Other CVD
COPD
All Other Causes
The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.
Definite chest imaging or lung function
Typing
Typing : 1、simple：cough, sputum 2、wheezing：with wheezing (actually
Chronic bronchitis plus asthma)
Emphysema
Definition
Emphysema is characterized by enlargement and destruction of respiratory bronchioles and /or alveoli in the lungs.
Etiology
Environment Factors ✓ Cigarette smoking ✓ Occupational dusts and chemicals ✓ Infections Host Factors ✓ Genes: Alpha1-antitrypsin deficiency
Feature: chronic mucus hypersecretion and cough.
Morbidity: 3.2% in population over 15 y，up to 15% in elderly over 50 y.
Etiology and mechanism
Environment Factors ✓ Cigarette smoking ✓ Occupational dusts and chemicals ✓ Infections Host Factors ✓ Genes ✓ Lung growth and defense mechanism
It is expected to be the third leading cause of death by 2020
Approximately 3% Chinese above 15 are currently suffering from COPD
Definition
COPD is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible.
sputum when infection ➢ wheezing: seen in some patients
Clinical manifestation
Sign: 1. no obvious sign in early stage 2. sometimes moist rales and rhonchi
1.15.5
1.10.0
0.05.5
0.0 0
–59%
–64%
–35%
Hale Waihona Puke +163%–7%
1965 - 2019 1965 - 2019 1965 - 2019 1965 - 2019 1965 - 2019
Why COPD is Important ?
COPD is the only chronic disease that is showing progressive upward trend in both mortality and morbidity