World COPD Day 2005 Slide Kit. Definition of COPD Chronic obstructive pulmonary disease (COPD) is a...

World COPD Day 2005 Slide Kit

World COPD Day 2005 Slide Kit

Definition of COPDDefinition of COPD

Chronic obstructive pulmonary disease(COPD) is a disease state characterized by airflow limitation that is not fullyreversible. The airflow limitation is usuallyboth progressive and associated with anabnormal inflammatory response of thelungs to noxious particles or gases.

Chronic obstructive pulmonary disease(COPD) is a disease state characterized by airflow limitation that is not fullyreversible. The airflow limitation is usuallyboth progressive and associated with anabnormal inflammatory response of thelungs to noxious particles or gases.

Facts About COPDFacts About COPD

Cigarette smoking is the primary cause of COPD.

In the US 47.2 million people (28% of men and 23% of women) smoke.

The WHO estimates 1.1 billion smokers worldwide, increasing to 1.6 billion by 2025. In low- and middle-income countries, rates are increasing at an alarming rate.

Cigarette smoking is the primary cause of COPD.

In the US 47.2 million people (28% of men and 23% of women) smoke.

The WHO estimates 1.1 billion smokers worldwide, increasing to 1.6 billion by 2025. In low- and middle-income countries, rates are increasing at an alarming rate.

Burden of COPD Key PointsBurden of COPD Key Points

The burden of COPD is underestimated because it is not usually recognized and diagnosed until it is clinically apparent and moderately advanced.

Prevalence, morbidity, and mortality vary appreciably across countries but in all countries where data are available, COPD is a significant health problem in both men and women.

The burden of COPD is underestimated because it is not usually recognized and diagnosed until it is clinically apparent and moderately advanced.

Prevalence, morbidity, and mortality vary appreciably across countries but in all countries where data are available, COPD is a significant health problem in both men and women.

Burden of COPD MortalityBurden of COPD Mortality

COPD is the 4th leading cause of death in the United States (behind heart disease, cancer, and cerebrovascular disease).

In 2000, the WHO estimated 2.74 million deaths worldwide from COPD.

In 1990, COPD was ranked 12th as a burden of disease; by 2020 it is projected to rank 5th.

COPD is the 4th leading cause of death in the United States (behind heart disease, cancer, and cerebrovascular disease).

In 2000, the WHO estimated 2.74 million deaths worldwide from COPD.

In 1990, COPD was ranked 12th as a burden of disease; by 2020 it is projected to rank 5th.

Leading Causes of DeathsU.S., 2002Leading Causes of DeathsU.S., 2002

All other causes of death 529,661All other causes of death 529,661

10.10. Septicemia 33,881Septicemia 33,881

9.9. Nephritis 41,018Nephritis 41,018

8.8. Alzheimer’s disease 58,785Alzheimer’s disease 58,785

7. 7. Influenza and pneumonia 65,984Influenza and pneumonia 65,984

6.6. Diabetes 73,119Diabetes 73,119

5.5. Accidents 102.303Accidents 102.303

4.4. COPD and allied conditions 125,500COPD and allied conditions 125,500

3.3. Cerebrovascular disease (stroke) 163,010Cerebrovascular disease (stroke) 163,010

2. 2. Cancer 558,847Cancer 558,847

1.1.

Cause of Death Number Cause of Death Number

Heart Disease 695,754

Source: NHLBI, NIH, DHHSSource: NHLBI, NIH, DHHS

Percent Change in Age-Adjusted Death Rates, U.S., 1965-1998Percent Change in Age-Adjusted Death Rates, U.S., 1965-1998

00

0.50.5

1.01.0

1.51.5

2.02.0

2.52.5

3.03.0

Proportion of 1965 Rate Proportion of 1965 Rate

1965 - 19981965 - 1998 1965 - 19981965 - 1998 1965 - 19981965 - 1998 1965 - 19981965 - 1998 1965 - 19981965 - 1998

–59%–59% –64%–64% –35%–35% +163%+163% –7%–7%

CoronaryHeart

Disease

CoronaryHeart

Disease

StrokeStroke Other CVDOther CVD COPDCOPD All OtherCauses

All OtherCauses

Source: NHLBI/NIH/DHHSSource: NHLBI/NIH/DHHS

Ischemic heart diseaseCerebrovascular diseaseLower resp infectionDiarrheal diseasePerinatal disordersCOPDTuberculosisMeaslesRoad traffic accidentsLung cancer

Ischemic heart diseaseCerebrovascular diseaseLower resp infectionDiarrheal diseasePerinatal disordersCOPDTuberculosisMeaslesRoad traffic accidentsLung cancer

Stomach CancerHIVSuicide

Stomach CancerHIVSuicide

6th6th

3rd3rd

Murray & Lopez. Lancet 1997

Future Mortality WorldwideFuture Mortality Worldwide1990 2020

Burden of COPD Economic BurdenBurden of COPD Economic Burden

The economic costs of COPD are high and will continue to rise in direct relation to the ever-aging population, the increasing prevalence of the disease, and the cost of new and existing medical and public health interventions.

The economic costs of COPD are high and will continue to rise in direct relation to the ever-aging population, the increasing prevalence of the disease, and the cost of new and existing medical and public health interventions.

Direct and Indirect Costs of COPD, 2002 (US $ Billions)Direct and Indirect Costs of COPD, 2002 (US $ Billions)

Direct Medical Cost: $18.0

Total Indirect Cost: $ 14.1– Mortality related IDC 7.3

– Morbidity related IDC 6.8

Total Cost $32.1

Direct Medical Cost: $18.0

Total Indirect Cost: $ 14.1– Mortality related IDC 7.3

– Morbidity related IDC 6.8

Total Cost $32.1Source: NHLBI, NIH, DHHS

Burden of COPD Future BurdenBurden of COPD Future Burden

The global burden of COPD will increase enormously over the foreseeable future as the toll from tobacco use in developing countries becomes apparent.

The global burden of COPD will increase enormously over the foreseeable future as the toll from tobacco use in developing countries becomes apparent.

Risk Factors for COPDRisk Factors for COPD

Host Factors Genes (e.g. alpha1-antitrypsin deficiency)

Hyperresponsiveness

Lung growth

Exposure Tobacco smoke

Occupational dusts and chemicals

Infections

Socioeconomic status

Host Factors Genes (e.g. alpha1-antitrypsin deficiency)

Hyperresponsiveness

Lung growth

Exposure Tobacco smoke

Occupational dusts and chemicals

Infections

Socioeconomic status

Pathogenesis of COPDPathogenesis of COPD

NOXIOUS AGENT(tobacco smoke, pollutants, occupational agent)

COPD

Genetic factors

Respiratory infection

Other

Noxious particles

and gases

Lung inflammation

Host factors

COPD pathology

ProteinasesOxidative stress

Anti-proteinasesAnti-oxidants

Repair mechanisms

INFLAMMATION

Small airway diseaseAirway inflammationAirway remodeling

Parenchymal destructionLoss of alveolar attachments

Decrease of elastic recoil

AIRFLOW LIMITATION

ASTHMAASTHMASensitizing agent

COPDCOPDNoxious agent

Asthmatic airway inflammationCD4+ T-lymphocytes

Eosinophils

COPD airway inflammationCD8+ T-lymphocytes

MacrophagesNeutrophils

Airflow limitationCompletelyreversible

Completelyirreversible

Causes of Airflow Limitation Causes of Airflow Limitation

Irreversible Fibrosis and narrowing of the

airways Loss of elastic recoil due to

alveolar destruction Destruction of alveolar support

that maintains patency of small airways

Irreversible Fibrosis and narrowing of the

airways Loss of elastic recoil due to

alveolar destruction Destruction of alveolar support

that maintains patency of small airways

Causes of Airflow Limitation Causes of Airflow Limitation

Reversible Accumulation of inflammatory cells,

mucus, and plasma exudate in bronchi Smooth muscle contraction in

peripheral and central airways Dynamic hyperinflation during exercise

Reversible Accumulation of inflammatory cells,

mucus, and plasma exudate in bronchi Smooth muscle contraction in

peripheral and central airways Dynamic hyperinflation during exercise

GOLD Workshop Report

Four Components of COPD Management

GOLD Workshop Report

Four Components of COPD Management

1. Assess and monitor disease

2. Reduce risk factors

3. Manage stable COPD Education Pharmacologic Non-pharmacologic

4. Manage exacerbations

1. Assess and monitor disease

2. Reduce risk factors

3. Manage stable COPD Education Pharmacologic Non-pharmacologic

4. Manage exacerbations5

2005

Objectives of COPD ManagementObjectives of COPD Management

Prevent disease progression Relieve symptoms Improve exercise tolerance Improve health status Prevent and treat exacerbations Prevent and treat complications Reduce mortality Minimize side effects from treatment

Prevent disease progression Relieve symptoms Improve exercise tolerance Improve health status Prevent and treat exacerbations Prevent and treat complications Reduce mortality Minimize side effects from treatment

Assess and Monitor Disease: Key PointsAssess and Monitor Disease: Key Points

Diagnosis of COPD is based on a history of exposure to risk factors and the presence of airflow limitation that is not fully reversible, with or without the presence of symptoms.

Diagnosis of COPD is based on a history of exposure to risk factors and the presence of airflow limitation that is not fully reversible, with or without the presence of symptoms.


Patients who have chronic cough and sputum production with a history of exposure to risk factors should be tested for airflow limitation, even if they do not have dyspnea.

Patients who have chronic cough and sputum production with a history of exposure to risk factors should be tested for airflow limitation, even if they do not have dyspnea.


For the diagnosis and assessment of COPD, spirometry is the gold standard.

Health care workers involved in the diagnosis and management of COPD patients should have access to spirometry.

For the diagnosis and assessment of COPD, spirometry is the gold standard.

Health care workers involved in the diagnosis and management of COPD patients should have access to spirometry.

SYMPTOMS

coughcoughsputumsputumdyspneadyspnea

EXPOSURE TO RISKFACTORS

tobaccotobaccooccupationoccupation

indoor/outdoor pollutionindoor/outdoor pollution

SPIROMETRYSPIROMETRY

Diagnosis of COPDDiagnosis of COPD

Spirometry: Normal and COPDSpirometry: Normal and COPD

0

5

1

4

2

3Liter

1 65432

FVC

FVC

FEV1

FEV1

Normal

COPD

3.900

5.200

2.350

4.150 80 %

60 %NormalCOPD

FVCFEV1 FVCFEV1/

Seconds

Factors Determining Severity Of Chronic COPDFactors Determining Severity Of Chronic COPD

Severity of symptoms Severity of airflow limitation Frequency and severity of exacerbations Presence of complications of COPD Presence of respiratory insufficiency Comorbidity General health status Number of medications needed to manage the

disease

Severity of symptoms Severity of airflow limitation Frequency and severity of exacerbations Presence of complications of COPD Presence of respiratory insufficiency Comorbidity General health status Number of medications needed to manage the

disease

Classification by SeverityClassification by SeverityStage Characteristics0: At risk Normal spirometry

Chronic symptoms (cough, sputum)

I: Mild FEV1/FVC < 70%; FEV1 80% predicted With or without chronic symptoms (cough,

sputum)

II: Moderate FEV1/FVC < 70%; 50% FEV1 < 80% predicted With or without chronic symptoms (cough, sputum,

dyspnea) III: Severe FEV1/FVC < 70%; 30% FEV1 < 50% predicted

With or without chronic symptoms (cough, sputum, dyspnea)

IV: Very Severe FEV1/FVC < 70%; FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure

Stage Characteristics0: At risk Normal spirometry

Chronic symptoms (cough, sputum)

I: Mild FEV1/FVC < 70%; FEV1 80% predicted With or without chronic symptoms (cough,

sputum)

II: Moderate FEV1/FVC < 70%; 50% FEV1 < 80% predicted With or without chronic symptoms (cough, sputum,

dyspnea) III: Severe FEV1/FVC < 70%; 30% FEV1 < 50% predicted

With or without chronic symptoms (cough, sputum, dyspnea)

IV: Very Severe FEV1/FVC < 70%; FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure

Reduce Risk FactorsKey PointsReduce Risk FactorsKey Points

• Reduction of total personal exposure to tobacco smoke, occupational dusts and chemicals, and indoor and outdoor air pollutants are important goals to prevent the onset and progression of COPD.

• Smoking cessation is the single most effective - and cost effective - intervention to reduce the risk of developing COPD and stop its progression (Evidence A).

• Reduction of total personal exposure to tobacco smoke, occupational dusts and chemicals, and indoor and outdoor air pollutants are important goals to prevent the onset and progression of COPD.

• Smoking cessation is the single most effective - and cost effective - intervention to reduce the risk of developing COPD and stop its progression (Evidence A).


Brief tobacco dependence treatment is effective (Evidence A), and every tobacco user should be offered at least this treatment at every visit to a health care provider.

Three types of counseling are especially effective: practical counseling, social support as part of treatment, and social support arranged outside of treatment (Evidence A).

Brief tobacco dependence treatment is effective (Evidence A), and every tobacco user should be offered at least this treatment at every visit to a health care provider.

Three types of counseling are especially effective: practical counseling, social support as part of treatment, and social support arranged outside of treatment (Evidence A).


Several effective pharmacotherapies for tobacco dependence are available (Evidence A), and at least one of these medications should be added to counseling if necessary, and in the absence of contraindications.

Several effective pharmacotherapies for tobacco dependence are available (Evidence A), and at least one of these medications should be added to counseling if necessary, and in the absence of contraindications.


Progression of many occupationally-induced respiratory disorders can be reduced or controlled through a variety of strategies aimed at reducing the burden of inhaled particles and gases (Evidence B).

Progression of many occupationally-induced respiratory disorders can be reduced or controlled through a variety of strategies aimed at reducing the burden of inhaled particles and gases (Evidence B).

Brief Strategies To Help The Patient Willing To Quit SmokingBrief Strategies To Help The Patient Willing To Quit Smoking

• ASK Systematically identify all tobacco users at every visit.

• ADVISE Strongly urge all tobacco users to quit.

• ASSESS Determine willingness to make a quit attempt.

• ASSIST Aid the patient in quitting.

• ARRANGE Schedule follow-up contact.

• ASK Systematically identify all tobacco users at every visit.

• ADVISE Strongly urge all tobacco users to quit.

• ASSESS Determine willingness to make a quit attempt.

• ASSIST Aid the patient in quitting.

• ARRANGE Schedule follow-up contact.

Manage Stable COPD Key PointsManage Stable COPD Key Points

For patients with COPD, health education can play a role in improving skills, ability to cope with illness, and health status. It is effective in accomplishing certain goals, including smoking cessation (Evidence A).

All COPD-patients benefit from exercise training programs, improving with respect to both exercise tolerance and symptoms of dyspnea and fatigue (Evidence A).

For patients with COPD, health education can play a role in improving skills, ability to cope with illness, and health status. It is effective in accomplishing certain goals, including smoking cessation (Evidence A).

All COPD-patients benefit from exercise training programs, improving with respect to both exercise tolerance and symptoms of dyspnea and fatigue (Evidence A).


The overall approach to managing stable COPD should be characterized by a stepwise increase in the treatment, depending on the severity of the disease.

None of the existing medications for COPD has been shown to modify the long-term decline in lung function that is the hallmark of this disease (Evidence A). Therefore, pharmacotherapy for COPD is used to decrease symptoms and/or complications.

The overall approach to managing stable COPD should be characterized by a stepwise increase in the treatment, depending on the severity of the disease.

None of the existing medications for COPD has been shown to modify the long-term decline in lung function that is the hallmark of this disease (Evidence A). Therefore, pharmacotherapy for COPD is used to decrease symptoms and/or complications.


Bronchodilator medications are central to the symptomatic management of COPD (Evidence A). They are given on an as-needed basis or on a regular basis to prevent or reduce symptoms.

The principal bronchodilator treatments are beta2-agonists, anticholinergics, theophylline, and a combination of these drugs (Evidence A).

Bronchodilator medications are central to the symptomatic management of COPD (Evidence A). They are given on an as-needed basis or on a regular basis to prevent or reduce symptoms.

The principal bronchodilator treatments are beta2-agonists, anticholinergics, theophylline, and a combination of these drugs (Evidence A).

Bronchodilators in Stable COPDBronchodilators in Stable COPD

Bronchodilator medications are central to symptom management in COPD.

Inhaled therapy is preferred.

The choice between beta2-agonist, anticholinergic, theophylline, or combination therapy depends on availability and individual response in terms of symptom relief and side effects.

Bronchodilator medications are central to symptom management in COPD.

Inhaled therapy is preferred.

The choice between beta2-agonist, anticholinergic, theophylline, or combination therapy depends on availability and individual response in terms of symptom relief and side effects.

Bronchodilators in Stable COPDBronchodilators in Stable COPD

Bronchodilators are prescribed on an as-needed or on a regular basis to prevent or reduce symptoms.

Regular treatment with long-acting inhaled bronchodilators is more effective and convenient than treatment with short-acting bronchodilators, but more expensive.

Combining bronchodilators may improve efficacy and decrease the risk of side effects compared to increasing the dose of a single bronchodilator.

Bronchodilators are prescribed on an as-needed or on a regular basis to prevent or reduce symptoms.

Regular treatment with long-acting inhaled bronchodilators is more effective and convenient than treatment with short-acting bronchodilators, but more expensive.

Combining bronchodilators may improve efficacy and decrease the risk of side effects compared to increasing the dose of a single bronchodilator.

Glucocorticosteroids in Stable COPD Glucocorticosteroids in Stable COPD

Regular treatment with inhaled glucocorticosteroids is appropriate for symptomatic COPD patients with an FEV1 < 50% predicted (Stage III: Severe COPD and Stage IV: Very Severe COPD) and repeated exacerbations e.g. 3 in the last three years (Evidence A).

Inhaled glucocorticosteroid combined with a long-acting B2-agonist is more effective than the individual components (Evidence A).

Regular treatment with inhaled glucocorticosteroids is appropriate for symptomatic COPD patients with an FEV1 < 50% predicted (Stage III: Severe COPD and Stage IV: Very Severe COPD) and repeated exacerbations e.g. 3 in the last three years (Evidence A).

Inhaled glucocorticosteroid combined with a long-acting B2-agonist is more effective than the individual components (Evidence A).

Glucocorticosteroids in Stable COPD Glucocorticosteroids in Stable COPD

Chronic treatment with systemic glucocortico-steroids should be avoided because of an unfavorable benefit-to-risk ratio (Evidence A).

Chronic treatment with systemic glucocortico-steroids should be avoided because of an unfavorable benefit-to-risk ratio (Evidence A).

Oxygen Therapy in Stable COPD Oxygen Therapy in Stable COPD

The long-term administration of oxygen (> 15 hours per day) to patients with chronic respiratory failure has been shown to increase survival (Evidence A).

The long-term administration of oxygen (> 15 hours per day) to patients with chronic respiratory failure has been shown to increase survival (Evidence A).

Management of COPD by Severity of DiseaseManagement of COPD by Severity of Disease

Stage 0: At risk

Stage I: Mild COPD

Stage II: Moderate COPD

Stage III: Severe COPD

Stage IV: Very Severe COPD

Stage 0: At risk

Stage I: Mild COPD

Stage II: Moderate COPD

Stage III: Severe COPD

Stage IV: Very Severe COPD

Management of COPD: All stagesManagement of COPD: All stages

Avoidance of risk factors

- smoking cessation

- reduction of indoor pollution- reduction of occupational exposure

Influenza vaccination

Avoidance of risk factors

- smoking cessation

- reduction of indoor pollution- reduction of occupational exposure

Influenza vaccination

Management of COPD Stage 0: At RiskManagement of COPD Stage 0: At Risk

Characteristics Recommended Treatment

• Chronic symptoms- cough- sputum

• No spirometric abnormalities

Management of COPD Stage I: Mild COPDManagement of COPD Stage I: Mild COPD


• FEV1/FVC < 70 %

• FEV1 > 80 % predicted

• With or without chronic symptoms

• Short-acting bronchodilator as needed

Management of COPD Stage II: Moderate COPDManagement of COPD Stage II: Moderate COPD


• FEV1/FVC < 70%

• 50% < FEV1< 80% predicted


• Short-acting broncho-dilator as needed• Regular treatment with

one or more long-acting bronchodilators

• Rehabilitation

Management of COPD Stage III: Severe COPDManagement of COPD Stage III: Severe COPD


• FEV1/FVC < 70%

• 30% < FEV1 < 50% predicted


• Short-acting broncho-dilator as needed• Regular treatment with one or more long-acting bronchodilators• Inhaled glucocortico-steroids if repeated exacerbations• Rehabilitation

Management of COPD Stage IV: Very Severe COPDManagement of COPD Stage IV: Very Severe COPD


• FEV1/FVC < 70%

• FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure

• Short-acting bronchodilator as needed • Regular treatment with one or more long-acting bronchodilators• Inhaled glucocorticosteroids if repeated exacerbations• Treat complications• Rehabilitation• Long-term oxygen therapy if respiratory failure• Consider surgical options

Old (2001) 0: At Risk I: Mild II: Moderate

IIA IIB

III: Severe

New (2003) 0: At Risk I: Mild II: Moderate III: Severe IV: Very Severe

Therapy at Each Stage of COPD

Characteristics • Chronic Symptoms• Exposure to risk factors• Normal spirometry

• FEV1/FVC < 70%

• FEV1 80%• With or without symptoms

• FEV1/FVC < 70%

• 50% < FEV1 < 80%• With or without symptoms

• FEV1/FVC < 70%

• 30% < FEV1 < 50%• With or without symptoms

• FEV1/FVC < 70%

• FEV1 < 30% or FEV1 < 50%

predicted plus chronic respiratory failure

Avoidance of risk factor(s); influenza vaccination

Add short-acting bronchodilator when needed

Add regular treatment with one or more long-acting bronchodilatorsAdd rehabilitation

Add inhaled glucocorticosteroids if repeated exacerbations

Add long-term oxygen if chronic respiratory failureConsider surgical treatments

Manage ExacerbationsKey PointsManage ExacerbationsKey Points

Exacerbations of respiratory symptoms requiring medical intervention are important clinical events in COPD.

The most common causes of an exacerbation are infection of the tracheobronchial tree and air pollution, but the cause of about one-third of severe exacerbations cannot be identified (Evidence B).

Exacerbations of respiratory symptoms requiring medical intervention are important clinical events in COPD.

The most common causes of an exacerbation are infection of the tracheobronchial tree and air pollution, but the cause of about one-third of severe exacerbations cannot be identified (Evidence B).


Inhaled bronchodilators (beta2-agonists and/or anticholinergics), theophylline, and systemic, preferably oral, glucocortico-steroids are effective for the treatment of COPD exacerbations (Evidence A).

Inhaled bronchodilators (beta2-agonists and/or anticholinergics), theophylline, and systemic, preferably oral, glucocortico-steroids are effective for the treatment of COPD exacerbations (Evidence A).


Patients experiencing COPD exacerbations with clinical signs of airway infection (e.g., increased volume and change of color of sputum, and/or fever) may benefit from antibiotic treatment (Evidence B).

Patients experiencing COPD exacerbations with clinical signs of airway infection (e.g., increased volume and change of color of sputum, and/or fever) may benefit from antibiotic treatment (Evidence B).


Noninvasive intermittent positive pressure ventilation (NIPPV) in exacerbations improves blood gases and pH, reduces in-hospital mortality, decreases the need for invasive mechanical ventilation and intubation, and decreases the length of hospital stay (Evidence A).

Noninvasive intermittent positive pressure ventilation (NIPPV) in exacerbations improves blood gases and pH, reduces in-hospital mortality, decreases the need for invasive mechanical ventilation and intubation, and decreases the length of hospital stay (Evidence A).

Management of COPDManagement of COPD

In selecting a treatment plan, the benefits and risks to the individual, and the direct and indirect costs to the individual, his or her family, and the community must be considered.

In selecting a treatment plan, the benefits and risks to the individual, and the direct and indirect costs to the individual, his or her family, and the community must be considered.

Do you know what COPD is? This chronic lung disease is a major cause of illness, yet many people have it and don’t know it.

If you answer these questions, it will help you find out if you could have COPD.

1. Do you cough several times most days? Yes ___ No ___

2. Do you bring up phlegm or mucus most days? Yes ___ No ___

3. Do you get out of breath more easily than others your age? Yes ___ No ___

4. Are you older than 40 years? Yes ___ No ___

5. Are you a current smoker or an ex-smoker? Yes ___ No ___

If you answered yes to three or more of these questions, ask your doctor if you might have COPD and should have a simple breathing test. If COPD is found early, there are steps you can take to prevent further lung damage and make you feel better.

Take time to think about your lungs……Learn about COPD!

Do you know what COPD is? This chronic lung disease is a major cause of illness, yet many people have it and don’t know it.

If you answer these questions, it will help you find out if you could have COPD.

1. Do you cough several times most days? Yes ___ No ___

2. Do you bring up phlegm or mucus most days? Yes ___ No ___

3. Do you get out of breath more easily than others your age? Yes ___ No ___

4. Are you older than 40 years? Yes ___ No ___

5. Are you a current smoker or an ex-smoker? Yes ___ No ___

If you answered yes to three or more of these questions, ask your doctor if you might have COPD and should have a simple breathing test. If COPD is found early, there are steps you can take to prevent further lung damage and make you feel better.

Take time to think about your lungs……Learn about COPD!

Could it be COPD?Could it be COPD?

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