Embed Size (px)
Citation preview
Leonardo M. FabbriLeonardo M. Fabbri
[email protected]@unimore.it
First World Conference First World Conference of COPD patientsof COPD patients
a global mandate for COPD a global mandate for COPD care care
Holiday Inn Holiday Inn HotelHotel
Rome 14 June Rome 14 June 20092009
Impact of co-morbid conditions on care of
COPD patients
http//pneumologia.unimo.ithttp//pneumologia.unimo.it
Pathogenesis of COPD
Modified from Barnes, 2003
Cigarette smokeor air pollutant
Alveolar macrophage
Neutrophil
Proteases
? CD8+ T-cell
Alveolar wall destruction
EMPHYSEMA
Mucus hypersecretion
CHRONIC BRONCHITIS
Inflammatory cytokines(IL-8, LTB4) CXCL-10CXCL-10
CXCR3CXCR3
Leading Causes of Death in U.S.
1. Myocardial Infarction2. Cancer3. Cerebrovascular Diseases4. COPD
Cigarette Related DiseasesLeading Causes of
Death Worldwide 2010
Inhaled particles:pulmonary and heart co-morbidity
Complex Chronic Comorbidities of COPD
Fabbri et al Eur Respir J 2008;31:204-212
Prevalence of heart failure in Prevalence of heart failure in stablestable ‘COPD’ ‘COPD’ (aged 65 years or over)(aged 65 years or over) Rutten FH et al, Eur Heart J 2005;26:1887-94Rutten FH et al, Eur Heart J 2005;26:1887-94
405 ‘COPD‘
65years
244 (60.2%)
COPD (GOLD)
191 (39.8%)
‘rest’
33 (20.5%)
Heart failure
50 (20.5%)
heart failure
8%
12%
48%
32%
H F o n ly
H F +C O P D
C O P D o n ly
H F - / C O P D -
Rutten FH et al, Eur Heart J 2005;26:1887-94
Prevalence of COPD and COPD severity in Prevalence of COPD and COPD severity in patients with Chronic Heart Failurepatients with Chronic Heart Failure
CHF + COPD
CHF
29 %
71 %
GOLD: Global Obstructive Lung disease
All but two of the patients were unaware of COPDAll but two of the patients were unaware of COPD
0
20
40
60
80
100
GOLD I GOLD II GOLD III
% o
f pati
ents
Boschetto, Ceconi, Ferrari et al Eur Heart J, in preparation
Add inhaled glucocorticosteroids if repeated exacerbations
IV: Very Severe III: Severe II: Moderate I: Mild
Therapy at Each Stage of COPDTherapy at Each Stage of COPD
FEV1/FVC < 70%
FEV1 > 80% predicted
FEV1/FVC < 70%
50% < FEV1 < 80% predicted
FEV1/FVC < 70%
30% < FEV1 < 50% predicted
FEV1/FVC < 70%
FEV1 < 30% predictedor FEV1 < 50%
predicted plus chronic respiratory failure
Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation
Active reduction of risk factor(s); influenza vaccinationAdd short-acting bronchodilator (when needed)
Add long term oxygen if chronic respiratory failure. Consider surgical treatments
5-yrs mortality5-yrs mortality
The present study analysed data from 20,296 subjects aged >45 yrs at baseline in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS).
Add inhaled glucocorticosteroids if repeated exacerbations
IV: Very Severe III: Severe II: Moderate I: Mild
Therapy at Each Stage of COPDTherapy at Each Stage of COPD
FEV1/FVC < 70%
FEV1 > 80% predicted
FEV1/FVC < 70%
50% < FEV1 < 80% predicted
FEV1/FVC < 70%
30% < FEV1 < 50% predicted
FEV1/FVC < 70%
FEV1 < 30% predictedor FEV1 < 50%
predicted plus chronic respiratory failure
Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation
Active reduction of risk factor(s); influenza vaccinationAdd short-acting bronchodilator (when needed)
Add long term oxygen if chronic respiratory failure. Consider surgical treatments
What systemic aspects of COPD can be affected by therapy
• Weakness• Weight loss• Cardiac risk• Arrythmias
• Coagulability• Depression
• Osteoporosis• Fluid retention
Quality of Australian clinical guidelines and Quality of Australian clinical guidelines and relevance to the care of older people with multiple relevance to the care of older people with multiple
comorbid conditionscomorbid conditions
Professional societies and charities should Professional societies and charities should be encouraged and supported to develop be encouraged and supported to develop
clinical guidelines in compliance with clinical guidelines in compliance with NHMRC requirementsNHMRC requirements
Future guidelines should place more Future guidelines should place more emphasis on the management of older emphasis on the management of older
people with multiple comorbid conditionspeople with multiple comorbid conditions
Vitri AL et al., MJA 2008; 189: 360–365Vitri AL et al., MJA 2008; 189: 360–365
Levin A. et al, Levin A. et al, CMAJ 2008; 179 (11):1154-1162CMAJ 2008; 179 (11):1154-1162
GUIDELINES FOR THE MANAGEMENTGUIDELINES FOR THE MANAGEMENT
OF CHRONIC KIDNEY DISEASEOF CHRONIC KIDNEY DISEASE
BOX 1: Guidelines for the treatment of BOX 1: Guidelines for the treatment of hypertensionhypertension in patients with chronic kidney disease in patients with chronic kidney disease
BOX 2: Guidelines for the treatment of BOX 2: Guidelines for the treatment of diabetesdiabetes in patients with chronic kidney disease in patients with chronic kidney disease
BOX 3: Guidelines for the treatment of BOX 3: Guidelines for the treatment of dyslipidemiadyslipidemia in patients with chronic kidney disease in patients with chronic kidney disease
BOX 4: Guidelines for BOX 4: Guidelines for lifestyle managementlifestyle management for patients with chronic kidney disease for patients with chronic kidney disease
• BOX 5: Guidelines for the measurement and treatment of BOX 5: Guidelines for the measurement and treatment of proteinuria proteinuria in patients with chronic in patients with chronic kidney diseasekidney disease
Levin A. et al, Levin A. et al, CMAJ 2008; 179 (11):1154-1162CMAJ 2008; 179 (11):1154-1162
GUIDELINES FOR THE MANAGEMENTGUIDELINES FOR THE MANAGEMENTOF CHRONIC KIDNEY DISEASEOF CHRONIC KIDNEY DISEASE
BOX 6: Guidelines for the treatment of BOX 6: Guidelines for the treatment of anemiaanemia in patients with stage 3-5 chronic kidney disease in patients with stage 3-5 chronic kidney disease
BOX 7: Guidelines for the assessment and treatment of BOX 7: Guidelines for the assessment and treatment of mineral metabolism abnormalitiesmineral metabolism abnormalities in in patients with chronic kidney diseasepatients with chronic kidney disease
BOX 8: Guidelines for preparation for initiation of BOX 8: Guidelines for preparation for initiation of renal replacement therapyrenal replacement therapy for patients with for patients with chronic kidney diseasechronic kidney disease
BOX 9: Guidelines for BOX 9: Guidelines for comprehensive conservative managementcomprehensive conservative management for patients with chronic for patients with chronic kidney diseasekidney disease
Levin A. et al, Levin A. et al, CMAJ 2008; 179 (11):1154-1162CMAJ 2008; 179 (11):1154-1162
GUIDELINES FOR THE MANAGEMENTGUIDELINES FOR THE MANAGEMENTOF CHRONIC KIDNEY DISEASEOF CHRONIC KIDNEY DISEASE
Chronic Systemic Inflammatory Syndrome
(CSIS)
Age > 50 years
Smoking > 10 pack/years
Abnormal lung function
Ventricular dysfunction and/or ↑ BNP
Metabolic syndrome
↑ CRP
Fabbri and Rabe, The Lancet 1 September 2007
I'm a 41 years old italian "Lammie", diagnosed with Lam in 2007, a rare and chronic desease I'm a 41 years old italian "Lammie", diagnosed with Lam in 2007, a rare and chronic desease which destroys the lungs progressively. Many young women die prematurely because of it. which destroys the lungs progressively. Many young women die prematurely because of it. Unfortunately about Lam much is still unknown. Since my diagnosis I'm trying to do all I can Unfortunately about Lam much is still unknown. Since my diagnosis I'm trying to do all I can
to talk to as much as possible to people, researchers, doctors about it and stimulate their to talk to as much as possible to people, researchers, doctors about it and stimulate their interest and to find more people in the world which can dedicate their studies to the interest and to find more people in the world which can dedicate their studies to the
research of a cure and to get to know Lam. research of a cure and to get to know Lam.
The scientific community believes that the number of lam patients could be more than 30% The scientific community believes that the number of lam patients could be more than 30% compared to the known cases as Lam is often confused with Emphysema or COPD or not compared to the known cases as Lam is often confused with Emphysema or COPD or not
diagnosed at all . I thought that the Rome meeting could be a chance for us patients to diagnosed at all . I thought that the Rome meeting could be a chance for us patients to spread also the knowledge about Lam globally and an occasion promote the Lam sight, spread also the knowledge about Lam globally and an occasion promote the Lam sight,
which is which aims to create a global lam patient data. which is which aims to create a global lam patient data.
I'm sending the copy of this message also to Doctor Amy Farber, who has made so much I'm sending the copy of this message also to Doctor Amy Farber, who has made so much for the global Lam community during the last years, founding the Lam Treatment Alliance in for the global Lam community during the last years, founding the Lam Treatment Alliance in
Harvard.Harvard.
www.lamtreatmentalliance.org, , www.thelamfoundation.orgwww.lamsight.org
LYMPHANGIOLEIOMYOMATOSISLYMPHANGIOLEIOMYOMATOSIS
LYMPHANGIOLEIOMIOMATOSISLYMPHANGIOLEIOMIOMATOSIS
• Rare (1 per million) and progressive interstitial lung disease of unknown etiology, which can occur sporadically or in association with tuberous sclerosis.
• LAM almost exclusively affects females, generally developing before menopause.
• There are a few case reports describing LAM in males and children with tuberous sclerosis.
Dipartimento di Oncologia Ematologia e PneumologiaSezione di Malattie dell’Apparato Respiratorio
Direttore: Prof. Luca Richeldi
Dott. Fabrizio LuppiDott. Pietro Roversi
Dott. Paolo SpagnoloDott.ssa Giulia CerviDott. Giacomo SgallaDott.ssa Silvia Marani
Leonardo M. FabbriLeonardo M. Fabbri
[email protected]@unimore.it
First World Conference First World Conference of COPD patientsof COPD patients
a global mandate for COPD a global mandate for COPD care care
Holiday Inn Holiday Inn HotelHotel
Rome 14 June Rome 14 June 20092009
Impact of co-morbid conditions on care of
COPD patients
http//pneumologia.unimo.ithttp//pneumologia.unimo.it
