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COPD: Reversing the Reversible in 2014

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

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COPD: Reversing the Reversible in 2014

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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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