Differential Diagnosis Of Chronic Obstructive Pulmonary Disease

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MDDifferential Diagnosis of ChronicObstructive Pulmonary DiseaseRobert Sarnoff, MD275084 2/09Faculty DisclosureCompany PfizerBoehringerIngelheimNature of Affiliation Speakers BureauSpeakers BureauUnlabeled Product Usage NoneNone

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MDCurrent Definition of COPD A preventable and treatable disease Associated with significant extrapulmonary effects andimportant comorbid conditions Characterized by airflow limitation that is– Partially reversible– Usually progressive– Associated with an abnormal inflammatory response to noxiousparticles or gasesGlobal Initiative for Chronic Obstructive Disease. Global strategy for the diagnosis, management, and prevention of COPD. Updated 2008.http://www.goldcopd.com/Guidelineitem.asp?l1 2&l2 1&intId 989. Accessed November 21, 2008.COPD Remains Underdiagnosed24 Million COPD Cases Estimated in the US*Undiagnosed†Diagnosed12 Million(50%)12 Million(50%)*Data for diagnosed and total number of cases of COPD are derived from two different CDC surveys, from 2006 and 1988-1994 respectively.†Assumption based on available data from CDC.American Lung Association. 4-8ade-7f5d5e762256%7D/COPD DEC07.PDF. AccessedFebruary 16, 2009.

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MDWhere Can We ImproveCOPD Management?COPD remains underdiagnosed1 Awareness of COPD guidelines suboptimal2 Spirometry used inconsistently2 Mortality increasing among women3 Present in the fifth decade of life,4 though early symptoms may be missed2Early diagnosis and treatmentmay lead to better outcomes5Diagnosis and treatment may prevent or delay progression of lung functiondecline and symptoms5 Spirometry is key to the diagnosis of COPD5 Education represents an opportunity to improve outcomes for COPD patients2,51. Mannino DM et al. MMWR Surveillance Summary. 2002;51:1-16.2. Yawn BP, Wollan PC. Int J COPD. 2008;3:311-317.3. Deaths from chronic obstructive pulmonary disease—United States, 2000-2005. MMWR Morb Mortal Wkly Rep. 2008;57:1229-1232.4. American Association for Respiratory Care. http://www.aarc.org/resources/confronting copd/exesum.pdf. Accessed February 11, 2009.5. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonarydisease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1 2&l2 1&intId 989. Accessed November 21, 2008.Top 5 Causes of Death: COPD on the Rise120%1970--2002% Change, 1970100%80%60%40%103%Heart 0%-80%Jemal A et al. JAMA. 2005;294:1255-1259.-41%-52%-63%

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MDFactors That May Influence eAgeOxidativeOxidative ionsAdapted from Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructivepulmonary disease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1 2&l2 1&intId 989. Accessed November 21, 2008.Spirometry Is Essentialfor Diagnosing COPDIf . . .ChronicChronic symptomssymptoms cough,cough, sputum,sputum, and/orand/or shortnessshortness ofof breathbreathAnd . . .Exposureorand/Exposure toto riskrisk factorsfactors tobacco,tobacco, occupationaloccupational irritants,irritants, and/orand/orindoor/outdoorindoor/outdoor pollutionpollutionThen . . .Spirometry** toSpirometrySpirometry*to confirmconfirm COPDCOPD diagnosisdiagnosis FEV/FVC 0.70 0.70 FEVFEV11 determinesdetermines stagingstagingFEV11/FVC*Additional testing: chest x-ray, echocardiogram, arterial blood gas, sputum analysis, computed tomography (CT) scan.Global Initiative for Chronic Obstructive Lung Disease. Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease.Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1 2&l2 1&intId 989. Accessed November 21, 2008.

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MDSpirometry Is a Useful Tool to AssessCOPD Severity and ProgressionPostPostbronchodilator FEV1 %PredictedFEV1/FVCStageSeverityIMild 0.70 80Chronic cough andsputum productionIIModerate 0.7050 to 80Dyspnea aboveIIISevere 0.7030 to 50Progressive dyspneaIVVerySevere 30Respiratory failure, rightheart failure, weight loss,arterial hypoxemia above 0.70Typical SymptomsGlobal Initiative for Chronic Obstructive Lung Disease. Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease.Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1 2&l2 1&intId 989. Accessed November 21, 2008.

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MDDifferentiating COPD and AsthmaAsthmaCOPDOnset1Early in life ette smoke,occupational pollutantsSymptoms1VariableSlowly progressiveAirflow limitation1Largely reversiblePartially reversibleClinical features2,3Episodic wheeze, chesttightness, cough,dyspneaChronic dyspnea, cough,sputum, wheezeInflammatory cells1Primarily eosinophilsPrimarily neutrophils1. Global Initiative for Chronic Obstructive Lung Disease. GlobalGlobal strategy for diagnosis, management, and prevention of chronic obstructive pulmonarydisease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1 2&l2 1&intId 989.http://www.goldcopd.com/Guidelineitem.asp?l1 2&l2 1&intId 989. Accessed November 21, 2008.2. Currie GP, Legge JS. Chapter 3: Diagnosis. Blackwell BMJ Books. December 2006.3. Dewar M, Curry RW. Am Fam Physician.Physician. 2006;73:6692006;73:669-676.

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MD

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MD

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MDGoals of COPD Management Relieve symptomsShort Term Minimize side effects Improve exercise toleranceand Prevent and treat exacerbations and complications Improve health statusLong Term Prevent disease progression Reduce mortalityCOPD management includes both pharmacologic and nonpharmacologic treatment.Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonarydisease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1 2&l2 1&intId 989. Accessed November 21, 2008.

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MDOverview of COPD nderProteinases/Cell irway Obstruction,Elastic Recoil c/ ralChangesGlobal Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.Updated 2008. Available at: http://www.goldcopd.com/Guidelineitem.asp?l1 2&l2 1&intId 989. Accessed November 21, 2008.Other Diagnoses That CanHave Similar PresentationsDiagnosisSigns/SymptomsRecommended testingCongestive HeartFailure1,2 Fine basilar crackles on auscultation Chest xx-ray Lung function testing EchocardiogramBronchiectasis1,3 Large volumes of purulent sputum Commonly associated with bacterial infection Coarse crackles/clubbing on auscultation CT scan Lung function testingCystic fibrosis2,4 Onset at any age Chest xx-ray Sweat test Genetic testingObliterativeBronchiolitis1,2 Onset in younger age, nonsmokers May have history of rheumatoid arthritis orfume exposure CT scanDiffusePanbronchiolitis1 Most patients are male and nonsmokers Almost all have chronic sinusitis Chest XX-ray High resolution CT scanCT computed tomography.1. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonarydisease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1 2&l2 1&intId 989. Accessed November 21, 2008.2. Dewar M, Curry RW. Am Fam Physician. 2006;73:669-676.3. National Heart, Lung and Blood Institute. Bronchiectasis. rn-diagnosis.html. AccessedJanuary 27, 2009.4. National Heart, Lung and Blood Institute. Cystic fibrosis. -diagnosis.html. AccessedJanuary 29, 2009.

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MDDiagnostic Testing Considerations Spirometry Chest xx-ray Echocardiogram CT scanWhen to refer to a specialist?Nonpharmacologic Therapyto Manage COPDSmoking CessationPatient EducationVaccinationPulmonaryRehabilitationOxygen TherapySurgical and NonNonsurgical AlternativesGlobal Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonarydisease. Updated 2008. http://www.goldcopd.com/Guidelineitem.asp?l1 2&l2 1&intId 989. Accessed November 21, 2008.

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MD

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MD

Sometime it's COPD and Sometimes it's NotRobert Sarnoff, MD

Differential Diagnosis of Chronic Obstructive Pulmonary Disease Robert Sarnoff, MD 275084 2/09 Faculty Disclosure Company Nature of Affiliation Unlabeled Product Usage None None . Global Initiative for Chronic Obstructive Disease. Global strategy for the diagnosis, management, and prevention of COPD. Updated 2008.