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Polman R, Hurst JR, Uysal OF, Mandal S, Linz D, Simons S. Cardiovascular disease and risk in COPD: a state of the art review. Expert Rev Cardiovasc Ther 2024; 22:177-191. [PMID: 38529639 DOI: 10.1080/14779072.2024.2333786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular diseases (CVD) commonly co-exist. Outcomes of people living with both conditions are poor in terms of symptom burden, receiving evidence-based treatment and mortality. Increased understanding of the underlying mechanisms may help to identify treatments to relieve this disease burden. This narrative review covers the overlap of COPD and CVD with a focus on clinical presentation, mechanisms, and interventions. Literature up to December 2023 are cited. AREAS COVERED 1. What is COPD 2. The co-existence of COPD and cardiovascular disease 3. Mechanisms of cardiovascular disease in COPD. 4. Populations with COPD are at risk of CVD 5. Complexity in the co-diagnosis of COPD in those with cardiovascular disease. 6. Therapy for COPD and implications for cardiovascular events and risk. 7. Cardiovascular risk and exacerbations of COPD. 8. Pro-active identification and management of CV risk in COPD. EXPERT OPINION The prospective identification of co-morbid COPD in CVD patients and of CVD and CV risk in people with COPD is crucial for optimizing clinical outcomes. This includes the identification of novel treatment targets and the design of clinical trials specifically designed to reduce the cardiovascular burden and mortality associated with COPD. Databases searched: Pubmed, 2006-2023.
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Affiliation(s)
- Ricardo Polman
- Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | | | - Swapna Mandal
- UCL Respiratory, University College London, London, UK
| | - Dominik Linz
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Sami Simons
- Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
- Department of Respiratory Medicine, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
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James BD, Greening NJ, Tracey N, Haldar P, Woltmann G, Free RC, Steiner MC, Evans RA, Ward TJ. Prognostication of co-morbidity clusters on hospitalisation and mortality in advanced COPD. Respir Med 2024; 222:107525. [PMID: 38182000 DOI: 10.1016/j.rmed.2023.107525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/23/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024]
Abstract
RATIONALE As the prevalence of multimorbidity increases, understanding the impact of isolated comorbidities in people COPD becomes increasingly challenging. A simplified model of common comorbidity patterns may improve outcome prediction and allow targeted therapy. OBJECTIVES To assess whether comorbidity phenotypes derived from routinely collected clinical data in people with COPD show differences in risk of hospitalisation and mortality. METHODS Twelve clinical measures related to common comorbidities were collected during annual reviews for people with advanced COPD and k-means cluster analysis performed. Cox proportional hazards with adjustment for covariates was used to determine hospitalisation and mortality risk between clusters. MEASUREMENTS AND MAIN RESULTS In 203 participants (age 66 ± 9 years, 60 % male, FEV1%predicted 31 ± 10 %) no comorbidity in isolation was predictive of worse admission or mortality risk. Four clusters were described: cluster A (cardiometabolic and anaemia), cluster B (malnourished and low mood), cluster C (obese, metabolic and mood disturbance) and cluster D (less comorbid). FEV1%predicted did not significantly differ between clusters. Mortality risk was higher in cluster A (HR 3.73 [95%CI 1.09-12.82] p = 0.036) and B (HR 3.91 [95%CI 1.17-13.14] p = 0.027) compared to cluster D. Time to admission was highest in cluster A (HR 2.01 [95%CI 1.11-3.63] p = 0.020). Cluster C was not associated with increased risk of mortality or hospitalisation. CONCLUSIONS Despite presence of advanced COPD, we report striking differences in prognosis for both mortality and hospital admissions for different co-morbidity phenotypes. Objectively assessing the multi-system nature of COPD could lead to improved prognostication and targeted therapy for patients.
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Affiliation(s)
- Benjamin D James
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Neil J Greening
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Nicole Tracey
- Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Pranabashis Haldar
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Gerrit Woltmann
- Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Robert C Free
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; School of Computing and Mathematical Sciences, University of Leicester, Leicester, UK
| | - Michael C Steiner
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Rachael A Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Thomas Jc Ward
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK.
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Fähndrich S, Herr C, Teuteberg S, Alter P, Söhler S, Soriano D, Classen J, Adams J, Weinhold V, Watz H, Waschki B, Zeller T, Eichenlaub M, Trudzinski FC, Michels JD, Omlor A, Seiler F, Moneke I, Biertz F, Stolz D, Welte T, Kauczor HU, Kahnert K, Jörres RA, Vogelmeier CF, Bals R. Midregional proatrial naturetic peptide (MRproANP) and copeptin (COPAVP) as predictors of all-cause mortality in recently diagnosed mild to moderate COPD-results from COSYCONET. Respir Res 2024; 25:56. [PMID: 38267944 PMCID: PMC10809634 DOI: 10.1186/s12931-024-02690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND MRproANP and COPAVP are prognostic markers for mortality in chronic obstructive pulmonary disease (COPD). Furthermore, these biomarkers predict mortality due to cardiovascular diseases, which are important prognostically determining comorbidities in patients with COPD. However, less is known about these biomarkers in recently diagnosed mild to moderate COPD. Therefore, we analyzed these biomarkers as potential predictors of mortality in recently diagnosed mild to moderate COPD. METHODS The blood biomarkers considered were copeptin (COPAVP), midregional adrenomedullin (MRproADM), midregional proatrial naturetic peptide (MRproANP), and fibrinogen. Analyses were performed in patients with stable "recently diagnosed mild to moderate COPD" defined by GOLD grades 0-2 and diagnosis of COPD ≤ 5 years prior to inclusion into the COSYCONET cohort (COPD and Systemic Consequences-Comorbidities Network), using Cox regression analysis with stepwise adjustment for multiple COPD characteristics, comorbidities, troponin and NT-proBNP. RESULTS 655 patients with recently diagnosed mild to moderate COPD were included. In the initial regression model, 43 of 655 patients died during the 6-year follow-up, in the final model 27 of 487. Regression analyses with adjustment for confounders identified COPAVP and MRproANP as statistically robust biomarkers (p < 0.05 each) of all-cause mortality, while MRproADM and fibrinogen were not. The fourth quartile of MRproANP (97 pmol/L) was associated with a hazard ratio of 4.5 (95%CI: 1.6; 12.8), and the fourth quartile of COPAVP (9.2 pmol/L) with 3.0 (1.1; 8.0). The results for MRproANP were confirmed in the total cohort of grade 0-4 (n = 1470 finally). CONCLUSION In patients with recently diagnosed mild to moderate COPD, elevated values of COPVP and in particular MRproANP were robust, independent biomarkers for all-cause mortality risk after adjustment for multiple other factors. This suggests that these markers might be considered in the risk assessment of early COPD.
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Affiliation(s)
- S Fähndrich
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.
| | - C Herr
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - S Teuteberg
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - P Alter
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), German Center for Lung Research (DZL), Marburg, Germany
| | - S Söhler
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), German Center for Lung Research (DZL), Marburg, Germany
| | - D Soriano
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - J Classen
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - J Adams
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - V Weinhold
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - H Watz
- Airway Research Center North (ARCN), Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, DZ, Germany
| | - B Waschki
- LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN), Grosshansdorf, Germany
- Pneumology, Hospital Itzehoe, Itzehoe, Germany
- University Heart & Vascular Center Hamburg, Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Zeller
- University Heart & Vascular Center Hamburg, Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - M Eichenlaub
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - F C Trudzinski
- Department of Pneumology and Critical Care, Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Thoraxklinik Heidelberg gGmbH, Heidelberg, Germany
| | - J D Michels
- Department of Pneumology and Critical Care, Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Thoraxklinik Heidelberg gGmbH, Heidelberg, Germany
| | - A Omlor
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - F Seiler
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - I Moneke
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - F Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - D Stolz
- Department of Pneumology, Faculty of Medicine, Medical Center, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - T Welte
- Department of Respiratory Medicine, Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - H U Kauczor
- Diagnostic and Interventional Radiology, Member of the German Center of Lung Research, University Hospital Heidelberg, Heidelberg, Germany
| | - K Kahnert
- Department of Internal Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), LMU University Hospital, LMU Munich, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - R A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich, Germany
| | - C F Vogelmeier
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), German Center for Lung Research (DZL), Marburg, Germany
- Airway Research Center North (ARCN), Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, DZ, Germany
| | - R Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, Saarbrücken, Germany
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Wahab L, Cornelissen CG, Windisch W, Dreher M. GLI-12 Reference Values versus Fixed 0.7 Ratio for the Detection of Airflow Obstruction in the Presence of Lung Hyperinflation. Biomed Hub 2024; 9:16-24. [PMID: 38264215 PMCID: PMC10805410 DOI: 10.1159/000535507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/22/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Airflow obstruction (AO) is evidenced by reduced forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) with the threshold for diagnosis often being set at <0.7. However, currently the ATS/ERS standards for interpretation of lung function tests recommend the lower limit of normal (LLN), calculated by reference equations of the Global Lung Initiative from 2012 (GLI-12), as a threshold for AO diagnosis. The present study aims to investigate phenotypes, with focus on hyperinflation, which influence AO prevalence defined by FEV1/FVC < LLN when compared to the fixed 0.7 threshold. Methods Data from 3,875 lung function tests (56.4% men, aged 18-95) including 3,824 body plethysmography recordings performed from July 2021 to June 2022 were analysed. The difference between both classifiers was quantified, before and after stratification by sex, age, and hyperinflation. Results AO diagnosis was significantly less frequent with the LLN threshold (18.2%) compared to the fixed threshold (28.0%) (p < 0.001) with discordance rate of 10.5%. In the presence of mild or moderate hyperinflation, there was substantial agreement (Cohen's kappa: 0.616, 0.718) between the classifiers compared to near perfect agreement in the presence of severe hyperinflation (Cohen's kappa: 0.896). In addition, subgroup analysis after stratification for sex, age, and hyperinflation showed significant differences between both classifiers. Conclusion The importance of using the LLN threshold instead of the fixed 0.7 threshold for the diagnosis of AO is highlighted. When using the fixed threshold AO, misdiagnosis was more common in the presence of mild to moderate hyperinflation.
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Affiliation(s)
- Lora Wahab
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian G. Cornelissen
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Wolfram Windisch
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln, gGmbH, Witten/Herdecke University, Witten, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
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Gerlich J, Ohlander J, Kromhout H, Vermeulen R, Söhler S, Radon K, Nowak D, Karrasch S, Adaskina N, Vogelmeier C, Ochmann U, Jörres RA. Cumulative occupational exposure to gases and fumes is associated with impairment in lung function and disease-related quality of life in a German COPD patient cohort. Occup Environ Med 2023; 81:oemed-2023-108908. [PMID: 38160050 PMCID: PMC10850675 DOI: 10.1136/oemed-2023-108908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The impact of occupational exposures on lung function impairments and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) was analysed and compared with that of smoking. METHODS Data from 1283 men and 759 women (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1-4 or former grade 0, without alpha-1-antitrypsin deficiency) of the COPD and Systemic Consequences Comorbidities Network cohort were analysed. Cumulative exposure to gases/fumes, biological dust, mineral dust or the combination vapours/gases/dusts/fumes was assessed using the ALOHA job exposure matrix. The effect of both occupational and smoking exposure on lung function and disease-specific QoL (St George's Respiratory Questionnaire) was analysed using linear regression analysis adjusting for age, body mass index, diabetes, hypertension and coronary artery disease, stratified by sex. RESULTS In men, exposure to gases/fumes showed the strongest effects among occupational exposures, being significantly associated with all lung function parameters and QoL; the effects were partially stronger than of smoking. Smoking had a larger effect than occupational exposure on lung diffusing capacity (transfer factor for carbon monoxide) but not on air trapping (residual volume/total lung capacity). In women, occupational exposures were not significantly associated with QoL or lung function, while the relationships between lung function parameters and smoking were comparable to men. CONCLUSIONS In patients with COPD, cumulative occupational exposure, particularly to gases/fumes, showed effects on airway obstruction, air trapping, gas uptake capacity and disease-related QoL, some of which were larger than those of smoking. These findings suggest that lung air trapping and QoL should be considered as outcomes of occupational exposure to gases and fumes in patients with COPD. TRIAL REGISTRATION NUMBER NCT01245933.
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Affiliation(s)
- Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Johan Ohlander
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Sandra Söhler
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research (DZL), Philipps-Universität Marburg, Marburg, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
| | | | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research (DZL), Philipps-Universität Marburg, Marburg, Germany
| | - Uta Ochmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Rudolf A Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Alter P, Stoleriu C, Kahnert K, Henke MO, Bals R, Trudzinski FC, Watz H, Speicher T, Söhler S, Welte T, Rabe KF, Wouters EFM, Vogelmeier CF, Jörres RA. Characteristics of Current Smokers versus Former Smokers with COPD and Their Associations with Smoking Cessation Within 4.5 Years: Results from COSYCONET. Int J Chron Obstruct Pulmon Dis 2023; 18:2911-2923. [PMID: 38084341 PMCID: PMC10710827 DOI: 10.2147/copd.s436669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Background Many patients with chronic obstructive pulmonary disease (COPD) continue smoking. We used data from the "real-life" COSYCONET COPD cohort to evaluate whether these patients differed from patients with COPD who either had ceased smoking prior to inclusion or ceased during the follow-up time of the study. Methods The analysis was based on data from visits 1-5 (covering 4.5 years), including all patients with the diagnosis of COPD who were either ex-smokers or smokers and categorized as GOLD 1-4 or the former GOLD 0 category. We compared the characteristics of smokers and ex-smokers at baseline (visit 1), as well as the course of lung function in the follow-up of permanent ex-smokers, permanent smokers and incident ex-smokers (smokers at visit 1 who ceased smoking before visit 5). We also identified baseline factors associated with subsequent smoking cessation. Results Among 2500 patients who were ever-smokers, 660 were current smokers and 1840 ex-smokers at baseline. Smokers were younger than ex-smokers (mean 61.5 vs 66.0 y), had a longer duration of smoking but fewer pack-years, a lower frequency of asthma, higher forced expiratory volume in 1 sec (FEV1, 59.4 vs 55.2% predicted) and higher functional residual capacity (FRC, 147.7 vs 144.3% predicted). Similar results were obtained for the longitudinal subpopulation, comprising 713 permanent ex-smokers, 175 permanent smokers, and 55 incident ex-smokers. When analyzing the time course of lung function, higher FRC, lower FEV1 and the presence of asthma (p < 0.05 each) were associated with incident cessation prior to visit 5, while less airway obstruction was associated with smoking continuation. Conclusion These findings, which were consistent in the cross-sectional and longitudinal analyses, suggest that lung hyperinflation was associated with being or becoming ex-smoker. Possibly, it is perceived by patients as one of the factors motivating their attempts to quit smoking, independent from airway obstruction.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Cosmina Stoleriu
- Asklepios Lungenklinik Gauting, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Gauting, Germany
| | - Kathrin Kahnert
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- MediCenterGermering, Germering, Germany
| | - Markus Oliver Henke
- Klinik für Innere Medizin und Pneumologie, Krankenhaus Martha-Maria, Munich, Germany
| | - Robert Bals
- Department of Internal Medicine V, Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Franziska C Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the Center for Lung Research (DZL), Heidelberg, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tim Speicher
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Sandra Söhler
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
- Department of Medicine, Christian-Albrechts-University, Kiel, Germany
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Wang Z, Hu Y, Ou H, Feng J, Dong S, Ren S, Lu G, Li J. Speckle tracking tissue motion mitral annulus displacement to assess early changes in the left ventricle and its association with lung function in patients with chronic obstructive pulmonary disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1439-1448. [PMID: 37883119 DOI: 10.1002/jcu.23568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To evaluate the early changes in left ventricular (LV) in patients with chronic obstructive pulmonary disease (COPD) by measuring tissue motion mitral annulus displacement (TMAD) and three-dimensional (3D) parameters using speckle tracking imaging (STI), and to explore its correlation with lung function. METHODS Forty two COPD patients (GOLD I, GOLD II, GOLD III) and 30 healthy individuals (control group) were included. STI was used to assess the changes in LV structure and systolic function. Receiver operating characteristic (ROC) curves were drawn, and correlations among TMAD parameters, LV systolic function, structural, pulmonary artery systolic pressure (PASP), and lung function were analyzed. RESULTS Compared to the control group, COPD patients were able to undergo LV remodeling, with a decrease in the absolute value of global longitudinal strain (GLS) and TMAD, but no significant modification of LVEF. Correlation analysis showed that TMAD was positively related to the absolute value of GLS (r > 0.51, P < 0.01) and predicted forced expiratory volume in the first second (FEV1%) (r > 0.56, P < 0.01), and negatively to PASP (r < -0.52, P < 0.01). The LV posterior wall thickness (LVPWd), relative wall thickness (RWT), end-diastolic volume (LVEDV) and PASP negatively correlated with FEV1%. CONCLUSION The LV geometric changes and systolic function impairment in COPD patients were found to correlate with airflow restriction (FEV1%). TMAD aided in detection of early changes in LV systolic function in COPD patients. It negatively correlated with PASP and positively with FEV1%. Moreover, it was more convenient than GLS.
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Affiliation(s)
- Zijing Wang
- Department of Ultrasound, The First Affiliated Hospital, Shihezi University, Shihezi, China
| | - Yunhua Hu
- School of Medicine, Shihezi University, Shihezi, China
| | - Huajing Ou
- Department of Respiratory Medicine, The First Affiliated Hospital, Shihezi University, Shihezi, China
| | - Jia Feng
- Department of Ultrasound, The First Affiliated Hospital, Shihezi University, Shihezi, China
| | - Shanshan Dong
- Department of Ultrasound, The First Affiliated Hospital, Shihezi University, Shihezi, China
| | - Shan Ren
- Department of Critical Care Medicine, The First Affiliated Hospital, Shihezi University, Shihezi, China
| | - Guilin Lu
- Department of Ultrasound, The First Affiliated Hospital, Shihezi University, Shihezi, China
| | - Jun Li
- Department of Ultrasound, The First Affiliated Hospital, Shihezi University, Shihezi, China
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8
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Kahnert K, A. Jörres R, Behr J, Welte T. The Diagnosis and Treatment of COPD and Its Comorbidities. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:434-444. [PMID: 36794439 PMCID: PMC10478768 DOI: 10.3238/arztebl.m2023.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/12/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third most common cause of death around the world. The affected patients suffer not only from impaired lung function, but also from a wide variety of comorbidities. Their cardiac comorbidities, in particular, lead to increased mortality. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, including guidelines from Germany and abroad. RESULTS The usual diagnostic criteria for COPD are a post-bronchodilator FEV1/FVC quotient below the fixed threshold of 0.7, or, preferably, below the lower limit of normal (LLN) according to the GLI reference values for the avoidance of over- and underdiagnosis. The overall prognosis is markedly affected by comorbidities of the lung itself and those that involve other organs; in particular, many persons with COPD die of heart disease. The potential presence of heart disease must be borne in mind in the evaluation of patients with COPD, as lung disease can impair the detection of heart disease. CONCLUSION As patients with COPD are often multimorbid, the early diagnosis and adequate treatment not only of their lung disease, but also of their extrapulmonary comorbidities are very important. Well-established diagnostic instruments and well-tested treatments are available and are described in detail in the guidelines concerning the comorbidities. Preliminary observations suggest that more attention should be paid to the potential positive effects of treating comorbidities on the lung disease itself, and vice versa.
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Affiliation(s)
- Kathrin Kahnert
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL)
| | - Rudolf A. Jörres
- Institute of Occupational, Social and Environmental Medicine,Ludwig Maximilians University LMU, Comprehensive Pneumology Center Munich, Munich
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL)
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Center of Lung Research (DZL), Hannover
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9
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Papaporfyriou A, Bartziokas K, Gompelmann D, Idzko M, Fouka E, Zaneli S, Bakakos P, Loukides S, Papaioannou AI. Cardiovascular Diseases in COPD: From Diagnosis and Prevalence to Therapy. Life (Basel) 2023; 13:1299. [PMID: 37374082 DOI: 10.3390/life13061299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is considered one of the leading causes of mortality. Cardiovascular comorbidities are diagnosed often in COPD patients, not only because of the common risk factors these two diseases share, but also because of the systemic inflammation which characterizes COPD and has deleterious effects in the cardiovascular system. The comorbid cardiovascular diseases in COPD result in several difficulties in the holistic treatment of these patients and affect outcomes such as morbidity and mortality. Several studies have reported that mortality from cardiovascular causes is common among COPD patients, while the risk for acute cardiovascular events increases during COPD exacerbations and remains high for a long time even after recovery. In this review, we focus on the prevalence of cardiovascular comorbidities in COPD patients, presenting the evidence regarding the interaction of the pathophysiological pathways which characterize each disease. Furthermore, we summarize information regarding the effects of cardiovascular treatment on COPD outcomes and vice versa. Finally, we present the current evidence regarding the impact of cardiovascular comorbidities on exacerbations, quality of life and survival of COPD patients.
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Affiliation(s)
- Anastasia Papaporfyriou
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Daniela Gompelmann
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Marco Idzko
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Evangelia Fouka
- General Hospital G. Papanikolaou, Pulmonary Department of Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Stavrina Zaneli
- 1st University Department of Respiratory Medicine, "Sotiria" Chest Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Bakakos
- 1st University Department of Respiratory Medicine, "Sotiria" Chest Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Andriana I Papaioannou
- 1st University Department of Respiratory Medicine, "Sotiria" Chest Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
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10
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Trudzinski FC, Kellerer C, Jörres RA, Alter P, Lutter JI, Trinkmann F, Herth FJF, Frankenberger M, Watz H, Vogelmeier CF, Kauczor HU, Welte T, Behr J, Bals R, Kahnert K. Gender-specific differences in COPD symptoms and their impact for the diagnosis of cardiac comorbidities. Clin Res Cardiol 2023; 112:177-186. [PMID: 34331588 PMCID: PMC9898364 DOI: 10.1007/s00392-021-01915-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND In chronic obstructive pulmonary disease (COPD), gender-specific differences in the prevalence of symptoms and comorbidity are known. RESEARCH QUESTION We studied whether the relationship between these characteristics depended on gender and carried diagnostic information regarding cardiac comorbidities. STUDY DESIGN AND METHODS The analysis was based on 2046 patients (GOLD grades 1-4, 795 women; 38.8%) from the COSYCONET COPD cohort. Assessments comprised the determination of clinical history, comorbidities, lung function, COPD Assessment Test (CAT) and modified Medical Research Council dyspnea scale (mMRC). Using multivariate regression analyses, gender-specific differences in the relationship between symptoms, single CAT items, comorbidities and functional alterations were determined. To reveal the relationship to cardiac disease (myocardial infarction, or heart failure, or coronary artery disease) logistic regression analysis was performed separately in men and women. RESULTS Most functional parameters and comorbidities, as well as CAT items 1 (cough), 2 (phlegm) and 5 (activities), differed significantly (p < 0.05) between men and women. Beyond this, the relationship between functional parameters and comorbidities versus symptoms showed gender-specific differences, especially for single CAT items. In men, item 8 (energy), mMRC, smoking status, BMI, age and spirometric lung function was related to cardiac disease, while in women primarily age was predictive. INTERPRETATION Gender-specific differences in COPD not only comprised differences in symptoms, comorbidities and functional alterations, but also differences in their mutual relationships. This was reflected in different determinants linked to cardiac disease, thereby indicating that simple diagnostic information might be used differently in men and women. CLINICAL TRIAL REGISTRATION The cohort study is registered on ClinicalTrials.gov with identifier NCT01245933 and on GermanCTR.de with identifier DRKS00000284, date of registration November 23, 2010. Further information can be obtained on the website http://www.asconet.net .
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Affiliation(s)
- Franziska C. Trudzinski
- grid.7700.00000 0001 2190 4373Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Christina Kellerer
- grid.6936.a0000000123222966School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany
| | - Rudolf A. Jörres
- grid.5252.00000 0004 1936 973XInstitute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ludwig Maximilians University (LMU), Munich, Germany
| | - Peter Alter
- grid.10253.350000 0004 1936 9756Department of Medicine, Pulmonary and Critical Care Medicine, German Center for Lung Research (DZL), Philipps University of Marburg (UMR), Marburg, Germany
| | - Johanna I. Lutter
- grid.4567.00000 0004 0483 2525Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Munich, Germany
| | - Frederik Trinkmann
- grid.7700.00000 0001 2190 4373Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Felix J. F. Herth
- grid.7700.00000 0001 2190 4373Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Marion Frankenberger
- grid.5252.00000 0004 1936 973XUniversity Munich, Asklepios Hospital Gauting and Helmholtz Zentrum München, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), Ludwig-Maximilians University (LMU), Munich, Germany
| | - Henrik Watz
- grid.452624.3Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research, Grosshansdorf, Germany
| | - Claus F. Vogelmeier
- grid.10253.350000 0004 1936 9756Department of Medicine, Pulmonary and Critical Care Medicine, German Center for Lung Research (DZL), Philipps University of Marburg (UMR), Marburg, Germany
| | - Hans-Ulrich Kauczor
- grid.5253.10000 0001 0328 4908Department of Diagnostic and Interventional Radiology, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University Hospital of Heidelberg, Heidelberg, Germany
| | - Tobias Welte
- grid.10423.340000 0000 9529 9877Department of Pneumology, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jürgen Behr
- grid.411095.80000 0004 0477 2585Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, Ludwig-Maximilians University (LMU), Munich, Germany
| | - Robert Bals
- grid.411937.9Department of Internal Medicine V, Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Kathrin Kahnert
- grid.411095.80000 0004 0477 2585Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), University Hospital, Ludwig-Maximilians University (LMU), Munich, Germany
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11
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Alter P, Kahnert K, Trudzinski FC, Bals R, Watz H, Speicher T, Söhler S, Welte T, Rabe KF, Wouters EFM, Vogelmeier CF, Jörres RA. Clinical factors linked to the type of respiratory medication in COPD: results from the COSYCONET cohort. Ther Adv Respir Dis 2023; 17:17534666231208584. [PMID: 37936408 PMCID: PMC10631320 DOI: 10.1177/17534666231208584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The use of maintenance medication in patients with chronic obstructive pulmonary disease (COPD) in real life is known to deviate from recommendations in guidelines, which are largely based on randomized controlled trials and selected populations. OBJECTIVES We used the COSYCONET (COPD and Systemic Consequences - Comorbidities Network) cohort to analyze factors linked to the use of COPD drugs under non-interventional circumstances. DESIGN COSYCONET is an ongoing, multi-center, non-interventional cohort of patients with COPD. METHODS Patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 0-4 participating in visits 1-5 were included. Data covered the period from 2010 to 2018. Generalized linear models were used to examine the relation of COPD characteristics to different types of respiratory medication. RESULTS A total of 1043 patients were included. The duration of observation was 4.5 years. Use of respiratory medication depended on GOLD grades 0-4 and groups A-D. Long-acting muscarinic antagonist therapy increased over time, and was associated with low carbon monoxide (CO) diffusing capacity, while inhaled corticosteroid (ICS) use decreased. Active smoking was associated with less maintenance therapy in general, and female sex with less ICS use. From the eight items of the COPD Assessment Test, only hill and stair climbing were consistently linked to treatment. CONCLUSION Using data from a large, close to real-life observational cohort, we identified factors linked to the use of various types of respiratory COPD medication. Overall, use was consistent with GOLD recommendations. Beyond this, we identified other correlates of medication use that may help us to understand and improve therapy decisions in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT01245933.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), Baldingerstrasse 1, Marburg 35033, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Kathrin Kahnert
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, German Center for Lung Research (DZL), Munich, Germany
- MediCenterGermering, Germering, Germany
| | - Franziska C. Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Center for Lung Research (DZL), Heidelberg, Germany
| | - Robert Bals
- Department of Internal Medicine V – Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tim Speicher
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Sandra Söhler
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F. Rabe
- LungenClinic Grosshansdorf and Department of Medicine, Christian-Albrechts University, Kiel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Emiel F. M. Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands and Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A. Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
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12
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Alter P, Lucke T, Watz H, Andreas S, Kahnert K, Trudzinski FC, Speicher T, Söhler S, Bals R, Waschki B, Welte T, Rabe KF, Vestbo J, Wouters EFM, Vogelmeier CF, Jörres RA. Cardiovascular predictors of mortality and exacerbations in patients with COPD. Sci Rep 2022; 12:21882. [PMID: 36536050 PMCID: PMC9763357 DOI: 10.1038/s41598-022-25938-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
In chronic obstructive pulmonary disease (COPD), comorbidities and worse functional status predict worse outcomes, but how these predictors compare with regard to different outcomes is not well studied. We thus compared the role of cardiovascular comorbidities for mortality and exacerbations. Data from baseline and up to four follow-up visits of the COSYCONET cohort were used. Cox or Poisson regression was employed to determine the relationship of predictors to mortality or mean annual exacerbation rate, respectively. Predictors comprised major comorbidities (including cardiovascular disease), lung function (forced expiratory volume in 1 s [FEV1], diffusion capacity for carbon monoxide [TLCO]) and their changes over time, baseline symptoms, exacerbations, physical activity, and cardiovascular medication. Overall, 1817 patients were included. Chronic coronary artery disease (p = 0.005), hypertension (p = 0.044) and the annual decline in TLCO (p = 0.001), but not FEV1 decline, were predictors of mortality. In contrast, the annual decline of FEV1 (p = 0.019) but not that of TLCO or cardiovascular comorbidities were linked to annual exacerbation rate. In conclusion, the presence of chronic coronary artery disease and hypertension were predictors of increased mortality in COPD, but not of increased exacerbation risk. This emphasizes the need for broad diagnostic workup in COPD, including the assessment of cardiovascular comorbidity.Clinical Trials: NCT01245933.
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Affiliation(s)
- Peter Alter
- grid.10253.350000 0004 1936 9756Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Baldingerstrasse 1, 35033 Marburg, Germany
| | - Tanja Lucke
- grid.411095.80000 0004 0477 2585Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Henrik Watz
- grid.414769.90000 0004 0493 3289Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Stefan Andreas
- grid.411984.10000 0001 0482 5331LungClinic Immenhausen and Department of Cardiology and Pneumology, University Medical Center Göttingen, Member of the German Center for Lung Research (DZL), Göttingen, Germany
| | - Kathrin Kahnert
- grid.411095.80000 0004 0477 2585Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Franziska C. Trudzinski
- grid.7700.00000 0001 2190 4373Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Tim Speicher
- grid.10253.350000 0004 1936 9756Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Baldingerstrasse 1, 35033 Marburg, Germany
| | - Sandra Söhler
- grid.10253.350000 0004 1936 9756Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Baldingerstrasse 1, 35033 Marburg, Germany
| | - Robert Bals
- grid.411937.9Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Benjamin Waschki
- grid.414769.90000 0004 0493 3289Department of Pneumology, Hospital Itzehoe, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), LungenClinic Grosshansdorf, Grosshansdorf, Germany ,grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Tobias Welte
- grid.452624.3Clinic for Pneumology, Hannover Medical School, Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F. Rabe
- grid.9764.c0000 0001 2153 9986LungenClinic Grosshansdorf and Department of Medicine, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Christian-Albrechts University, Kiel, Kiel/Grosshansdorf, Germany
| | - Jørgen Vestbo
- grid.5379.80000000121662407Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Emiel F. M. Wouters
- grid.412966.e0000 0004 0480 1382Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands ,grid.476478.e0000 0004 9342 5701Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Claus F. Vogelmeier
- grid.10253.350000 0004 1936 9756Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Baldingerstrasse 1, 35033 Marburg, Germany
| | - Rudolf A. Jörres
- grid.411095.80000 0004 0477 2585Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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13
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Kahnert K, Fischer C, Alter P, Trudzinski F, Welte T, Behr J, Herth F, Kauczor HU, Bals R, Watz H, Rabe K, Söhler S, Kokot I, Vogelmeier C, Jörres R. [What have we learned from the German COPD cohort COSYCONET and where do we go from here?]. Pneumologie 2022; 77:81-93. [PMID: 36526266 PMCID: PMC9931494 DOI: 10.1055/a-1966-0848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
COSYCONET 1 is the only German COPD cohort which is large enough to be internationally comparable. The recruitment, which started in 2010 and ended in December 2013, comprised 2741 patients with the diagnosis of COPD who were subsequently investigated in regular follow-up visits. All visits included a comprehensive functional and clinical characterisation. On the basis of this detailed data set, it was possible to address a large number of clinical questions. These questions ranged from the prescription of medication, the detailed analysis of comorbidities, in particular cardiovascular disease, and biomarker assessment to radiological and health-economic aspects. Currently, more than 60 publications of COSYCONET data are internationally available. The present overview provides a description of all the results that were obtained, focussing on the relationship between different clinical and functional aspects as well as their potential practical consequences. In addition, information on the follow-up study COSYCONET 2 is given.
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Affiliation(s)
- Kathrin Kahnert
- 27192Medizinische Klinik und Poliklinik V, Klinikum der Universitat München LMU, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), München, Deutschland,Korrespondenzadresse PD Dr. med. Kathrin Kahnert Klinikum der Universität München LMU, Medizinische Klinik VZiemssenstr. 180336 MünchenDeutschland
| | - Carolina Fischer
- 27192Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Peter Alter
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Franziska Trudzinski
- 14996Thoraxklinik-Heidelberg gGmbH, Translational Lung
Research Centre Heidelberg (TLRC), Member of the German Center for Lung
Research, Heidelberg, Deutschland
| | - Tobias Welte
- 9177Klinik für Pneumologie, Medizinische Hochschule Hannover, Member of the German Center of Lung Research (DZL), Hannover, Deutschland
| | - Jürgen Behr
- 27192Medizinische Klinik und Poliklinik V, Klinikum der Universitat München LMU, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), München, Deutschland
| | - Felix Herth
- 14996Thoraxklinik-Heidelberg gGmbH, Translational Lung
Research Centre Heidelberg (TLRC), Member of the German Center for Lung
Research, Heidelberg, Deutschland
| | - Hans-Ulrich Kauczor
- 27178Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Deutschland
| | - Robert Bals
- 39072Innere Medizin V – Pulmonologie, Allergologie, Beatmungs-und Umweltmedizin, Universitätsklinikum des Saarlandes, Associated member of the Germen Center of Lung Research (DZL), Homburg, Deutschland,9377Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, Saarbrücken, Deutschland
| | - Henrik Watz
- 9213Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Deutschland
| | - Klaus Rabe
- 9213Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Deutschland,98594Medizinische Fakultät, Christian-Albrechts Universität zu Kiel, Kiel, Deutschland
| | - Sandra Söhler
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Inge Kokot
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Claus Vogelmeier
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Rudolf Jörres
- 27192Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
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14
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Machado FVC, Vogelmeier CF, Jörres RA, Watz H, Bals R, Welte T, Spruit MA, Alter P, Franssen FME. Differential Impact of Low Fat-Free Mass in People With COPD Based on BMI Classifications: Results From the COPD and Systemic Consequences-Comorbidities Network. Chest 2022; 163:1071-1083. [PMID: 36470414 DOI: 10.1016/j.chest.2022.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/27/2022] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND Alterations in body composition, including a low fat-free mass index (FFMI), are common in patients with COPD and occur regardless of body weight. RESEARCH QUESTION Is the impact of low FFMI on exercise capacity, health-related quality of life (HRQL), and systemic inflammation different among patients with COPD stratified in different BMI classifications? STUDY DESIGN AND METHODS We analyzed baseline data of patients with COPD from the COPD and Systemic Consequences-Comorbidities Network cohort. Assessments included lung function, bioelectrical impedance analysis, 6-min walk distance (6MWD), HRQL, and inflammatory markers. Patients were stratified in underweight, normal weight (NW), preobese, and obese according to BMI and as presenting low, normal, or high FFMI using 25th and 75th percentiles of reference values. Linear mixed models were used to investigate the associations between fat-free mass (FFM) and fat mass with secondary outcomes in each BMI group. RESULTS Two thousand one hundred thirty-seven patients with COPD (Global Initiative for Chronic Obstructive Lung Disease stages 1-4; 61% men; mean ± SD age, 65 ± 8 years; mean ± SD FEV1, 52.5 ± 18.8% predicted) were included. The proportions of patients in underweight, NW, preobese, and obese groups were 12.3%, 31.3%, 39.6%, and 16.8%, respectively. The frequency of low FFMI decreased from lower to higher BMI groups (underweight, 81%; NW, 53%; preobese, 42%; and obese, 39%). FFM was associated with the 6MWD in the underweight group, even when adjusting for a broad set of covariates (P < .05). HRQL was not associated with FFM after adjustment for lung function or dyspnea (P > .32). Fat mass was associated with higher systemic inflammation in the NW and preobese groups (P < .05). INTERPRETATION In patients with COPD with lower weight, such as underweight patients, higher FFMI is associated independently with better exercise capacity. In contrast, in preobese and obese patients with COPD, a higher FFMI was not consistently associated with better outcomes.
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Affiliation(s)
- Felipe V C Machado
- Department of Research and Development, Ciro, Horn; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands; REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Diepenbeek, Belgium.
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps-University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Robert Bals
- Department of Internal Medicine V-Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Hannover, Germany
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps-University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Frits M E Franssen
- Department of Research and Development, Ciro, Horn; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
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15
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Kahnert K, Jörres RA, Jobst B, Wielpütz MO, Seefelder A, Hackl CM, Trudzinski FC, Watz H, Bals R, Behr J, Rabe KF, Vogelmeier CF, Alter P, Welte T, Herth F, Kauczor H, Biederer J. Association of coronary artery calcification with clinical and physiological characteristics in patients with COPD: Results from COSYCONET. Respir Med 2022; 204:107014. [DOI: 10.1016/j.rmed.2022.107014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/28/2022] [Accepted: 10/13/2022] [Indexed: 10/31/2022]
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16
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Alter P, Kahnert K, Trudzinski FC, Bals R, Watz H, Speicher T, Söhler S, Andreas S, Welte T, Rabe KF, Wouters EFM, Sassmann-Schweda A, Wirtz H, Ficker JH, Vogelmeier CF, Jörres RA. Disease Progression and Age as Factors Underlying Multimorbidity in Patients with COPD: Results from COSYCONET. Int J Chron Obstruct Pulmon Dis 2022; 17:1703-1713. [PMID: 35936574 PMCID: PMC9346297 DOI: 10.2147/copd.s364812] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
- Correspondence: Peter Alter, Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Baldingerstrasse 1, Marburg, Germany, Email
| | - Kathrin Kahnert
- Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Franziska C Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tim Speicher
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Sandra Söhler
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Stefan Andreas
- LungClinic Immenhausen and Department of Cardiology and Pneumology, University Medical Center Göttingen, Germany, Member of the German Center for Lung Research (DZL), Göttingen, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf and Department of Medicine, Christian-Albrechts University, Kiel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands and Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | | | - Hubert Wirtz
- Department of Internal Medicine I, Pneumology, University of Leipzig, Leipzig, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum Nuremberg, Nürnberg, Germany
- Paracelsus Medical University Nuremberg, Nürnberg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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17
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Balbirsingh V, Mohammed AS, Turner AM, Newnham M. Cardiovascular disease in chronic obstructive pulmonary disease: a narrative review. Thorax 2022; 77:thoraxjnl-2021-218333. [PMID: 35772939 DOI: 10.1136/thoraxjnl-2021-218333] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/06/2022] [Indexed: 11/04/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease (CVD) and concomitant disease leads to reduced quality of life, increased hospitalisations and worse survival. Acute pulmonary exacerbations are an important contributor to COPD burden and are associated with increased cardiovascular (CV) events. Both COPD and CVD represent a significant global disease impact and understanding the relationship between the two could potentially reduce this burden. The association between CVD and COPD could be a consequence of (1) shared risk factors (environmental and/or genetic) (2) shared pathophysiological pathways (3) coassociation from a high prevalence of both diseases (4) adverse effects (including pulmonary exacerbations) of COPD contributing to CVD and (5) CVD medications potentially worsening COPD and vice versa. CV risk in COPD has traditionally been associated with increasing disease severity, but there are other relevant COPD subtype associations including radiological subtypes, those with frequent pulmonary exacerbations and novel disease clusters. While the prevalence of CVD is high in COPD populations, it may be underdiagnosed, and improved risk prediction, diagnosis and treatment optimisation could lead to improved outcomes. This state-of-the-art review will explore the incidence/prevalence, COPD subtype associations, shared pathophysiology and genetics, risk prediction, and treatment of CVD in COPD.
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Affiliation(s)
- Vishanna Balbirsingh
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Andrea S Mohammed
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Michael Newnham
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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18
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Lopez-Campos JL, Almagro P, Gómez JT, Chiner E, Palacios L, Hernández C, Navarro MD, Molina J, Rigau D, Soler-Cataluña JJ, Calle M, Cosío BG, Casanova C, Miravitlles M. Spanish COPD Guideline (GesEPOC) Update: Comorbidities, Self-Management and Palliative Care. Arch Bronconeumol 2022; 58:334-344. [PMID: 35315327 DOI: 10.1016/j.arbres.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022]
Abstract
The current health care models described in GesEPOC indicate the best way to make a correct diagnosis, the categorization of patients, the appropriate selection of the therapeutic strategy and the management and prevention of exacerbations. In addition, COPD involves several aspects that are crucial in an integrated approach to the health care of these patients. The evaluation of comorbidities in COPD patients represents a healthcare challenge. As part of a comprehensive assessment, the presence of comorbidities related to the clinical presentation, to some diagnostic technique or to some COPD-related treatments should be studied. Likewise, interventions on healthy lifestyle habits, adherence to complex treatments, developing skills to recognize the signs and symptoms of exacerbation, knowing what to do to prevent them and treat them within the framework of a self-management plan are also necessary. Finally, palliative care is one of the pillars in the comprehensive treatment of the COPD patient, seeking to prevent or treat the symptoms of a disease, the side effects of treatment, and the physical, psychological and social problems of patients and their caregivers. Therefore, the main objective of this palliative care is not to prolong life expectancy, but to improve its quality. This chapter of GesEPOC 2021 presents an update on the most important comorbidities, self-management strategies, and palliative care in COPD, and includes a recommendation on the use of opioids for the treatment of refractory dyspnea in COPD.
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Affiliation(s)
- José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - Pere Almagro
- Servicio de Medicina Interna, Hospital Universitario Mutua de Tarrasa, Tarrasa, Barcelona, España
| | | | - Eusebi Chiner
- Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, España
| | - Leopoldo Palacios
- Unidad de Gestión Clínica El Torrejón, Distrito Sanitario Huelva-Costa y Condado-Campiña, Huelva, España
| | - Carme Hernández
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Dispositivo transversal hospitalización a domicilio, Dirección Médica y Enfermera, Hospital Clínic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | | | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, Fuenlabrada, Madrid, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | | | - Myriam Calle
- Servicio de Neumología, Hospital Clínico San Carlos, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Borja G Cosío
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Baleares, España
| | - Ciro Casanova
- Unidad de Investigación, Servicio de Neumología, Hospital Universitario de La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Tenerife, España
| | - Marc Miravitlles
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
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19
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Figueira-Gonçalves JM, Hernández-Pérez JM, Cabrera-López C, Wangüemert-Pérez AL, García-Talavera I, Ramallo-Fariña Y, Ramos-Izquierdo C, González-García LM, Guanche-Dorta S. Characteristics of patients referred to Canary Island pneumology outpatient services for chronic obstructive pulmonary disease: the EPOCan study. BMC Res Notes 2022; 15:36. [PMID: 35144675 PMCID: PMC8830167 DOI: 10.1186/s13104-022-05930-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Assessing patients with chronic obstructive pulmonary disease (COPD) accounts for 30% of all pneumology outpatient evaluations. COPD is a heterogeneous disease and generates a massive public health problem. Overall morbidity, particularly cardiovascular disease, challenges patient management. This is an observational, multicentre study, performed at four hospitals in the Canary Islands (Spain), aimed at characterising patients with COPD referred to pneumology outpatient services. Demographic variables, lung function, and morbidity were assessed. Results Of the 877 included patients, 44.9% were active smokers with a mean (± SD) age of 68.2 ± 10.3 years. The median (IQR) score for the Charlson comorbidity index was 2 (2), and 70.6% of the patients were assigned high risk according to the Spanish Guidelines for COPD (GesEPOC) 2021. The degree of airflow obstruction defined by the GOLD 2021 stages 1, 2, 3, and 4 corresponded to 13.6%, 49%, 31%, and 6.3% of patients, respectively. The most frequently associated morbidities were arterial hypertension (59.5%), dyslipidaemia (54.3%), and type 2 diabetes mellitus (31.2%); 32% of the patients suffered heart disease. There is a high prevalence of active smoking, type 2 diabetes mellitus, and heart disease in patients referred for COPD to Canary Island pneumology outpatient services. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-05930-7.
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Affiliation(s)
- Juan Marco Figueira-Gonçalves
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain. .,University Institute of Tropical Disease and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain.
| | - José María Hernández-Pérez
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Ignacio García-Talavera
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Foundation of the Canary Islands Health Research Institute (FIISC), Santa Cruz de Tenerife, SpainHealth Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Carolina Ramos-Izquierdo
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Luis Manuel González-García
- Primary Care Centre of the Canary Islands Public Health Service, Breña Baja, La Palma, Santa Cruz de Tenerife, Spain
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20
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Lopez-Campos JL, Almagro P, Gómez JT, Chiner E, Palacios L, Hernández C, Navarro MD, Molina J, Rigau D, Soler-Cataluña JJ, Calle M, Cosío BG, Casanova C, Miravitlles M. [Translated article] Spanish COPD Guideline (GesEPOC) Update: Comorbidities, Self-Management and Palliative Care. ARCHIVOS DE BRONCONEUMOLOGÍA 2022. [DOI: 10.1016/j.arbres.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Kang HS, Jung JW, Park HJ, Park DI, Park JS, Park JH, Lee SH, Chun EM, Kim JY, Choi HS. A pilot investigation of e-cigarette use and smoking behaviour among patients with chronic airway disease or respiratory symptoms. CLINICAL RESPIRATORY JOURNAL 2021; 16:17-26. [PMID: 34486226 PMCID: PMC9060118 DOI: 10.1111/crj.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
Background This pilot study aimed to investigate the current status of e‐cigarettes (ECs) use patterns among patients with chronic airway disease or chronic respiratory symptoms and the effects of ECs use on respiratory and mental health. Methods A cross‐sectional survey was conducted at the outpatient clinic of eight teaching hospitals in South Korea between November 2019 and December 2019. All adult ECs users (19 years and above) who visited the outpatient clinic as a patient with chronic airway disease or chronic respiratory symptoms were eligible to participate in this study. Results A total of 51 subjects responded to the survey. Most of the participants were male (92.2%) and the mean age was 41.8 years. Dominant airway diseases were asthma and chronic obstructive pulmonary disease. Most of the subjects had a history of cigarette smoking, and 19 subjects were dual users of current cigarettes and ECs. Most of the subjects started ECs use due to health‐related reasons. When comparing exclusive ECs users and dual users, St. George's respiratory questionnaire (SGRQ) scores, the proportion of cases with moderate to severe depressive symptoms, and average Fagerstrom test for nicotine dependence scores for ECs were higher in dual users than exclusive ECs users (mean 4.64 vs. 2.38, p = 0.006), respectively. Conclusion Most of the subjects started ECs use due to health concerns, but dual users have more respiratory symptoms and higher nicotine dependence in this pilot study. One hypothesis that comes from these results is that greater nicotine dependence may influence behaviours, habits, and views about ECs. These preliminary observations need confirmation in a large cohort.
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Affiliation(s)
- Hye Seon Kang
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Woo Jung
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hye Jung Park
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Dong Il Park
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jong Sook Park
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Bucheon, Republic of Korea
| | - Joo Hun Park
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ajou University, Suwon, Republic of Korea
| | - Sang Haak Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Mi Chun
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jae Yeol Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hye Sook Choi
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
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22
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Le TT, Qato DM, Magder L, Bjarnadóttir M, Zafari Z, Simoni-Wastila L. Prevalence and Newly Diagnosed Rates of Multimorbidity in Older Medicare Beneficiaries with COPD. COPD 2021; 18:541-548. [PMID: 34468243 DOI: 10.1080/15412555.2021.1968815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Few studies have quantified the multimorbidity burden in older adults with chronic obstructive pulmonary disease (COPD) using large and generalizable data. Such evidence is essential to inform evidence-based research, clinical care, and resource allocation. This retrospective cohort study used a nationally representative sample of Medicare beneficiaries aged 65 years or older with COPD and 1:1 matched (on age, sex, and race) non-COPD beneficiaries to: (1) quantify the prevalence of multimorbidity at COPD onset and one-year later; (2) quantify the rates [per 100 person-years (PY)] of newly diagnosed multimorbidity during in the year prior to and in the year following COPD onset; and (3) compare multimorbidity prevalence in beneficiaries with and without COPD. Among 739,118 eligible beneficiaries with and without COPD, the average number of multimorbidity was 10.0 (SD = 4.7) and 1.0 (SD = 3.3), respectively. The most prevalent multimorbidity at COPD onset and at one-year after, respectively, were hypertension (70.8% and 80.2%), hyperlipidemia (52.2% and 64.8%), anemia (42.1% and 52.0%), arthritis (39.8% and 47.7%), and congestive heart failure (CHF) (31.3% and 38.8%). Conditions with the highest newly diagnosed rates before and following COPD onset, respectively, included hypertension (39.8 and 32.3 per 100 PY), hyperlipidemia (22.8 and 27.6), anemia (17.8 and 20.3), CHF (16.2 and 13.2), and arthritis (12.9 and 13.2). COPD was significantly associated with increased odds of all measured conditions relative to non-COPD controls. This study updates existing literature with more current, generalizable findings of the substantial multimorbidity burden in medically complex older adults with COPD-necessary to inform patient-centered, multidimensional care.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1968815 .
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Affiliation(s)
- Tham T Le
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
| | - Danya M Qato
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Larry Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Margrét Bjarnadóttir
- Department of Decision, Operation, and Information Technologies, University of Maryland, College Park, MD, USA
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
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23
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COPD maintenance medication is linked to left atrial size: Results from the COSYCONET cohort. Respir Med 2021; 185:106461. [PMID: 34116329 DOI: 10.1016/j.rmed.2021.106461] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/09/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lung function impairment in COPD is known to be related to reductions of left heart size, while short-term interventional trials with bronchodilators showed positive effects on cardiac parameters. We investigated whether COPD maintenance therapy has analogous long-term effects. METHODS Pooled data of GOLD grade 1-4 patients from visits 1 and 3 (1.5 y apart) of the COSYCONET cohort were used. Medication was categorized as use of ICS, LABA + ICS, LABA + LAMA and triple therapy (LABA + LAMA + ICS), contrasting "always" versus "never". Echocardiographic parameters comprised left ventricular end-diastolic and -systolic diameter (LVEDD, LVESD), ejection fraction (LVEF) and left atrial diameter (LA). Associations were identified by multiple regression analysis, as well as propensity score analysis. RESULTS Overall, 846 patients (mean age 64.5 y; 41% female) were included, 53% using ICS at both visits, 51% LABA + ICS, 56% LABA + LAMA, 40% LABA + LAMA + ICS (triple) therapy. Conversely, 30%, 32%, 28% and 42% had no ICS, LABA + ICS, LABA + LAMA or triple therapy, respectively, at both visits. Among echocardiographic measures, only LA showed statistically significant associations (increases) with medication, whereby significant effects were linked to ICS, LABA + ICS and LABA + LAMA (p < 0.05 each, "always" versus "never") and propensity score analyses underlined the role of LABA + LAMA. CONCLUSIONS In this observational study, COPD maintenance therapy, especially LABA + LAMA, was linked to left atrial size, consistent with the results of short-term interventional trials. These findings suggest that maintenance medication for COPD does not only improve lung function and patient reported outcomes but may also have an impact on the cardiovascular system. TRIAL REGISTRATION NCT01245933.
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Urban MH, Mayr AK, Schmidt I, Grasmuk-Siegl E, Burghuber OC, Funk GC. Effects of Dynamic Hyperinflation on Left Ventricular Diastolic Function in Healthy Subjects - A Randomized Controlled Crossover Trial. Front Med (Lausanne) 2021; 8:659108. [PMID: 34017848 PMCID: PMC8129530 DOI: 10.3389/fmed.2021.659108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Diastolic dysfunction of the left ventricle is common in patients with chronic obstructive pulmonary disease (COPD). Dynamic hyperinflation has been suggested as a key determinant of reduced diastolic function in COPD. We aimed to investigate the effects of induced dynamic hyperinflation on left ventricular diastolic function in healthy subjects to exclude other confounding mechanisms associated with COPD. Design: In this randomized controlled crossover trial (NCT03500822, https://www.clinicaltrials.gov/), we induced dynamic hyperinflation using the validated method of expiratory resistance breathing (ERB), which combines tachypnea with expiratory resistance, and compared the results to those of tachypnea alone. Healthy male subjects (n = 14) were randomly assigned to the ERB or control group with subsequent crossover. Mild, moderate, and severe hyperinflation (i.e., ERB1, ERB2, ERB3) were confirmed by intrinsic positive end-expiratory pressure (PEEPi) using an esophageal balloon catheter. The effects on diastolic function of the left ventricle were measured by transthoracic echocardiographic assessment of the heart rate-adjusted transmitral E/A-ratio and E/e'-ratio. Results: We randomly assigned seven participants to the ERB group and seven to the control group (age 26 [24-26] vs. 24 [24-34], p = 0.81). Severe hyperinflation decreased the E/A-ratio compared to the control condition (1.63 [1.49-1.77] vs. 1.85 [0.95-2.75], p = 0.039), and moderate and severe ERB significantly increased the septal E/e'-ratio. No changes in diastolic function were found during mild hyperinflation. PEEPi levels during ERB were inversely correlated with the E/A ratio (regression coefficient = -0.007, p = 0.001). Conclusions: Our data indicate dynamic hyperinflation as a determinant of left ventricular diastolic dysfunction in healthy subjects. Therapeutic reduction of hyperinflation might be a treatable trait to improve diastolic function in patients with COPD.
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Affiliation(s)
- Matthias Helmut Urban
- Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Otto Wagner Hospital, Ludwig-Boltzmann Institute for Lung Health, Vienna, Austria
| | - Anna Katharina Mayr
- Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Ingrid Schmidt
- Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria.,Institute for Physical and Rehabilitation Medicine/Cardiorespiratory Therapy, Klinik Floridsdorf, Vienna, Austria
| | - Erwin Grasmuk-Siegl
- Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Otto Chris Burghuber
- Otto Wagner Hospital, Ludwig-Boltzmann Institute for Lung Health, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Department of Internal and Respiratory Medicine, Klinik Ottakring, Vienna, Austria
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25
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Lutter JI, Jörres RA, Welte T, Watz H, Waschki B, Alter P, Trudzinski FC, Ohlander J, Behr J, Bals R, Studnicka M, Holle R, Vogelmeier CF, Kahnert K. Impact of Education on COPD Severity and All-Cause Mortality in Lifetime Never-Smokers and Longtime Ex-Smokers: Results of the COSYCONET Cohort. Int J Chron Obstruct Pulmon Dis 2020; 15:2787-2798. [PMID: 33177816 PMCID: PMC7652228 DOI: 10.2147/copd.s273839] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/23/2020] [Indexed: 01/03/2023] Open
Abstract
Background Beyond smoking, several risk factors for the development of chronic obstructive pulmonary disease (COPD) have been described, among which socioeconomic status including education is of particular interest. We studied the contribution of education to lung function and symptoms relative to smoking in a group of never-smokers with COPD compared to a group of long-time ex-smokers with COPD. Methods We used baseline data of the COSYCONET cohort, including patients of GOLD grades 1-4 who were either never-smokers (n=150, age 68.5y, 53.3% female) or ex-smokers (≥10 packyears) for at least 10 years (n=616, 68.3y, 29.9% female). Socioeconomic status was analyzed using education level and mortality was assessed over a follow-up period of 4.5 years. Analyses were performed using ANOVA and regression models. Results Spirometric lung function did not differ between groups, whereas CO diffusing capacity and indicators of lung hyperinflation/air-trapping showed better values in the never-smoker group. In both groups, spirometric lung function depended on the education level, with better values for higher education. Quality of life and 6-MWD were significantly different in never-smokers as well as patients with higher education. Asthma, alpha-1-antitrypsin deficiency, and bronchiectasis were more often reported in never-smokers, and asthma was more often reported in patients with higher education. Higher education was also associated with reduced mortality (hazard ratio 0.46; 95% CI 0.22-0.98). Conclusion Overall, in the COSYCONET COPD cohort, differences in functional status between never-smokers and long-time ex-smokers were not large. Compared to that, the dependence on education level was more prominent, with higher education associated with better outcomes, including mortality. These data indicate that non-smoking COPD patients' socioeconomic factors are relevant and should be taken into account by clinicians.
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Affiliation(s)
- Johanna I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Munich 80336, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Hannover 30625, Germany
| | - Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf 22927, Germany
| | - Benjamin Waschki
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg 35043, Germany
| | - Franziska C Trudzinski
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Johan Ohlander
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany.,Institute for Risk Assessment Sciences, Utrecht University, Utrecht 3584 CM, Netherlands
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, 80336, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Homburg 66424, Germany
| | - Michael Studnicka
- Department of Pneumology, Paracelsus Medical University Salzburg, Universitätsklinikum Salzburg, Salzburg 5020, Austria
| | - Rolf Holle
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Ludwig-Maximilians-University Munich (LMU), Munich 81377, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg 35043, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, 80336, Germany
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26
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Lopez-Campos JL, Ruiz-Duque B, Carrasco-Hernandez L, Caballero-Eraso C. Integrating Comorbidities and Phenotype-Based Medicine in Patient-Centered Medicine in COPD. J Clin Med 2020; 9:jcm9092745. [PMID: 32854364 PMCID: PMC7565552 DOI: 10.3390/jcm9092745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022] Open
Abstract
Despite recent notable innovations in the management of chronic obstructive pulmonary disease (COPD), no major advances in patient-centered medicine have been achieved. Current guidelines base their proposals on the average results from clinical trials, leading to what could be termed ‘means-based’ medical practice. However, the therapeutic response is variable at the patient level. Additionally, the variability of the clinical presentation interacts with comorbidities to form a complex clinical scenario for clinicians to deal with. Consequently, no consensus has been reached over a practical approach for combining comorbidities and disease presentation markers in the therapeutic algorithm. In this context, from the patients’ first visit, the clinician faces four major dilemmas: (1) establishing the correct diagnosis of COPD as opposed to other airway diseases, such as bronchial asthma; (2) deciding on the initial therapeutic approach based on the clinical characteristics of each case; (3) setting up a study strategy for non-responding patients; (4) pursuing a follow-up strategy with two well-defined periods according to whether close or long-term follow-up is required. Here, we will address these major dilemmas in the search for a patient-centered approach to COPD management and suggest how to combine them all in a single easy-to-use strategy.
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Affiliation(s)
- José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, 41013 Sevilla, Spain; (B.R.-D.); (L.C.-H.); (C.C.-E.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - Borja Ruiz-Duque
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, 41013 Sevilla, Spain; (B.R.-D.); (L.C.-H.); (C.C.-E.)
| | - Laura Carrasco-Hernandez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, 41013 Sevilla, Spain; (B.R.-D.); (L.C.-H.); (C.C.-E.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Candelaria Caballero-Eraso
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, 41013 Sevilla, Spain; (B.R.-D.); (L.C.-H.); (C.C.-E.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Andreas S, Bothner U, de la Hoz A, Kloer I, Trampisch M, Alter P. A Post Hoc Holter ECG Analysis of Olodaterol and Formoterol in Moderate-to-Very-Severe COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:1955-1965. [PMID: 32848381 PMCID: PMC7428408 DOI: 10.2147/copd.s246353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) are at risk of developing cardiac arrhythmias and elevated heart rate. A theoretical mechanistic association based on the interaction of long-acting β2-agonists (LABAs) with adrenoreceptors in the heart and vasculature is assumed as a potential class-related risk. Therefore, we performed a pooled analysis of Holter electrocardiogram (ECG) data from four 48-week, randomized, double-blind, placebo-controlled, parallel-group, Phase III clinical trials evaluating olodaterol (5 μg or 10 μg) or formoterol (12 µg) versus placebo. Methods We analyzed Holter ECG data from a representative subset of 775 patients with Global Initiative for Chronic Obstructive Lung Disease stage 2–4 COPD from four studies (1222.11–14) assessing olodaterol (5 μg and 10 μg) and formoterol (12 µg) versus placebo. Results No statistically significant (P>0.3) or clinically relevant differences in the shift from baseline of premature supraventricular or ventricular beats were observed among the active treatment and the placebo groups. Minor and transient differences were observed in the adjusted mean heart rate from baseline during treatment in all groups. There was a numerically small but statistically significant increase for formoterol at Week 24, olodaterol 5 μg at Weeks 12 and 40, and olodaterol 10 μg at Week 40 (all less than 3.0 beats per minute). Mean heart rates returned to a statistically non-significant change at Week 48 for all treatment groups. No increase in major adverse cardiovascular events was observed. Conclusion Treatment with olodaterol or formoterol is not associated with arrhythmias or a persistent increase in heart rate as assessed by Holter ECG in patients with COPD. Trial Registration ClinicalTrials.gov identifiers: NCT00782210 (1222.11); NCT00782509 (1222.12); NCT00793624 (1222.13); NCT00796653 (1222.14).
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Affiliation(s)
- Stefan Andreas
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,LungClinic Immenhausen, Immenhausen, Germany, Member of the German Center for Lung Research (DZL)
| | - Ulrich Bothner
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Alberto de la Hoz
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Isabel Kloer
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany, Member of the German Center for Lung Research (DZL)
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28
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Andreas S, McGarvey L, Bothner U, Trampisch M, de la Hoz A, Fležar M, Buhl R, Alter P. Absence of Adverse Effects of Tiotropium/Olodaterol Compared with the Monocomponents on Long-Term Heart Rate and Blood Pressure in Patients with Moderate-to-Very-Severe COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:1935-1944. [PMID: 32848379 PMCID: PMC7428407 DOI: 10.2147/copd.s246348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction Long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are established maintenance bronchodilator treatments for chronic obstructive pulmonary disease (COPD) with the potential to increase heart rate (HR) and impact blood pressure (BP). While previous studies indicate that HR and BP are not negatively influenced by tiotropium or olodaterol monotherapy, the effect of tiotropium/olodaterol has not been evaluated. We report a post hoc analysis of the effect of dual bronchodilation with tiotropium/olodaterol versus monocomponents on HR and BP in patients with moderate-to-very-severe COPD included in the large TONADO® study. Methods The TONADO® trials (1237.5 [NCT01431274] and 1237.6 [NCT01431287]) were two replicate, randomized, double-blind, parallel-group, 52-week, Phase III trials that compared tiotropium/olodaterol (5/5 μg and 2.5/5 μg) with tiotropium (5 μg and 2.5 μg) and olodaterol (5 μg) in patients with moderate-to-very-severe COPD. Patients with cardiovascular comorbidities were included. Changes in HR and systolic/diastolic BP were measured before and after dosing with the study medication at each visit (baseline, Week 12, Week 24 and Week 52). Results Overall, 3,100 patients were included in this analysis. Over 52 weeks, small changes from baseline in mean HR (<2 beats per minute [bpm]) and small changes from pre- to post-dose (<1 bpm) were evident at different time points. There was a non-significant increase from baseline in mean diastolic and systolic BP (<2 mmHg) observed over 52 weeks of treatment. The short-term (1 hour pre- to 1 hour post-dose) mean changes in systolic and diastolic BP over 52 weeks in the tiotropium/olodaterol 5/5 µg group were comparable with those observed for the monocomponents at all time points. Conclusion There were no differences in HR or BP among patients on tiotropium/olodaterol when compared with monocomponents. This supports the already demonstrated cardiovascular safety profile of tiotropium/olodaterol as long-acting maintenance bronchodilator treatment for COPD, including patients with cardiovascular comorbidities.
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Affiliation(s)
- Stefan Andreas
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
- LungClinic Immenhausen, Immenhausen, Germany, Member of the German Center for Lung Research (DZL)
| | | | - Ulrich Bothner
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Alberto de la Hoz
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Roland Buhl
- Pulmonary Department, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany, Member of the German Center for Lung Research (DZL)
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29
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Alter P, Orszag J, Kellerer C, Kahnert K, Speicher T, Watz H, Bals R, Welte T, Vogelmeier CF, Jörres RA. Prediction of air trapping or pulmonary hyperinflation by forced spirometry in COPD patients: results from COSYCONET. ERJ Open Res 2020; 6:00092-2020. [PMID: 32743009 PMCID: PMC7383055 DOI: 10.1183/23120541.00092-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background Air trapping and lung hyperinflation are major determinants of prognosis and response to therapy in chronic obstructive pulmonary disease (COPD). They are often determined by body plethysmography, which has limited availability, and so the question arises as to what extent they can be estimated via spirometry. Methods We used data from visits 1–5 of the COPD cohort COSYCONET. Predictive parameters were derived from visit 1 data, while visit 2–5 data was used to assess reproducibility. Pooled data then yielded prediction models including sex, age, height, and body mass index as covariates. Hyperinflation was defined as ratio of residual volume (RV) to total lung capacity (TLC) above the upper limit of normal. (ClinicalTrials.gov identifier: NCT01245933). Results Visit 1 data from 1988 patients (Global Initiative for Chronic Obstructive Lung Disease grades 1–4, n=187, 847, 766, 188, respectively) were available for analysis (n=1231 males, 757 females; mean±sd age 65.1±8.4 years; forced expiratory volume in 1 s (FEV1) 53.1±18.4 % predicted (% pred); forced vital capacity (FVC) 78.8±18.8 % pred; RV/TLC 0.547±0.107). In total, 7157 datasets were analysed. Among measures of hyperinflation, RV/TLC showed the closest relationship to FEV1 % pred and FVC % pred, which were sufficient for prediction. Their relationship to RV/TLC could be depicted in nomograms. Even when neglecting covariates, hyperinflation was predicted by FEV1 % pred, FVC % pred or their combination with an area under the curve of 0.870, 0.864 and 0.889, respectively. Conclusions The degree of air trapping/hyperinflation in terms of RV/TLC can be estimated in a simple manner from forced spirometry, with an accuracy sufficient for inferring the presence of hyperinflation. This may be useful for clinical settings, where body plethysmography is not available. This proposed method allows estimation of hyperinflation in COPD by spirometry, obviating the need for body plethysmography or further techniques. Results are depicted in easily applicable nomograms that can be used in clinical practice.https://bit.ly/3c0tUNL
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Affiliation(s)
- Peter Alter
- Dept of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Jan Orszag
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), member of the DZL, Munich, Germany
| | - Christina Kellerer
- School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany
| | - Kathrin Kahnert
- Dept of Internal Medicine V, University Hospital, LMU Munich, CPC-M, member of the DZL, Munich, Germany
| | - Tim Speicher
- Dept of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, member of the DZL, Grosshansdorf, Germany
| | - Robert Bals
- Dept of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, member of the DZL, Hannover, Germany
| | - Claus F Vogelmeier
- Dept of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), member of the DZL, Munich, Germany
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30
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Kahnert K, Götschke J, Bausewein C, Behr J. [The palliative care of COPD]. MMW Fortschr Med 2020; 162:36-43. [PMID: 32514988 DOI: 10.1007/s15006-020-0016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Kathrin Kahnert
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität, Marchioninistraße 15, D-81377, München, Deutschland.
| | - Jeremias Götschke
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, LMU, Deutschland
| | - Claudia Bausewein
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, LMU, Deutschland
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, LMU, Deutschland
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31
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von Siemens SM, Perneczky R, Vogelmeier CF, Behr J, Kauffmann-Guerrero D, Alter P, Trudzinski FC, Bals R, Grohé C, Söhler S, Waschki B, Lutter JI, Welte T, Jörres RA, Kahnert K. The association of cognitive functioning as measured by the DemTect with functional and clinical characteristics of COPD: results from the COSYCONET cohort. Respir Res 2019; 20:257. [PMID: 31727165 PMCID: PMC6854705 DOI: 10.1186/s12931-019-1217-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/15/2019] [Indexed: 01/13/2023] Open
Abstract
Alterations of cognitive functions have been described in COPD. Our study aimed to disentangle the relationship between the degree of cognitive function and COPD characteristics including quality of life (QoL). Data from 1969 COPD patients of the COSYCONET cohort (GOLD grades 1–4; 1216 male/ 753 female; mean (SD) age 64.9 ± 8.4 years) were analysed using regression and path analysis. The DemTect screening tool was used to measure cognitive function, and the St. George‘s respiratory questionnaire (SGRQ) to assess disease-specific QoL. DemTect scores were < 9 points in 1.6% of patients and < 13 points in 12% when using the original evaluation algorithm distinguishing between < 60 or > =60 years of age. For statistical reasons, we used the average of both algorithms independent of age in all subsequent analyses. The DemTect scores were associated with oxygen content, 6-min-walking distance (6-MWD), C-reactive protein (CRP), modified Medical Research Council dyspnoea scale (mMRC) and the SGRQ impact score. Conversely, the SGRQ impact score was independently associated with 6-MWD, FVC, mMRC and DemTect. These results were combined into a path analysis model to account for direct and indirect effects. The DemTect score had a small, but independent impact on QoL, irrespective of the inclusion of COPD-specific influencing factors or a diagnosis of cognitive impairment. We conclude that in patients with stable COPD lower oxygen content of blood as a measure of peripheral oxygen supply, lower exercise capacity in terms of 6-MWD, and higher CRP levels were associated with reduced cognitive capacity. Furthermore, a reduction in cognitive capacity was associated with reduced disease-specific quality of life. As a potential clinical implication of this work, we suggest to screen especially patients with low oxygen content and low 6-MWD for cognitive impairment.
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Affiliation(s)
- Sarah Marietta von Siemens
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr 1, 80336, Munich, Germany
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,German Center for Neurodegenerative Disorders (DZNE) Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, London, UK
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany.,Asklepios Fachkliniken München-Gauting, Robert-Koch-Allee 2, 82131, Gauting, Germany
| | - Diego Kauffmann-Guerrero
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - Franziska C Trudzinski
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - Christian Grohé
- Evangelische Lungenklinik, Lindenberger Weg 27, 13125, Berlin, Germany
| | - Sandra Söhler
- ASCONET Study Coordination Office, University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Benjamin Waschki
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Johanna I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstädter Landstr. 1, 85764, Munich, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr 1, 80336, Munich, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany.
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