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Understanding COPD: Prevalence, Treatments, and Reversible Components

Chronic Obstructive Pulmonary Disease (COPD) affects approximately 5.9% of the U.S. population, leading to significant morbidity and mortality. With over 126,000 deaths in 2005 alone, it’s crucial to differentiate between COPD and asthma, as they often coexist. Key components of COPD include emphysema and chronic bronchitis. Treatment options range from short-acting and long-acting bronchodilators to newer therapies like leukotriene modifiers. Understanding the progression and treatment of COPD can aid in managing this debilitating condition effectively.

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Understanding COPD: Prevalence, Treatments, and Reversible Components

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  1. COPD: Reversing the Reversible in 2014 Donald M. Pell M. D., FCCP

  2. Introduction • Prevalence 5.9% of U.S. population or about 24,000,000 adults (ATS Gold Paper 2004) • In 2000 there were 122,000 deaths (CDC data) • For the first time more women than men • 2nd to heart disease as a cause of disability • Annual cost 2002 est. $32.1 billion • 70% of the patients were less than 65

  3. Introduction By 2005, there were 126,000 deaths and the number of male deaths had increased by 8%. The number of female deaths had increased by 11% (CDC data)

  4. Spectrum of COPD COPD 80% PURE EMPHYSEMA 10% CHRONIC BRONCHITIS 10%

  5. REVERSIBLE COMPONENTS of COPD • SPUTUM • SPASM • SWELLING

  6. Differentiating COPD and Asthma • No diagnostic test for either is conclusive • Frequent coexistence of both problems • 10% overlap

  7. Autonomic Effects on Respiratory Tract

  8. Short Acting Beta 2 Agonist BRONCHODILATOR Medication Dose Duration Isuprel Isoproterenol 130mcg/p 2pq3-4h .5-2h Bronkosol Isoetharine 3-40mcg/p 2pq4h 2-4h Alupent Metaproterenol 65mcg/p 2pq4-6h 4-6h Brethine Terbutaline 200mcg/p 2pq4-6h 4-6h Proventil Albuterol 90mcg/p 2pq4-6h 4-6h Maxair Pirbuterol 200mcg/p 2pq4-6h 4-6h Tornolate Bitolterol 370mcg/p 2pq4-6h 5-8h DMP-2000

  9. Long Acting Beta 2 Agonist BRONCHODILATOR Medication Dose Duration SereventDiskus Inhale 1 BID 12h Foradil (Fomoterol) Inhale 1 BID 12h Advair 50/500 Inhale 1 BID 12h Symbicort160/4.5 Inhale 2 BID 12h Lancet, Feb 2003

  10. Theophylline • Mechanisms of effects • Improved efficiency of the diaphragm • Anti-inflammatory • Bronchodilator • Respiratory center stimulant • Narrow therapeutic window • Frequent drug interactions

  11. FEV1 and Aging • Healthy lungs lose about 20 cc@ year after age 25 • COPD patients lose about 80 cc@ year

  12. Summary of New Therapies • Non pharmaceutical supplements (Boswellia) • Supplemental Oxygen (Oximizer) • COPD rehab • Leukotriene modifiers • Cilomilast • Tioproprium Bromide • Foradil • Statins • ACE Inhibitors

  13. Leukotriene Modifiers and COPD • Reports at international and national meetings • Proposed mechanism • Local experience 18 patients with severe COPD • 2 week trial LM • Average response to SABA before trial 9% • After trial 40%

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