Systemic manifestations of COPD
Department of Pulmonology, Leiden University Medical Center, C3-P, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. Chest
(Impact Factor: 7.48).
01/2011; 139(1):165-73. DOI: 10.1378/chest.10-1252
COPD is characterized by a poorly reversible airflow limitation resulting from chronic inflammation, mainly due to tobacco exposure. Over the past few years, the understanding of COPD has evolved from it being a disease affecting the lungs to it being a complex, heterogeneous, and generalized disorder in an aging population. Extrapulmonary comorbidities significantly complicate the management and influence the prognosis of patients with COPD. Although certain comorbidities like cardiovascular diseases share some risk factors with COPD, such as cigarette smoking, other frequently observed comorbidities, including musculoskeletal wasting, metabolic syndrome, and depression, cannot be easily attributed to smoking. There is increasing evidence that chronic inflammation is a key factor in COPD and that inflammation might be the common pathway linking these comorbidities and explaining why they typically develop together. Physicians treating patients with COPD need to become aware of these extrapulmonary aspects. Any patient with COPD should be carefully evaluated for comorbidities and the systemic consequences of COPD since they not only influence the prognosis but also have an impact on disease management. The treatment of COPD is no longer focused exclusively on inhaled therapy but is taking on a multidimensional approach, especially because the treatment of the comorbidities might positively affect the course of COPD itself.
Available from: Diaa Fathalla
- "These systemic effects due to smoking may account for the frequent concurrent presence of other chronic illnesses such as cardiovascular diseases and metabolic disorders in COPD patients . Among COPD patients, cardiovascular diseases (CVD) are responsible for approximately 50% of all hospitalizations and 20% of all deaths . However, population-based studies have suggested that regardless of smoking status, age or sex, a COPD diagnosis increases the risk of cardiovascular morbidity and mortality by approximately two folds . "
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ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. It has some significant extra pulmonary effects that may contribute to its severity in individual patient. Among COPD patients, cardiovascular diseases (CVD) are responsible for approximately 50% of all hospitalizations and 20% of all deaths. Left ventricular diastolic dysfunction (LVDD) is a frequent condition in COPD patients. Inflammation is considered to be one of the systemic manifestations of COPD and provides an alternative hypothesis to explain the relationship between airflow limitation and cardiovascular risk. The present study aimed to assess the prevalence of LV diastolic dysfunction in COPD patients and its relation to the disease severity and presence of inflammatory markers.
Available from: Neil Barnes
- "Significant cardiovascular morbidity and mortality exists in chronic obstructive pulmonary disease (COPD) which is independent of shared risk factors such as smoking . Different mechanisms linking these two common conditions have been proposed, including arterial stiffness, a surrogate shown to be an independent predictor of cardiovascular disease in a number of other chronic inflammatory conditions  . "
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ABSTRACT: Significant cardiovascular morbidity and mortality exists in chronic obstructive pulmonary disease (COPD). Arterial stiffness is raised in COPD and may be a mechanistic link. Non-invasive assessment of arterial stiffness has the potential to be a surrogate outcome measure, although no reproducibility data exists in COPD patients. Two studies (23 and 33 COPD patients) were undertaken to 1) assess the Vicorder reproducibility of carotid-femoral pulse wave velocity and Augmentation index in COPD; 2) compare it to SphygmoCor; and 3) assess the contribution of lung hyperinflation to measurement variability. There were excellent correlations and good agreement between repeat Vicorder measurements for carotid-femoral pulse wave velocity (r = 0.96 (p < 0.001); mean difference ±SD = -0.03 ± 0.36 m/s (p = 0.65); co-efficient of reproducibility = 4.02%; limits of agreement = -0.68-0.75 m/s). Augmentation index significantly correlated (r = 0.736 (p < 0.001); mean difference ±SD = 0.72 ± 4.86% (p = 0.48), however limits of agreement were only 10.42-9.02%, with co-efficient of reproducibility of 27.93%. Comparing devices, Vicorder values were lower but there was satisfactory agreement. There were no correlation between lung hyperinflation (as measured by residual volume percent predicted, total lung capacity percent predicted or the ratio of inspiratory capacity to residual volume) and variability of measurements in either study. In COPD, measurement of carotid-femoral pulse wave velocity is highly reproducible, not affected by lung hyperinflation and suitable as a surrogate endpoint in research studies. Day-to-day variation in augmentation index highlights the importance of such studies prior to the planning and undertaking of clinical COPD research.
Available from: sciencedirect.com
- "Chronic obstructive pulmonary disease (COPD) is actually the fourth leading cause of chronic morbidity and mortality worldwide . Mortality from COPD is expected to increase further and to rank at the third position in 2020, after coronary artery disease and stroke . COPD is defined as a preventable and treatable disease with significant extrapulmonary effects that may contribute to its severity in individual patients. "
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