Asthma and COPD - Virginia Commonwealth University

Asthma and COPD - Virginia Commonwealth University

ASTHMA AND COPD Lauren Clark Introduction Definition Epidemiology Etiology Cost & Burden Intervention

Research Outline INTRODUCTION Chronic Lower Respiratory Diseases Chronic lower respiratory diseases: Asthma, bronchitis, COPD, emphysema, cystic fibrosis,

bronchiectasis, pneumoconiosis, sleep apnea The upstream causes and downstream consequences of chronic respiratory disease are complex, and related to the specific type of disease. Asthma COPD

Reversible airway obstruction Airway inflammation and reactive airway Definitions

Progressive non-reversible airway obstruction Bronchitis Excessive tracheobronchial mucus associated with bronchial airway narrowing and cough Emphysema Alveolar destruction and airspace enlargement

Chronic a Obstructive Pulmonary Disease common preventable but irreversible disease, characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to particles or gases

The chronic airflow limitation characteristic of COPD is caused by a mixture of small airways disease (chronic bronchitis) and parenchymal destruction (emphysema), the relative contributions of which vary from person to person Airflow limitations, cough, other respiratory symptoms

COPD How to diagnose COPD Asthma chronic disease involving the inflammation of airways in the lungs Airways

become more inflamed and muscles tighten trigging systems Coughing, tightness wheezing, shortness of breather and/or chest In most cases, we dont know the exact causes of asthma and we dont know how to cure it

No cure but can be adequately treated Types: Exercise-induced Allergic asthma Occupational asthma

Childhood asthma Obstructive lung disease (COPD & Asthma) is the inability to exhale all the air in the lung resulting in dyspnea. Diagnosis:

Spirometry Forced expiratory volume in the first one sec (FEV1)/Forced vital capacity (FVC) Obstructive FEV1/FVC < 0.75 How to Diagnose

Asthma EPIDEMIOLOGY COPD Prevalence In the National Health and Nutrition Examination Survey, 5% men and 6% of women report physician diagnosed COPD. Rates as

high as 9-13 % have been estimated in some populations Approximately 15 million adults have been diagnosed with COPD in all 50 States Since

nearly 24 million adults show signs of impaired lung function, researchers believe that COPD remains underdiagnosed Asthma Prevalence Affects 25.7 Million people nationally Number of adults who currently have asthma: 17.7 million Percent Number

million Percent of adults who currently have asthma: 7.4% of children who currently have asthma: 6.3 of children who currently have asthma: 8.6% Asthma prevalence in the United

States, 20012010 Adult Self-Reported Current Asthma Prevalence (%) by State or Territory, 2010 WA OR VT MT

ND ID WY MN SD UT CO

CA AZ OK NM MI IL IN OH WV

MO KS KY TN AR MS TX AK

NH NY MARI PA IA NE NV WI

VA NC SC GA AL LA FL HI

PR 6.0 7.7 7.8 8.5 8.6 9.3 9.4 9.9

ME 10.0 11.1 CT NJ DE MD DC COPD Incidence Incidence

has increased over the last 20 years, however has been a slight decrease in last 10 years Greater among men than women Greater in older individuals (>75)

Hard to determine actual percentages due very few studies measuring its incidence have been conducted Asthma Incidence Incidence 3.8/1000 (2006-2008, ACBS) (0.38%) for adults

12.5/1000 (1.25% for children COPD Etiology COPD results from a gene-environment interaction. Among people with the same smoking history, not all will develop COPD due to differences in genetic predisposition to the disease, or in how long they live

The genetic risk factor that is best documented is a severe hereditary deficiency of alpha-1 antitrypsin, a major circulating inhibitor of serine proteases People with this deficiency have received two abnormal alpha-1 antitrypsin genes. One of these abnormal genes came from their mother and one from their father

The World Health Organization recommends that COPD patients from areas with a particularly high prevalence of alpha-1 antitrypsin deficiency should be screened for this genetic disorder. COPD Risk Factors Exposure to particles cigarette

COPD smoking is the most commonly encountered risk factor for Tobacco smoking (cigarette, pipe, cigar, and other types of tobacco) Indoor air pollution (such as biomass fuel used for cooking and heating & second hand smoke) Outdoor

air pollution Occupational dusts and chemicals (irritants and fumes) Age - COPD develops slowly over years, so most people are at least 35 to 40 years old when symptoms begin Genetics as noted before alpha-1-antitrypsin deficiency Any factor that affects lung growth during gestation and childhood has the potential for increasing an individuals risk of developing COPD. Risk factors for COPD may also be related in more complex ways. For example, gender may influence whether a person takes up smoking or experiences certain occupational or environmental exposures; socioeconomic status may be linked to a childs birth weight (as it impacts on lung growth/development and in turn on susceptibility to

develop the disease). Asthma Etiology Allergic/ atopic/extrinsic More common in children Nonallergic/nonatropic/intrinsic

More common in adults Observation of higher IgE levels in patients of all age groups has added weight to the proposal of a unifying hypothesisfor a both types of asthma

Asthma Etiology Hygiene Hypothesis: Increase in eczema, asthma, allergies Family Size Study: as family size declined, allergies

increased Farm Study: Children growing up on farms has less allergies Immunology studies are now supporting this theory Potential outliers to this theory: Japan (lower asthma rates), Barbados (higher asthma rates). More

TV Watching Decreased sighing, less activity Asthma Etiology Genetic If Component

one parent has asthma, chances are 1 in 3 that each child will have asthma If both parents have asthma, chances are 7 in 10 that each child will have asthma Twin studies Also

concludeconsiderable genetic component of asthma, in which the genetic effects are mainly additive However, identification of all asthma related genes is cincomplete Asthma Risk Factors Having a blood relative (such as a parent or sibling)

with asthma Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever) Being overweight Being

a smoker Exposure to secondhand smoke Exposure to exhaust fumes or other types of pollution Exposure

to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing Asthma Risk Factors COPD Mortality COPD Mortality COPD is a leading cause of morbidity and mortality

worldwide and results in an economic and social burden that is both substantial and increasing 5th in 2002 projected to rise to 30% and be 3rd by 2030 COPD is the third leading cause of death in the United States behind cancer and heart disease 47.2

deaths per 100,000 population In 2009, 133,965 people died of COPD of which more than half (52.3%) were in women COPD has an age-adjusted death rate of 41.2 per 100,000 population; meaning that 41 persons out of 100,000 people died from COPD in 2009

COPD Global Mortality Asthma Mortality Deaths due to asthma are uncommon but are of serious concern because many of them are preventable contributing worldwide 1.1

Most Over to less than 1% of all deaths in most countries deaths per 100,000 population in the US deaths occur in older adults after middle age the past 50 years, mortality rates in these

younger age groups have fluctuated markedly in several high-income countries, attributed to changes in medical care for asthma, especially the introduction of new asthma medications COST & BURDEN Cost of COPD Direct medical costs for COPD in the US are more than $32 billion each year

Indirect costs $20.4 billion. The yearly financial toll of COPD is expected to reach an estimated $49 billion by 2020. An estimated 715,000 hospital discharges were reported in 2010; a discharge rate of 23.2 per 100,000 population COPD

is an important cause of hospitalization in our aged population Average length of stay with chronic bronchitis as first-listed diagnosis: 4.5 days 285,000 visits to emergency departments with chronic and unspecified bronchitis as the primary hospital discharge diagnosis

10.8% of residents in assisted living or other residential care have COPD Cost of Asthma Direct medical costs for Asthma in the US are more than $50.1 billion each year Indirect

costs $5.9 billion Number of visits to physician offices with asthma as primary diagnosis: 10.5 million Number of visits to emergency departments with asthma as primary diagnosis: 1.8 million

Number of discharges with asthma as first-listed diagnosis: 439,000 Average length of stay for asthma diagnosis: 3.6 days Burden of COPD A

Lung Association survey revealed that 51% of all COPD patients say their condition limits their ability to work. It also limits them in normal physical exertion, household chores, social activities , sleeping and family activities. Findings

of a 8 year prospective study suggested that disability in COPD patients progresses gradually over 7.5 years after initial diagnosis. After 7.5 years, most COPD patients are no longer capable of productive work. Burden of Asthma INTERVENTION COPD Prevention

Approximately smoking. 75% of COPD cases are attributed to cigarette Occupation-related COPD cases exposures may account for another 15% of

Genetic factors, asthma, respiratory infections, and indoor and outdoor exposures to air pollutants also play a role 10% Public health programs and policies that focus on tobacco-use prevention and cessation, reducing occupational exposure to dusts and chemicals, and reducing other indoor and outdoor air pollutants are critically important

Early treatment and control of asthma may also prevent the development of COPD. COPD Primary Prevention COPD Secondary & Tertiary Prevention Public Health Goals Goal

1: Surveillance and Evaluation Improve collection, analysis, dissemination, and reporting of COPDrelated public health data. Goal 2: Public Health Research and Prevention Strategies Improve

understanding of COPD development, prevention, and treatment. Goal 3: Programs and Policies Goal 4: Communication Increase

effective collaboration among stakeholders with COPDrelated interests. Heighten awareness of COPD in the following groups: people with COPD and their families, people with COPD risk factors, health professionals (especially primary care providers), provider systems, media, decision makers, policy makers, and the public. COPD Treatment Options Treatment of COPD requires a careful and thorough evaluation by a

physician to help alleviate symptoms, decrease the frequency and severity of exacerbations, and increase exercise tolerance. Asthma Prevention Primary Prevention: Increasing prevalence with unknown etiology. Smoking cessation, exercise and healthy weight.

Breast feeding Living with a dog (not at cat) Secondary While Prevention : we dont know why asthma rates are rising, we do know that people with asthma can control their symptoms by avoiding asthma triggers and correctly using prescribed medications, such as inhaled corticosteroids. - CDC

Occupational Asthma. Aluminum, anhydride, alpha amylase, colophony, crab, detergent enzyme, enzyme, egg, insect, isocyanate, laboratory animal, latex, meat, platinum, shrimp, solder, and western red cedar. (Per CDC) Avoidance of Triggers: Allergens, smoking, flu, RSV, etc. Asthma Prevention Tertiary Prevention :

Education Asthma Action Plan Improved Medical Care Routine Care Access to Medications Public Health Goals Goal

1: Surveillance and Evaluation Improve collection, analysis, dissemination, and reporting of asthma-related public health data. Goal 2: Public Health Research and Prevention Strategies

Improve understanding of asthma development, prevention, and treatment. Goal 3: Programs and Policies Increase effective collaboration among stakeholders with asthmarelated interests.

Goal 4: Communication Heighten awareness of asthma in the following groups: people with asthma and their families, people with asthma risk factors, families, health professionals (especially primary care providers), provider systems, media, decision makers, policy makers, and the public.

CURRENT RESEARCH Research Gaps What we still need to learn is how best to deliver healthcare that is better integrated and more coherent. That is, care based on a strategic alliance between primary

and secondary care and supported when needed by interdisciplinary teams for patients with high risk and complex COPD. Much of the evidence concerning risk factors for COPD comes from cross-sectional epidemiological studies that identify associations rather than cause-and-effect relationships. Although

several longitudinal studies of COPD have followed groups and populations for up to 20 years 25, none has monitored the progression of the disease through its entire course, or has included the pre-and perinatal periods which may be important in shaping an individuals future COPD risk. Develop better epidemical data Research Gaps Further research into the genetic factors in asthma

development Develop understanding of asthma causation QUESTIONS?

Recently Viewed Presentations

  • COE 202: Digital Logic Design Sequential Circuits Part 3

    COE 202: Digital Logic Design Sequential Circuits Part 3

    Use FF's excitation table to complete the table. Derive state equations. Obtain the FF input equations and the output equations. Use K-Maps. Draw the circuit diagram. KFUPM. Step1: Obtaining the State Diagram. A very important step in the design procedure.
  • Citing poetry in MLA style

    Citing poetry in MLA style

    When citing long sections (more than three lines) of poetry, keep formatting as close to the original as possible. In his poem "My Papa's Waltz," Theodore Roethke explores his childhood with his father:
  • Public Protector&#x27;S Presentation to The Portfolio Committee on ...

    Public Protector'S Presentation to The Portfolio Committee on ...

    PPSA KEY STRATEGIC OBJECTIVES AND PROGRAMMES . The Public Protector's 2014/15 Annual Performance Plan was structured according to the following key programmes and strategic objectives - (please refer to page 68 of the Annual Report for the detailed expenditure report)
  • AGE AND ORIGIN OF FLUORITE-BEARING, SNOWBIRD-TYPE VEINS, WESTERN

    AGE AND ORIGIN OF FLUORITE-BEARING, SNOWBIRD-TYPE VEINS, WESTERN

    concordia. ages for the fluorite-bearing assemblages. At the SB deposit the massive calcite core is transected by veins of quartz, ankerite. and purple fluorite (or . parisite) (Fig. 3). An age of 72±1.0 Ma (MSWD=0.57) for this assemblage (Fig. 4)...
  • The Oxnard College STEMinar Planning from College to

    The Oxnard College STEMinar Planning from College to

    What didn't work. Course was non-transferrable and grant ended so was an early victim to budget cuts. While successful in increasing student awareness and interest in STEM careers BUT many students in the class were already interested in STEM
  • EGR 2261 Unit 4 Control Structures I: Selection

    EGR 2261 Unit 4 Control Structures I: Selection

    One-Way Selection (cont'd.) One-way selection syntax: statement is executed if the value of the expression is true. But statement is skipped if the value is false; program goes to whatever comes next. statement is any C++ statement. It could be...
  • Genetic Architecture of Complex Traits - AU Pure

    Genetic Architecture of Complex Traits - AU Pure

    Sensitivity of maize to climate change in Denmark: an analysis using impact response surface [email protected] Ozturk Isik.1, Sillebak K. Ib1, Baby Sanmohan1, Vejlin Jonas1, Olesen E. Jørgen1
  • First Law of Thermodynamics  You will recall from

    First Law of Thermodynamics You will recall from

    First Law of Thermodynamics You will recall from Chapter 5 that energy cannot be created nor destroyed. Therefore, the total energy of the universe is a constant.