Epidemiology of comorbidities in chronic obstructive pulmonary disease: clusters, phenotypes and outcomes

Chronic obstructive pulmonary disease and atherosclerosis: common mechanisms and novel therapeutics

Chronic obstructive pulmonary disease (COPD) and atherosclerosis are chronic irreversible diseases, that share a number of common causative factors including cigarette smoking. Atherosclerosis drastically impairs blood flow and oxygen availability to tissues, leading to life-threatening outcomes including myocardial infarction (MI) and stroke. Patients with COPD are most likely to die as a result of a cardiovascular event, with 30% of all COPD-related deaths being attributed to cardiovascular disease (CVD). Both atherosclerosis and COPD involve significant local (i.e. lung, vasculature) and systemic inflammation and oxidative stress, of which current pharmacological treatments have limited efficacy, hence the urgency for the development of novel life-saving therapeutics. Currently these diseases must be treated individually, with no therapies available that can effectively reduce the likelihood of comorbid CVD other than cessation of cigarette smoking. In this review, the important mechanisms that drive atherosclerosis and CVD in people with COPD are explained and we propose that modulation of both the oxidative stress and the inflammatory burden will provide a novel therapeutic strategy to treat both the pulmonary and systemic manifestations related to these diseases.

Right heart failure as a risk factor for severe exacerbation in patients with chronic obstructive pulmonary disease: Prospective cohort study

BACKGROUND

The prognosis in patients with Chronic Obstructive Pulmonary Disease (COPD) depends, in large part, on the frequency of exacerbations. Cardiovascular diseases, including heart failure (HF), are the risk factors for exacerbations. However, the importance of HF type over the exacerbations in COPD patients is unknown.

OBJECTIVE

To determine whether right heart failure (RHF) is an independent risk factor for severe exacerbations in patients with COPD.

METHODS

A prospective cohort study of 133 patients diagnosed with COPD with a follow-up period from 2010 to 2016. Patients with bronchial hyperreactivity, asthma, or pulmonary embolism were excluded.

RESULTS

The mean age was 74.7 ± 8.2 years and 43.6% were men, 69.9% had severe exacerbations during follow-up. Subjects with RHF had lower FEV₁ (50.2 ± 19.9 vs 57.4 ± 16.9, P = .006) and greater incidence of stroke (15.4% vs 1.8%, P = .009) compared to those without RHF. Subjects with RHF were at higher risk of severe exacerbations (HR, 2.46; CI 95%, 1.32-4.58, P = .005) compared to those without RHF after adjusting for confounding variables.

CONCLUSION

In patients with COPD, RHF is an independent risk factor for suffering severe exacerbations.

Comorbidities and length of stay in chronic obstructive pulmonary disease patients

Chronic Obstructive Pulmonary Disease (COPD) has a significant burden on patients and the healthcare system. There is a link between COPD and comorbidities such as congestive heart failure (CHF), fluid and electrolyte disorders, and renal failure. This adds to the complexity of healthcare in these patients. The objective of this study is to determine if certain comorbidities affect length of stay. A sample of 3,399 patients with COPD were assessed from the Premier^© healthcare database. The cohort had a mean (standard deviation (SD)) age of 68.41 (10.85) years. The average number of comorbidities was 24.83 (10.46) with a mean length of stay (SD) of 11.64 (9.40) days. A negative binomial regression model was used to evaluate the impact that comorbidities have on the length of hospital stay. The authors found that the number of comorbidities was associated with an increased length of stay (r = .4596, p < .0001). Having at least one comorbidity was associated with a 13% greater length of stay (IRR = 1.13, 95% CI 1.11-1.15, p < 0.0001). CHF was associated with a 28% greater length of stay (IRR = 1.28, 95% CI 1.24-1.31, p < 0.0001). Fluid and electrolyte disorders were associated with a 2-fold greater length of stay (IRR = 2.57, 95% CI 2.52-2.62, p < 0.0001). Renal failure was associated with a 50% greater length of stay (IRR = 1.50, 95% CI 1.45-1.55, p < 0.0001). However, uncomplicated diabetes was associated with 13% shorter length of stay than not having uncomplicated diabetes (IRR = .87, 95% CI .82-.91, p < .0001). This study demonstrated that specific comorbidities have an impact on length of stay.

Persistent endothelial dysfunction turns the frequent exacerbator COPD from respiratory disorder into a progressive pulmonary and systemic vascular disease

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in developed countries of the world, while the main cause of mortality and morbidity in COPD patients are acute exacerbations and cardiovascular diseases. With regard to the frequency of exacerbations the phenotype "frequent exacerbators" has been defined, which, besides a more severe clinical course and a significantly higher total mortality, is also characterised by an elevated risk of cardiovascular mortality, as some indicators show us. It is notable that during the exacerbation of COPD, next to other changes, a significant aggravation of endothelial function occurs while the ED and COPD relationship seems very complex and is still in greater part unknown. Making the pathophysiological link between the frequency of exacerbations of COPD and ED could change our understanding of the character of this type of pulmonary disease. We hypothesize that frequent exacerbator COPD is a progressive and generalised vascular disease, not only an isolated respiratory disorder with ancillary systemic effects. Our opinion is that differences in COPD phenotype do not only determine the clinical picture but could also be of key importance in defining the progressivity of the disease. ED, which in these patients persists between frequent exacerbations, could be the main cause of the progression of pulmonary disease, and not only of the high cardiovascular risk of these patients. Such a persistent ED in FE COPD, with its pro-inflammatory, vasoconstrictory and prothrombotic mechanisms, could contemporaneously induce new exacerbations of COPD, the progression of pulmonary changes and the development of systemic atherosclerosis as a main extrapulmonary manifestation in these patients. Such a model defines endothelium as a common soil of progressive pulmonary and cardiovascular changes in FE COPD. It can fully explain all the elements of the clinical course and co-morbidity in FE COPD, for which we still do not have adequate explanation.