21. Epidemiology and prevention of chronic obstructive pulmonary disease
- Epidemiology
- Fourth most common cause of death worldwide
- Leading cause of morbidity in developed countries
- Male > female
- 6% prevalence in US
- Etiology
- Smoking
- 20 – 30 pack years gives 80-90% risk
- Passive smoking
- Air pollution
- Occupational exposure to dust
- Respiratory tract infections
- Premature birth
- Asthma
- Low socioeconomic status
- Physical inactivity
- Alpha-1-antitrypsin deficiency
- Smoking
- Diagnosed by spirometry
- Decreased Tiffeneau index < 70%
- <12% amelioration by bronchodilators
- Scoring
- GOLD – groups according to risk and symptoms
- BODE index – prognosis
- mMRC dyspnoea scale
- Prevention
- Primary
- Health education
- Promote smoking prevention
- Air pollution control
- Secondary
- Screening for A1ATD – family members too
- Screening of high-risk individuals
- Tertiary
- Stop smoking
- Oxygen therapy
- Pulmonary rehabilitation
- Vaccination
- Influenza
- Pneumococcus
- Exercise
- Primary