Vaccines: One of the COPD keys!

DPOC -COPD

                    

WORLD COPD DAY 2011

Vaccines: One of the keys of COPD!

Marcos Henrique Sant’Ana do Nascimento, MD. 1

1. Professor de Medicina PUCPR

Although Chronic Obstructive Pulmonary Disease (COPD) is a very common disease in the world and even in America, where about 24 million Americans are carriers, we draw attention to an alarming fact: About half of patients with COPD did not know they have the disease^1,2!
And therefore, a COPD carrier could not detect it, prevent its progression and have a better life …

In 2005, approximately one in 20 deaths in the United States had COPD as the underlying cause. Smoking is estimated to be responsible for at least 75% of COPD deaths ⁽³⁾.
This article serves to collaborate in an attempt to popularize the knowledge about COPD and its control thereby providing a better quality of life.

Let’s remember first: What is COPD ?

COPD is a common lung disease of smokers and ex-smokers (and some never smokers) who experience difficulty breathing, at rest or on exertion, with or without chronic cough and sputum production.⁽⁴⁾

COPD is characterized as an inflammatory lung disease characterized by airflow limitation that is not fully reversible.

The term COPD includes:

•          Chronic bronchitis;

•          Pulmonary Emphysema.

Prevention of COPD Progression and Complications:

The decrease in lung function is the event associated with COPD morbidity and mortality. And this is triggered by smoking and for COPD exacerbations, leading by infections. Therefore, to prevent the excessive decline in lung function should be a knowledge target for the patients and must be the primary goal for Physicians caring for COPD patients, in order to a best prognosis.

Prevent decline in lung function is the goal, how to approach this goal?

It is necessary, according to medical literature obey a tripod measures:
A) Quit Smoking:
You must understand that today we have a great pharmacological armamentarium as nicotine replacement therapy, bupropion and varenicline, besides referral to smoking cessation groups, that could be offered making smoking cessation a realistic and achievable goal.
Quitting smoking is the most important thing you can do yourself in terms of living better. Consider the aspect of health and also self esteem. Seek medical attention to get rid of nicotine addiction and get rid once and for all. Do this for you. You’ll feel better!

B) Take your medicines in a right way:

Some evidence supports the use of bronchodilators as the primary pharmacologic therapy to prevent and control symptoms, reduce the frequency and severity of acute exacerbations, and improve quality of life ⁽⁵⁾ .

(C)Vaccine prophylaxis

The most common cause of exacerbation of COPD is associated with viral respiratory and bacterial infections acquired in the community, as seen above. Viral Infection as cause of exacerbations are particularly common when there are large variations in temperature reaching its peak in winter, but are also common in spring and autumn. Moreover, since 2009, the World Health Organization (WHO) declared Pandemic influenza A/H1N1, a condition that put pregnant women and those with chronic respiratory diseases like asthma and COPD, among other conditions, in the line of greatest risk for morbidity and mortality, with both respiratory diseases listed as causes of increased hospitalization in the U.S. for swine flu ⁽⁶⁾ .

Patients with COPD are at high risk for complications from influenza because of the disease itself, which decreases pulmonary reserve, and other reasons, such as: corticosteroid use that could affect the immune system response, the malfunctioning of cilia caused by cigarette smoking that resulting in colonization of the bronchi by bacteria as Pneumococcus and Hemophilus influenzae.
So, the prevention of exacerbations is recognized as a key goal in COPD disease state management ^(7).

Flu Vaccine

Getting a flu vaccine is the best way to prevent influenza. Everyone with COPD or any other chronic pulmonary condition should receive the vaccine against 2009 H1N1 flu:

• People with COPD should get the “seasonal flu shot”—a vaccine made with inactivated (killed) flu virus. The flu shot is given with a needle, usually in the upper arm.⁽⁸⁾ The shot against 2009 H1N1 flu is a “killed” vaccine, so you cannot catch the flu from getting this shot.⁽⁸⁾
• Persons with COPD should not get the nasal spray vaccine which is a live vaccine and is not recommended by CDC.
• The flu shot, inactivated 2009 H1N1 vaccine, can be administered at the same visit as any other vaccine, including the pneumococcal polysaccharide vaccine.

Pneumococcal Polysaccharide Vaccine:

During previous influenza pandemics, secondary bacterial pneumonia was a significant cause of illness and death and Streptococcus pneumoniae was the most common etiology.According to interim guidelines issued by the CDC, all persons with existing indications for PPSV23 should be vaccinated following current recommendations, as this may be useful in preventing secondary infections and reducing illness and death. ⁽⁹⁾

REFERENCES:

(1)  Han MK et al. Chest. 2007;132:403-409.

(2) Lee TA et al. Chest. 2006;129:1509-1515.

(3)CDC. Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 1997–2001. MMWR 2005;54:625–8.

(4)Rennard SI. COPD: overview of definitions, epidemiology, and factors influencing its development. Chest 1998;113(Suppl 4):235–41s.

(5) O’Donnell DE, Aaron S, Bourbeau J, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease—2007 update. Can Respir J 2007;14(Suppl B):5–32B.

(6) CDC.2009 H1N1 Flu:Underlying Heath Conditions among Hospitalized Adults and Children: -Acessed in March 30,2010.

(7) Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.

(8) Cives – Center for Health Information for Travelers of UFRJ:  http://www.cva.ufrj.br/informacao/vacinas/gripe-pr.html -Acessed in March 30,2010.

(9) Centers for Disease Control and Prevention. Interim guidance for use of 23-valent pneumococcal polysaccharide vaccine during novel influenza A (H1N1) outbreak. July 9, 2009. http://www.cdc.gov/h1n1flu/guidance/ppsv_h1n1.htm.  -Acessed im March 30,2010.

DPOC: Estou correndo risco? – COPD: Am I at risk?

RX DPOC - COPD X-RAY

DPOC: ESTOU CORRENDO RISCO?

Dia Mundial da DPOC - World COPD DAY

A maioria das pessoas que correm risco em desenvolver Doença Pulmonar Obstrutiva Crônica ( DPOC ) nunca ouviu falar nesta sigla ou mesmo nas patologias que compreendem estas 4 letras.Portanto, a breve explanação que se segue tem o objetivo de orientar não apenas os leigos como colocar em evidência para todos os públicos das áreas de saúde a necessidade de reconhecer o mais breve possível pacientes que estão em risco de desenvolver DPOC.

Alguns dos fatores que colocam  você em risco deDPOC são:

1.Tabagismo:

DPOC mais frequentemente ocorre em pessoas com mais de 40 anos com uma história de tabagismo quer seja ativo ou passivo.Tabagismo é  a maior causa de DPOC e responde por 9 em cada 10 mortes relacionadas a DPOC.

2.Exposição ambiental:

DPOC também pode ser ocasionado em pessoas que estiveram  expostas a fatores que são irritantes para os pulmões como inalantes químicos, poeiras, exposição a fornos ou a fogões a lenha, e a poluição ambiental sem contar o próprio fumo passivo já mencionado acima.

3.Fatores Genéticos:

Em algumas situações menos comuns algumas pessoas desenvolvem DPOC a partir de uma deficiência genética denominada “deficiência de alfa 1 Antitripsina.Embora seja uma condição rara é importante que se conheça esta condição pois é uma forma de desenvolver DPOC que independe do tabagismo e da exposição a poluentes.

4. Mas o que é DPOC?

DPOC é uma sigla que significa Doença Pulmonar Obstrutiva Crônica e tem duas formas de apresentação :

“Broquite Crônica” e “Enfisema pulmonar.”

É  uma doença grave que ao longo do tempo leva o seu portador a queda na função pulmonar e a grave insuficiência respiratória.Quando o DPOC é grave, graus 3 ou 4 na classificação funcional da doença (GOLD), leva a constantes sintomas como tosse crônica, sibilos ou chiados, e a dispnéia ou falta de ar até mesmo para as atividades usuais do dia a dia como:Andar, tomar banho, vestir-se ou escovar/pentear os cabelos.

E Lembre: DPOC inclui enfisema e bronquite crônica, e o risco para o seu desenvolvimento em pessoas com mais de 35 anos, supera a insuficiência cardíaca, bem como o do câncer de mama e de próstata

Segundo o Estudo de avaliação do DPOC nas Américas, PLATINO, a prevalência de tabagismo encontra-se  entre  24% em São Paulo até  39% em Santiago do Chile.

Este percentual foi maior nos homens que nas mulheres em todos os centros estudados. A grande maioria dos fumantes utiliza cigarro com filtro,e aqueles que o fazem sem filtro, como os cigarros de palha, constituem 6,5%.

Mas há dados neste estudo que chama a atenção para um fato: um percentual de indivíduos com DPOC nunca havia sido diagnosticado como portador de DPOC. Além disto, o mesmo projeto constatou a existência de um percentual elevado de subdiagnósticos ou diagnósticos incorretos!

Então se você tem mais de 40 anos, tosse cronicamente ou fuma procure um pneumologista para maiores esclarecimentos. Afinal você não quer e não deve correr riscos desnecessariamente, já que a DPOC se trata de uma doença evitável e que possui tratamento.

FONTES:

PULMÃO S.A.- Arquivos

Ministério da Saúde Brasil;

SBPT-Consenso Brasileiro de DPOC;

The Lancet, news release, Sept. 8, 2011

Estudo PLATINO- Projeto Latino-Americano de Investigação em Obstrução pulmonar- ALAT

OMS- Organização Mundial de Saúde.

ENGLISH

COPD: I am at risk?

Most people at risk to develop COPD have never heard this acronym or even in the diseases that include these 4 letters.

Therefore, a brief explanation that follows is intended to guide not only the patients, but also to highlight for all audiences in the health areas that need to recognize as soon as possible patients who are at risk of developing COPD.

ALVEOLOS PULMONARES NO DPOC- COPD LUNGS ALVEOLI

Some of the factors that put you at risk for COPD are:

1.Smoking:

COPD most often occurs in people over 40 years with a history of smoking either active or secondhand one. Smoking act is the major cause of COPD and accounts for 9 out of 10 deaths related to COPD.

2. Environmental Exposition:

COPD can also be caused in people who were exposed to factors that are irritating to the lungs as inhaled chemicals, dust, exposure to ovens or stoves, and environmental pollution not to mention the very smoke already mentioned above.

3.Genetic Factors:

In some less common situations some people develop COPD from a genetic defect called “deficiency of alpha 1 Antitripsin enzyme. It  is a rare condition but is important to know  as it is a way of developing COPD independent of smoking and exposure to pollutants.

But what is COPD?

COPD is an acronym that stands for Chronic Obstructive Pulmonary Disease and share in 2 forms of diseases: “Chronic Bronchitis” and “Lung Emphysema.”

It is therefore a serious disease that over time the wearer takes a fall in lung function and leads to a severe respiratory insufficiency.

When the  COPD is severe, receives a graduation 3 or 4 in the functional classification of the disease, leads to constant symptoms like chronic cough, wheezing or wheezing, and dyspnea, or shortness of breath, even for the usual activities of daily life such as: Floor , bathing, dressing or brushing / combing hair.

Remember: COPD includes emphysema and chronic bronchitis, and the overall risk for developing it surpasses that of heart failure as well as breast and prostate cancer

According to the Research in pulmonary obstructive study in Latin America, PLATINUM STUDY, smoking prevalence ranged from 24% in Sao Paulo up to 39% in Santiago Chile.

This percentage was higher in men than in women in all studied centers.The vast majority of smokers use cigarettes with filter, and those who smoke without filter, such as cigarettes straw, is 6.5%.

But there are some data in this study that calls attention to one fact: a percentage of individuals with COPD had never been diagnosed with COPD!

Moreover, the same project call attention that there was a high percentage of misdiagnoses!

So if you have more than 40 years, chronic cough or smoke find a pulmonologist  for further information. After all, you do not want and should not take risks unnecessarily, since COPD it is a preventable disease!

SOURCES:

PULMAOS.A. – Archives

Ministry of Health Brazil;

Brazilian Pulmonology Society- Brazilian Consensus on COPD;

The Lancet, news release, Sept. 8, 2011

PLATINUM STUDY-Latin American Project for Research in pulmonary obstruction disease-ALAT

WHO-World Health Organization