Lauren Clark Outline Introduction Definition Epidemiology Etiology Cost amp Burden Intervention Research Introduction Chronic Lower Respiratory Diseases Chronic lower respiratory diseases ID: 568698
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Slide1
Asthma and COPD
Lauren Clark Slide2
Outline
Introduction
Definition
Epidemiology
Etiology
Cost & Burden
Intervention
ResearchSlide3
IntroductionSlide4
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”.Slide5
Definitions
COPD
Progressive
non-reversible
airway obstruction
Bronchitis – Excessive tracheobronchial mucus associated with bronchial airway narrowing and cough
Emphysema – Alveolar destruction and airspace enlargement
Asthma
Reversible
airway obstruction
Airway inflammation and reactive airway Slide6Slide7
COPD
Chronic Obstructive Pulmonary Disease
a 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 symptomsSlide8Slide9
How to diagnose
COPDSlide10
Asthma
chronic disease involving the inflammation of airways in the lungs
Airways become more inflamed and muscles tighten trigging systems
Coughing, wheezing, shortness of breather and/or chest tightness
In most cases, we don’t know the exact causes of asthma and we don’t know how to cure it
No cure but can be adequately treated
Types:
Exercise-induced
Allergic asthma
Occupational asthma
Childhood asthmaSlide11Slide12
How to Diagnose
Asthma
Obstructive lung disease (COPD & Asthma) is the
inability to exhale all the air in the lun
g resulting in
dyspnea.
Diagnosis
:
Spirometry
Forced expiratory volume in the first one sec (FEV1)/Forced vital capacity (FVC)
Obstructive FEV1/FVC < 0.75Slide13
EpidemiologySlide14
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 under-diagnosedSlide15Slide16Slide17Slide18
Asthma
Prevalence
Affects 25.7 Million people nationally
Number of adults who currently have asthma: 17.7 million
Percent of adults who currently have asthma: 7.4%
Number of children who currently have asthma: 6.3 million
Percent of children who currently have asthma: 8.6%
Asthma prevalence in the United States,
2001–2010Slide19Slide20
IA
ME
AK
WA
OR
CA
NV
ID
UT
MT
WY
CO
AZ
NM
TX
SD
NE
KS
OK
AR
LA
MN
WI
MI
IL
MO
IN
OH
KY
TN
MS
AL
GA
SC
FL
NC
VA
WV
PA
NY
MA
ND
VT
NH
DC
MD
DE
NJ
CT
RI
HI
PR
8.6 – 9.3
6.0 – 7.7
7.8 – 8.5
9.4 – 9.9
10.0 – 11.1
Adult Self-Reported Current Asthma Prevalence (%) by
State or Territory, 2010Slide21Slide22Slide23Slide24
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 conductedSlide25
Asthma
Incidence
Incidence (2006-2008, ACBS)
3.8/1000 (0.38%) for adults
12.5/1000 (1.25% for childrenSlide26Slide27
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. Slide28
COPD
Risk Factors
Exposure to particles
cigarette smoking is the most commonly encountered risk factor for COPD
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 beginGenetics –
as noted before alpha-1-antitrypsin deficiency Any factor that affects lung growth during gestation and childhood has the potential for increasing an individual’s 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 child’s birth weight (as it impacts on lung growth/development and in turn on susceptibility to develop the disease). Slide29
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 Slide30
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 activitySlide31
Asthma
Etiology
Genetic Component
If 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 cincompleteSlide32
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 manufacturingSlide33
Asthma
Risk FactorsSlide34
COPD
MortalitySlide35
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
5
th
in 2002 projected to rise to 30% and be 3
rd
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 populationIn 2009, 133,965 people died of COPD of which more than half (52.3%) were in womenCOPD 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 2009Slide36Slide37
COPD
Global Mortality Slide38
Asthma
Mortality
Deaths due to asthma are uncommon but are of serious concern because many of them are preventable
contributing to less than 1% of all deaths in most countries worldwide
1.1 deaths per 100,000 population in the US
Most deaths occur in older adults after middle age
Over 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 medicationsSlide39Slide40Slide41Slide42
Cost & BurdenSlide43
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 days285,000 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 COPDSlide44Slide45
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 daysSlide46Slide47
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. Slide48
Burden of
Asthma
Slide49Slide50
InterventionSlide51
COPD
Prevention
Approximately
75% of COPD cases are attributed to cigarette smoking.
Occupation-related exposures may account for another 15% of COPD cases
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.Slide52
COPD
Primary PreventionSlide53
COPD
Secondary & Tertiary PreventionSlide54
Public Health Goals
Goal 1: Surveillance and Evaluation
Improve collection, analysis, dissemination, and reporting of COPD-related public health data.
Goal 2: Public Health Research and Prevention Strategies
Improve understanding of COPD development, prevention, and treatment.
Goal 3: Programs and Policies
Increase effective collaboration among stakeholders with COPD-related interests.
Goal 4: Communication
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. Slide55
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. Slide56
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 Prevention :
“While we don’t 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.Slide57
Asthma
Prevention
Tertiary Prevention :
Education
Asthma Action Plan
Improved Medical Care
Routine Care
Access to MedicationsSlide58Slide59
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 asthma-related 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. Slide60
Current ResearchSlide61Slide62Slide63Slide64Slide65Slide66Slide67Slide68
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 individual’s future COPD risk.
Develop better epidemical data Slide69
Research Gaps
Further research into the genetic factors in asthma development
Develop understanding of asthma causationSlide70
Questions?