Vascular dysfunction in chronic obstructive pulmonary disease: Current evidence and perspectives
Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.Expert Review of Respiratory Medicine 02/2012; 6(1):37-43. DOI: 10.1586/ers.11.82
The natural course of chronic obstructive pulmonary disease (COPD) is complicated by the development of systemic consequences and comorbidities. COPD has been associated with an increased risk for cardiovascular disease, osteoporosis, cachexia and skeletal muscle weakness. In several large prospective cohort studies, the degree of airflow limitation was an independent predictor of both fatal and nonfatal cardiovascular events, implying a causal relationship between airflow obstruction and vascular disease. The pathomechanisms responsible for this association are mostly unknown. It has been proposed that systemic inflammation, oxidative stress, hypoxia and sympathetic activation may be mechanisms in COPD leading to vascular dysfunction and cardiovascular disease. However, the current evidence of a causal relationship between COPD and vascular dysfunction is insufficient and more data from well-designed studies are urgently needed, hopefully leading to novel therapeutic and preventive approaches in the care of patients with COPD.
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ABSTRACT: COPD is associated with increased cardiovascular mortality. Endothelial dysfunction may underpin this association. This cross-sectional study aims to determine the impact of airflow obstruction, systemic inflammation, oxidative stress, sympathetic activation, hypoxemia and physical activity on endothelial function in COPD.In stable COPD patients assessments of endothelial function by flow-mediated dilatation (FMD), cardiovascular risk (Pocock-score), airflow obstruction (FEV1), systemic inflammation (hsCRP, Interleukin-6), oxidative stress (malondialdehyde), sympathetic activation (baroreflex-sensitivity), hypoxemia (Pa,O2), hypercapnia (Pa,CO2), physical activity (steps per day) and exercise capacity (6-minutes walking distance) were performed. Associations between FMD and potential determinants were assessed in univariate and multivariate analysis.106 patients (35% GOLD stage I/II, 25% III, 40% IV) were included. In multivariate analysis FEV1 was positively associated with FMD, independent of other significant FMD determinants from univariate analysis (gender, smoking, combined inhaled long-acting β-adrenergic and steroid medication, heart rate, baroreflex-sensitivity, Pa,CO2) and adjusted for potential confounders (cardiovascular risk, age). In addition, the FMD and FEV1 association was modified by physical activity.The findings of this study demonstrate that the severity of airflow obstruction is a significant determinant of endothelial function in patients with COPD. A high level of physical activity seems to have a favourable effect on this association.European Respiratory Journal 02/2013; 42(5). DOI:10.1183/09031936.00144612 · 7.64 Impact Factor
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ABSTRACT: BACKGROUND: COPD is a global concern. Currently, several sets of guidelines, statements and strategies to managing COPD exist around the world. METHODS: The Czech Pneumological and Phthisiological Society (CPPS) has commissioned an Expert group to draft recommended guidelines for the management of stable COPD. Subsequent revisions were further discussed at the National Consensus Conference (NCC). Reviewers' comments contributed to the establishment of the document's final version. Diagnosis. The hallmark of the novel approach to COPD is the integrated evaluation of the patient's lung functions, symptoms, exacerbations and identifications of clinical phenotype(s). The CPPS defines 6 clinically relevant phenotypes: frequent exacerbator, COPD-asthma overlap, COPD-bronchiectasis overlap, emphysematic phenotype, bronchitic phenotype and pulmonary cachexia phenotype. Treatment. Treatment recommendations can be divided into four steps. 1(st) step = Risk exposure elimination: reduction of smoking and environmental tobacco smoke (ETS), decrease of home and occupational exposure risks. 2(nd) step = Standard treatment: inhaled bronchodilators, regular physical activity, pulmonary rehabilitation, education, inhalation training, comorbidity treatment, vaccination. 3(rd) step = Phenotype-specific therapy: PDE4i, ICS+LABA, LVRS, BVR, AAT augmentation, physiotherapy, mucolytic, ABT. 4(th) step = Care for respiratory insufficiency and terminal COPD: LTOT, lung transplantation, high intensity-NIV and palliative care. CONCLUSION: Optimal treatment of COPD patients requires an individualised, multidisciplinary approach to the patient's symptoms, clinical phenotypes, needs and wishes. The new Czech COPD guideline reflects and covers these requirements.Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 05/2013; 157(2). DOI:10.5507/bp.2013.039 · 1.20 Impact Factor
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