MARYAM BAJWA

BSC(HONS)DOCTOR OF PHYSICAL
THERAPY

SUPERVISER
MISS MEHAK
ENGLISH DEPARTMENT
CHRONIC
DPT BATCH 4
OBSTRUCTIVE YEAR 2018-2023

PULMONARY
DISEASE
[COPD]
TABLE OF CONTENTS:

Table of contents Page no

Abstract. 2
1. Introduction. 3
2. Literature Review. 4
3. Research Methodology. 5
4. Data Analysis. 7
5. Discussion. 8
6. Conclusion. 9
7. Recommendation. 10
8. Appendix. 11
9. References. 14

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Abstract:
Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease
characterized by nonreversible airway obstruction. Well-characterized symptoms such
as exertional dyspnea and fatigue have a negative impact on patients' quality of life
(QoL) and restrict physical activity in daily life. The impact of COPD symptoms on QoL
is often underestimated; for example, 36% of patients who describe their symptoms as
being mild-to-moderate also admit to being too breathless to leave the house.
Additionally, early morning and nighttime symptoms are a particular problem. Methods
are available to allow clinicians to accurately assess COPD symptoms, including
patient questionnaires. Integrated approaches to COPD management, particularly
pulmonary rehabilitation, are effective strategies for addressing symptoms, improving
exercise capacity and, potentially, also increasing physical activity. Inhaled
bronchodilators continue to be the mainstay of drug therapy in COPD, where options
can be tailored to meet patients' needs with careful selection of the inhaled medication
and the device used for its delivery. Overall, an integrated approach to disease
management should be considered for improving QoL and subsequent patient
outcomes in COPD.

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 1 Introduction:
1.1 objectives:
The World Health Organization (WHO) defines chronic obstructive pulmonary disease
(COPD) as: 'a lungs disease characterised by chronic obstruction of lung airflow that
interferes with normal breathing and is not fully reversible'. This is in contrast to the
variable airways obstruction seen in asthma which can be reversed by drug treatment.
The airflow obstruction in COPD is due to damage to the lung structure and destruction
of lung tissue (emphysema). This is normally due to smoking, but recurrent infection
also contributes to the process.

1.2 Research Question:

1. What is average life expectancy of 60 year old male after diagnosis with
stage 3 COPD?
2. Which factor will decrease MORTALITY rate in COPD?
3. Validity of BOLD signal in hypoxemic COPD patients?
4. What is the number of experts I need when I am examining the content validity of a
questionnaire using the content validity index?
5. RECENT ADVANCES ON mefr25% and MEFR75% and what is its role in asthma
and COPD?

1.3 Hypothesis:
“We propose that an acquired immune response to newly created or altered
epitopes is an essential component in the pathogenesis of COPD.”

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 2 Literature review:
The aim of this study is to quantify the burden of chronic obstructive pulmonary
disease (COPD)--incidence, prevalence, and mortality--and identify trends in
Australia, Canada, France, Germany, Italy, Japan, The Netherlands, Spain,
Sweden, the United Kingdom, and the United States of America. A structured
literature search was performed (January 2000 to September 2010) of PubMed and
EMBASE, identifying English-language articles reporting COPD prevalence,
incidence, or mortality. Of 2838 articles identified, 299 full-text articles were
reviewed, and data were extracted from 133 publications. Prevalence data were
extracted from 80 articles, incidence data from 15 articles, and mortality data from
58 articles. Prevalence ranged from 0.2%-37%, but varied widely across countries
and populations, and by COPD diagnosis and classification methods. Prevalence
and incidence were greatest in men and those aged 75 years and older. Mortality
ranged from 3-111 deaths per 100,000 population. Mortality increased in the last 30-
40 years; more recently, mortality decreased in men in several countries, while
increasing or stabilizing in women. Although COPD mortality increased over time,
rates declined more recently, likely indicating improvements in COPD management.
In many countries, COPD mortality has increased in women but decreased in men.
This may be explained by differences in smoking patterns and a greater vulnerability
in women to the adverse effects of smoking.

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 3 Research Methodology:
3.1 Sampling Technique:
The process of development of guidelines for diagnosis and management of
patients of chronic obstructive pulmonary disease (COPD) in India was undertaken
as a joint exercise of the two National Pulmonary Associations (Indian Chest
Society (ICS) and National College of Chest Physicians (NCCP)), by the
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education
and Research, Chandigarh. The committee constituted for this purpose included
representation of the two associations, and experts from other institutes and
medical colleges including those from disciplines of internal medicine, microbiology,
pharmacology, radio diagnosis, and community medicine. Chronic obstructive
pulmonary disease (COPD) is a major public health problem in India. Although
several International guidelines for diagnosis and management of COPD are
available, yet there are lot of gaps in recognition and management of COPD in India
due to vast differences in availability and affordability of healthcare facilities across
the country. The Indian Chest Society (ICS) and the National College of Chest
Physicians (NCCP) of India have joined hands to come out with these evidence-
based guidelines to help the physicians at all levels of healthcare to diagnose and
manage COPD in a scientific manner. Besides the International literature, the Indian
studies were specifically analyzed to arrive at simple and practical
recommendations.

Question for sampling technique which people also asked:

Q.1 Validity of BOLD signal in hypoxemic COPD patients?
Q.2 What is the best negative suction pressure in COPD patients?

Q.3 What is the Best management in Acute exacerbation of COPD resitant to medical
management ?

Q.4 Does research anybody the rate of parasitic infection in COPD-patient?

Q.5 Which is the best protocol of the sit-to-stand test in patients with COPD?

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3.2 Tools:
Microsoft Word Different websites, Books, articles and Peoples.

3.3 Population:
The overall prevalence of COPD in those 11 countries was found to be 3.6% and the
prevalence rate in Pakistan is 2.1% in the population aged 40 years and above.
According to the Global Adult Tobacco Survey 2009, 39.1% of the adult population
of Russia are regular smokers: 60.2% men and 21.7% women. Krasnoyarsk region
is a territory with widespread risk factors for COPD, such as tobacco smoke, air
pollution, and work exposure.

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4 Data Analysis:
We analyzed dusty areas cohort comprising 272 patients with COPD. The main factors
with the highest loading in 15 variables were selected using principal component
analysis (PCA) at baseline. The COPD patients were classified by hierarchical cluster
analysis using clinical, physiological, and imaging data based on PCA-transformed
data. The clinical parameters and outcomes during the 1-year follow-up were
evaluated among the subgroups. PCA revealed that six independent components
accounted for 77.3% of variance. Three distinct subgroups were identified through the
cluster analysis. Subgroup 1 included younger subjects with fewer symptoms and mild
airflow obstruction, and they had fewer exacerbations during the 1-year follow-up.
Subgroup 2 comprised subjects with additional symptoms and moderate airflow
obstruction, and they most frequently experienced exacerbations requiring
hospitalization during the 1-year follow-up. Subgroup 3 included subjects with
additional symptoms and mild airflow obstruction; this group had more female patients
and a modest frequency of exacerbations requiring hospitalization. Cluster analysis
using the baseline data of a COPD cohort identified three distinct subgroups with
different clinical parameters and outcomes. These findings suggest that the identified
subgroups represent clinically meaningful subtypes of COPD.

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5 Discussion:
This study was conducted in a random sample of the general population aged 40 years
or older in Anhui and it followed a stringent quality-control method to improve the
validity and reliability of the findings. To the best of our knowledge, this study is the first
survey of COPD in Anhui Province, China. As a part of the national survey, the data
from this study allows us to provide the direct comparison of COPD prevalence with
national estimation in China [6]. The findings also fill several knowledge gaps about the
prevalence of COPD in Province. First, the data indicates that 9.8% of the adult
population aged 40 years or older had spirometry-defined COPD, which was lower than
the national estimation (around 13.6%) in China in 2014–2015 but higher than the
previous nationwide estimation (8.2%) in 2002–2004. Second, the proportion (55%) of
mild COPD (GOLD I) in Anhui was closed to that (56%) in China in 2014–2015.
However, the proportion was only 24% in the previous survey from 2004. Third, our
investigation demonstrated that 99.6% patients were unaware of their diagnosis in
Anhui. Fourth, the percentage (0.7%) of previous lung function examination in
identified patients was lower than the percentage of the national survey (5.9%). Fifth,
57.2% patients with COPD were asymptomatic in this study, which was higher than the
estimate (35.3%) in 2004. This study was conducted in a random sample of the
general population aged 40 years or older in Anhui and it followed a stringent quality-
control method to improve the validity and reliability of the findings. To the best of our
knowledge, this study is the first survey of COPD in Anhui Province, China. As a part of
the national survey, the data from this study allows us to provide the direct comparison
of COPD prevalence with national estimation in China. The findings also fill several
knowledge gaps about the prevalence of COPD in Province. First, the data indicates
that 9.8% of the adult population aged 40 years or older had spirometry-defined COPD,
which was lower than the national estimation (around 13.6%) in China in 2014–2015
but higher than the previous nationwide estimation (8.2%) in 2002–2004. Second, the
proportion (55%) of mild COPD (GOLD I) in Anhui was closed to that (56%) in China in
2014–2015. However, the proportion was only 24% in the previous survey from 2004.
Third, our investigation demonstrated that 99.6% patients were unaware of their
diagnosis in Anhui. Fourth, the percentage (0.7%) of previous lung function
examination in identified patients was lower than the percentage of the national survey
(5.9%). Fifth, 57.2% patients with COPD were asymptomatic in this study, which was
higher than the estimate (35.3%) in 2004. For example, age-specific prevalence of
COPD in 60–69 years was slightly decreased in the females.

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6 Conclusions:
In conclusion, our data indicates that COPD is prevalent in the adult population of
Anhui Province and the prevalence is highest in north region. The frequency of
subjects with COPD who had a previous respiratory function test or who is aware of
their diagnosis of COPD are very low.
Tobacco smoking and indoor air pollution (exposure to coal for cooking or heating)
are major preventable risk factors for the disease in Anhui. Actions such as health
promotion for prevention of COPD, early detection of COPD in high-risk individuals,
individualized treatment of COPD, and enforcing appropriate region-specific policies
are urgently needed to reduce COPD-related burden.

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7 Recommendation:
Chronic obstructive pulmonary disease (COPD) is a major respiratory illness in world
that is both preventable and treatable. Our understanding of the pathophysiology of
this complex condition continues to grow and our ability to offer effective treatment to
those who suffer from it has improved considerably. The purpose of the present
educational initiative of the Canadian Thoracic Society (CTS) is to provide up to date
information on new developments in the field so that patients with this condition will
receive optimal care that is firmly based on scientific evidence. Since the previous CTS
management recommendations were published in 2003, a wealth of new scientific
information has become available.
The implications of this new knowledge with respect to optimal clinical care
have been carefully considered by the CTS Panel and the conclusions are presented
in the current document. Highlights of this update include new epidemiological
information on mortality and prevalence of COPD, which charts its emergence as a
major health problem for women; a new section on common comorbidities in COPD;
an increased emphasis on the meaningful benefits of combined pharmacological and
non-pharmacological therapies; and a new discussion on the prevention of acute
exacerbations. A revised stratification system for severity of airway obstruction is
proposed, together with other suggestions on how best to clinically evaluate individual
patients with this complex disease. The results of the largest randomized clinical trial
ever undertaken in COPD have recently been published, enabling the Panel to make
evidence-based recommendations on the role of modern pharmacotherapy. The Panel
hopes that these new practice guidelines, which reflect a rigorous analysis of the
recent literature, will assist caregivers in the diagnosis and management of this
common condition.

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8 Appendix:
Q #1:
Estimated numbers of people ever diagnosed with COPD 2004–12

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Q #2:
Number of males and females ever diagnosed with COPD per 100,000, 2004–12

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Q #3:
Number of people newly diagnosed with COPD per 100,000, by age group, 2004–12

Q #4:
Number of males and females per 100,000 newly diagnosed with COPD each year, 2004–12

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9 References:
1. Orie NG SH, De Vries K, Tammeling GJ, Witkop J: The host factor in bronchitis.
In: Orie NG, Sluiter HJ, editors. Bronchitis Assen, The Netherlands: Royal Van
Gorcum. 1961.
2. Reid L: The Role of Chronic Bronchitis in the Production of “Chronic Obstructive
Pulmonary Emphysema”.
3. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy
for the diagnosis, management, and prevention of chronic obstructive pulmonary
disease.
4. Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global
and regional estimates of COPD prevalence: systematic review and meta-
analysis. J Glob Health. 2015.
5. World Health Organization. Global surveillance, prevention and control of chronic
respiratory diseases: a comprehensive approach.
6. Zhong N, Wang C, Yao W, Chen P, Kang J, Huang S, et al. Prevalence of
chronic obstructive pulmonary disease in China: a large, population-based
survey. Am J Respir Crit Care Med. 2007.
7. Fang L, Gao P, Bao H, Tang X, Wang B, Feng Y, et al. Chronic obstructive
pulmonary disease in China: a nationwide prevalence study. Lancet Respir Med.
2018.
8. American Association for Public Opinion Research (AAPOR). Standard
definitions: final dispositions of case codes and outcome rates for surveys.
9. American Thoracic Society. Standardization of spirometry,1994 update. Am J
Respir Crit Care Med. 1995.
10. Brick JM, Kalton G. Handling missing data in survey research. Stat
Methods Med Res. 1996.

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