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Dwivedi J, Wal P, Dash B, Ovais M, Sachan P, Verma V. Diabetic Pneumopathy- A Novel Diabetes-associated Complication: Pathophysiology, the Underlying Mechanism and Combination Medication. Endocr Metab Immune Disord Drug Targets 2024; 24:1027-1052. [PMID: 37817659 DOI: 10.2174/0118715303265960230926113201] [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: 06/06/2023] [Revised: 07/03/2023] [Accepted: 07/20/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND The "diabetic lung" has been identified as a possible target organ in diabetes, with abnormalities in ventilation control, bronchomotor tone, lung volume, pulmonary diffusing capacity, and neuroadrenergic bronchial innervation. OBJECTIVE This review summarizes studies related to diabetic pneumopathy, pathophysiology and a number of pulmonary disorders including type 1 and type 2 diabetes. METHODS Electronic searches were conducted on databases such as Pub Med, Wiley Online Library (WOL), Scopus, Elsevier, ScienceDirect, and Google Scholar using standard keywords "diabetes," "diabetes Pneumopathy," "Pathophysiology," "Lung diseases," "lung infection" for review articles published between 1978 to 2023 very few previous review articles based their focus on diabetic pneumopathy and its pathophysiology. RESULTS Globally, the incidence of diabetes mellitus has been rising. It is a chronic, progressive metabolic disease. The "diabetic lung" may serve as a model of accelerated ageing since diabetics' rate of respiratory function deterioration is two to three-times higher than that of normal, non-smoking people. CONCLUSION Diabetes-induced pulmonary dysfunction has not gained the attention it deserves due to a lack of proven causality and changes in cellular properties. The mechanism underlying a particular lung illness can still only be partially activated by diabetes but there is evidence that hyperglycemia is linked to pulmonary fibrosis in diabetic people.
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Affiliation(s)
- Jyotsana Dwivedi
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Pranay Wal
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Biswajit Dash
- Department of Pharmaceutical Technology, ADAMAS University, West Bengal, India
| | | | - Pranjal Sachan
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
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Ferreira EJP, Cardoso LVSDC, de Matos CJO, Mota IL, Lira JMC, Lopes MEG, Santos GV, Dória Almeida ML, Aguiar-Oliveira MH, Sousa ACS, de Melo EV, Oliveira JLM. Cardiovascular Prognosis of Subclinical Chronic Obstructive Pulmonary Disease in Patients with Suspected or Confirmed Coronary Artery Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:1899-1908. [PMID: 37662489 PMCID: PMC10474840 DOI: 10.2147/copd.s410416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/06/2023] [Indexed: 09/05/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) worsens prognosis in patients with coronary artery disease (CAD). However, the cardiovascular prognosis in patients with stable or mildly symptomatic COPD remains unclear. Here, we sought to determine the long-term cardiovascular events in patients with subclinical or early-stage COPD with concomitant CAD. Methods This was a longitudinal analytical study involving 117 patients with suspected or established CAD who underwent assessment of pulmonary function by spirometry and who were followed up for six years (March 2015-January 2021). The patients were divided into two groups, one comprising COPD (n=44) and the other non-COPD (n=73) patients. Cox regression was used to evaluate the association between COPD and cardiovascular events, with adjustment for the established CAD risk factors, and the effect size was measured by the Cohen test. Results COPD patients were older (p=0.028), had a greater frequency of diabetes (p=0.026), were more likely to be smokers (p<0.001), and had higher modified Medical Research Council scores (p<0.001). There was no difference between the groups regarding gender, body mass index, hypertension, dyslipidemia, family history of CAD, and type of angina. CAD frequency and the proportion of patients with severe and multivessel CAD were significantly higher among COPD than among non-COPD patients (all p<0.001). At six-year follow-up, patients with COPD were more likely to have experienced adverse cardiovascular events than those without COPD (p<0.001; effect size, 0.720). After adjusting for established CAD risk factors, COPD occurrence remained an independent predictor for long-term adverse cardiovascular events (OR: 5.13; 95% CI: 2.29-11.50; p<0.0001). Conclusion COPD was associated with increased severity of coronary lesions and a greater number of adverse cardiovascular events in patients with suspected or confirmed CAD. COPD remained a predictor of long-term cardiovascular events in stable patients with subclinical or early-stage of COPD, independently of the established CAD risk factors.
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Affiliation(s)
- Eduardo José Pereira Ferreira
- Department of Medicine, Federal University of Sergipe, Lagarto, 49400-000, Brazil
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
| | - Lucas Villar Shan de Carvalho Cardoso
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | | | - Igor Larchert Mota
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
| | - Juliana Maria Chianca Lira
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Mayara Evelyn Gomes Lopes
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Giulia Vieira Santos
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Maria Luiza Dória Almeida
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Manuel Herminio Aguiar-Oliveira
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Antônio Carlos Sobral Sousa
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Enaldo Vieira de Melo
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Joselina Luzia Menezes Oliveira
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
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Santoro L, Falsetti L, Zaccone V, Nesci A, Tosato M, Giupponi B, Savastano MC, Moroncini G, Gasbarrini A, Landi F, Santoliquido A. Impaired Endothelial Function in Convalescent Phase of COVID-19: A 3 Month Follow Up Observational Prospective Study. J Clin Med 2022; 11:jcm11071774. [PMID: 35407382 PMCID: PMC8999944 DOI: 10.3390/jcm11071774] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Endothelial dysfunction has a role in acute COVID-19, contributing to systemic inflammatory syndrome, acute respiratory distress syndrome, and vascular events. Evidence regarding COVID-19 middle- and long-term consequences on endothelium are still lacking. Our study aimed to evaluate if COVID-19 severity could significantly affect the endothelial function after three months from the acute phase. Methods: We assessed endothelial function in outpatients with previous COVID-19 three months after negative SARS-CoV-2 molecular test by measuring flow-mediated dilation (FMD) in patients categorized according to a four-variable COVID-19 severity scale (“home care”; “hospital, no oxygen”; “hospital, oxygen”; “hospital requiring high-flow nasal canula, non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation”). FMD difference among COVID-19 severity categories was assessed with analysis of variance; we further clarified the relationship between FMD and previous COVID-19 severity with multivariate logistic models. Results: Among 658 consecutive COVID-19 subjects, we observed a significant linear trend of FMD reduction with the increase of the COVID-19 category (p < 0.0001). The presence of endothelial dysfunction was more frequent among hospitalized patients (78.3%) with respect to home-care patients (21.7%; p < 0.0001). COVID-19 severity was associated with increased endothelial dysfunction risk (OR: 1.354; 95% CI: 1.06−1.71; p = 0.011) at multivariate binary logistic analysis. FMD showed a significant direct correlation with PaO2 (p = 0.004), P/F ratio (p = 0.004), FEV1 (p = 0.008), and 6MWT (p = 0.0001). Conclusions: Hospitalized COVID-19 subjects showed an impaired endothelial function three months after the acute phase that correlated with pulmonary function impairment. Further studies are needed to evaluate if these subjects are at higher risk of developing pulmonary disease or future cardiovascular events.
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Affiliation(s)
- Luca Santoro
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.S.); (A.N.); (A.S.)
| | - Lorenzo Falsetti
- Department of Emergency Medicine, Internal and Sub-Intensive Medicine, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60166 Ancona, Italy;
| | - Vincenzo Zaccone
- Department of Emergency Medicine, Internal and Sub-Intensive Medicine, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60166 Ancona, Italy;
- Correspondence: ; Tel.: +39-3479617617
| | - Antonio Nesci
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.S.); (A.N.); (A.S.)
| | - Matteo Tosato
- Geriatrics Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (F.L.)
| | - Bianca Giupponi
- Department of Emergency Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Maria Cristina Savastano
- Department of Ophthalmology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Gianluca Moroncini
- Department of Experimental and Clinical Medicine, Clinica Medica, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60166 Ancona, Italy;
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Landi
- Geriatrics Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (F.L.)
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Angelo Santoliquido
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.S.); (A.N.); (A.S.)
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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4
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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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5
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Cherneva Z, Cherneva R. The Role of Stress Echocardiography in the Early Detection of Diastolic Dysfunction in Non-Severe Chronic Obstructive Pulmonary Disease Patients. Arq Bras Cardiol 2021; 116:259-265. [PMID: 33656074 PMCID: PMC7909987 DOI: 10.36660/abc.20190623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/22/2020] [Indexed: 11/26/2022] Open
Abstract
Fundamento A dispneia por esforço é uma queixa comum de pacientes com insuficiência cardíaca com fração de ejeção preservada (ICFEP) e doença pulmonar obstrutiva crônica (DPOC). A ICFEP é comum na DPOC e é um fator de risco independente para a progressão e exacerbação da doença. A detecção precoce, portanto, tem grande relevância clínica. Objetivos O objetivo deste estudo foi detectar a frequência de ICFEP mascarada em pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular manifesta, e analisar a correlação entre ICFEP mascarada e os parâmetros do teste cardiopulmonar de exercício (TCPE). Métodos Aplicamos o TCPE em 104 pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular evidente. A ecocardiografia foi realizada antes e no pico do TCPE. Os valores de corte para disfunção diastólica ventricular esquerda e direita induzida por estresse (DDVE/DDVD) foram E/e’ >15; E/e’ >6, respectivamente. A análise de correlação foi feita entre os parâmetros do TCPE e o estresse E/d’. Valor de p<0,05 foi considerado significativo. Resultados 64% dos pacientes tinham DDVE induzida por estresse; 78% tinham DDVD induzida por estresse. Ambos os grupos com estresse DDVE e DDVD obtiveram carga menor, V’O2 e pulso de O2 mais baixos, além de apresentarem redução na eficiência ventilatória (maiores inclinações de VE/VCO2). Nenhum dos parâmetros do TCPE foram correlacionados com E/e’ DDVE/DDVD induzida por estresse. Conclusão Há uma alta prevalência de disfunção diastólica induzida por estresse em pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular evidente. Nenhum dos parâmetros do TCPE se correlaciona com E/e’ induzida por estresse. Isso demanda a realização de Ecocardiografia sob estresse por exercício (EES) e TCPE para detecção precoce e manejo adequado da ICFEP mascarada nesta população. (Arq Bras Cardiol. 2021; 116(2):259-265)
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Affiliation(s)
- Zheyna Cherneva
- Medical Institute of the Ministry of Internal Affairs, Sofia - Bulgária
| | - Radostina Cherneva
- Saint Sophia University Hospital of Pulmonary Diseases, Sofia - Bulgária
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Graziani D, Soriano JB, Del Rio-Bermudez C, Morena D, Díaz T, Castillo M, Alonso M, Ancochea J, Lumbreras S, Izquierdo JL. Characteristics and Prognosis of COVID-19 in Patients with COPD. J Clin Med 2020; 9:E3259. [PMID: 33053774 PMCID: PMC7600734 DOI: 10.3390/jcm9103259] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023] Open
Abstract
Patients with Chronic Obstructive Pulmonary Disease (COPD) have a higher prevalence of coronary ischemia and other factors that put them at risk for COVID-19-related complications. We aimed to explore the impact of COVID-19 in a large population-based sample of patients with COPD in Castilla-La Mancha, Spain. We analyzed clinical data in electronic health records from 1 January to 10 May 2020 by using Natural Language Processing through the SAVANA Manager® clinical platform. Out of 31,633 COPD patients, 793 had a diagnosis of COVID-19. The proportion of patients with COVID-19 in the COPD population (2.51%; 95% CI 2.33-2.68) was significantly higher than in the general population aged >40 years (1.16%; 95% CI 1.14-1.18); p < 0.001. Compared with COPD-free individuals, COPD patients with COVID-19 showed significantly poorer disease prognosis, as evaluated by hospitalizations (31.1% vs. 39.8%: OR 1.57; 95% CI 1.14-1.18) and mortality (3.4% vs. 9.3%: OR 2.93; 95% CI 2.27-3.79). Patients with COPD and COVID-19 were significantly older (75 vs. 66 years), predominantly male (83% vs. 17%), smoked more frequently, and had more comorbidities than their non-COPD counterparts. Pneumonia was the most common diagnosis among COPD patients hospitalized due to COVID-19 (59%); 19% of patients showed pulmonary infiltrates suggestive of pneumonia and heart failure. Mortality in COPD patients with COVID-19 was associated with older age and prevalence of heart failure (p < 0.05). COPD patients with COVID-19 showed higher rates of hospitalization and mortality, mainly associated with pneumonia. This clinical profile is different from exacerbations caused by other respiratory viruses in the winter season.
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Affiliation(s)
- Desirée Graziani
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Joan B Soriano
- Respiratory Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (J.B.S.); (J.A.)
- Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Respiratory Diseases Networking Biomedical Research Centre (CIBERES), Institute of Health Carlos III (ISCIII), 28006 Madrid, Spain
| | | | - Diego Morena
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Teresa Díaz
- SAVANA Medica, 28013 Madrid, Spain; (C.D.R.-B.); (T.D.)
| | - María Castillo
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Miguel Alonso
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Julio Ancochea
- Respiratory Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (J.B.S.); (J.A.)
- Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Respiratory Diseases Networking Biomedical Research Centre (CIBERES), Institute of Health Carlos III (ISCIII), 28006 Madrid, Spain
| | | | - José Luis Izquierdo
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
- Department of Medicine and Medical Specialties, University of Alcalá, 28801 Madrid, Spain
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7
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Recio Iglesias J, Díez-Manglano J, López García F, Díaz Peromingo JA, Almagro P, Varela Aguilar JM. Management of the COPD Patient with Comorbidities: An Experts Recommendation Document. Int J Chron Obstruct Pulmon Dis 2020; 15:1015-1037. [PMID: 32440113 PMCID: PMC7217705 DOI: 10.2147/copd.s242009] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.
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Affiliation(s)
- Jesús Recio Iglesias
- Internal Medicine Department, Quironsalud Valencia Hospital, Valencia, Valencian Community, Spain
| | - Jesús Díez-Manglano
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Aragon, Spain
| | - Francisco López García
- Internal Medicine Department General University Hospital of Elche, Alicante, Valencian Community, Spain
| | - José Antonio Díaz Peromingo
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela, a Coruña, Galicia, Spain
| | - Pere Almagro
- Internal Medicine Department, Mútua Terrassa University Hospital, Terrassa, Barcelona, Catalonia, Spain
| | - José Manuel Varela Aguilar
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Andalusia, Spain.,CIBER of Epidemiology and Public Health, Madrid, Community of Madrid, Spain
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Hlavati M, Buljan K, Tomić S, Horvat M, Butković-Soldo S. Impaired cerebrovascular reactivity in chronic obstructive pulmonary disease. Acta Neurol Belg 2019; 119:567-575. [PMID: 31215005 DOI: 10.1007/s13760-019-01170-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/11/2019] [Indexed: 11/27/2022]
Abstract
Impaired cerebrovascular reactivity (CVR) is associated with stroke. Cerebrovascular diseases are common comorbidity in chronic obstructive pulmonary disease (COPD) patients. The aim of our study was to quantify CVR in the anterior and posterior cerebral circulation during voluntary breath-holding in COPD patients according to airflow limitation severity. In this cross-sectional study, we compared 90 COPD patients without previous cerebrovascular disease and 30 age- and sex-matched healthy volunteers (mean age 67 ± 7.9, 87 males). Using transcranial Doppler ultrasound and breath-holding index (BHI), we analysed baseline mean flow velocities (MFV) and CVR of middle cerebral artery (MCA) and basilar artery (BA). Our results demonstrated that COPD patients had lower baseline MFV of both MCA and BA than controls. COPD patients had significantly lower BHImMCA and BHImBA than controls (0.8 and 0.7 versus 1.24 and 1.07, respectively; p < 0.001). With the severity of airflow obstruction, there were significant declines of BHImMCA and BHImBA in mild (0.94 and 0.83), moderate (0.8 and 0.7) and severe to very severe COPD (0.7 and 0.6), respectively (p < 0.001). For all participants, we found a significant and positive correlation between forced expiratory volume in one second (FEV1) and BHImMCA (Rho = 0.761, p < 0.001) and between FEV1 and BHImBA (Rho = 0.409, p < 0.001). COPD patients have impaired CVR in anterior and posterior cerebral circulation. Impairment of CVR increase with the airflow limitation severity. CVR is an appropriate marker to identify vulnerable COPD subjects at high risk to develop cerebrovascular disease. Prospective studies are needed for further evaluation.
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Affiliation(s)
- Marina Hlavati
- Department for Diagnostic and Therapeutical Procedures, Neurology Unit, General Hospital Našice, Bana Jelačića 10, 31500, Našice, Croatia.
- Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia.
| | - Krunoslav Buljan
- Neurology Clinic, Clinic Hospital Centre Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia
| | - Svetlana Tomić
- Neurology Clinic, Clinic Hospital Centre Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia
| | - Mirjana Horvat
- Department of Internal Medicine, Pulmonology Unit, General Hospital Našice, Bana Jelačića 10, 31500, Našice, Croatia
| | - Silva Butković-Soldo
- Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia
- Neurology Clinic, Clinic Hospital Centre Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia
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9
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Buklioska-Ilievska D, Minov J, Kochovska-Kamchevska N, Prgova-Veljanova B, Petkovikj N, Ristovski V, Baloski M. Cardiovascular Comorbidity in Patients with Chronic Obstructive Pulmonary Disease: Echocardiography Changes and Their Relation to the Level of Airflow Limitation. Open Access Maced J Med Sci 2019; 7:3568-3573. [PMID: 32010378 PMCID: PMC6986525 DOI: 10.3889/oamjms.2019.848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 01/13/2023] Open
Abstract
AIM To compare the frequency of echocardiographic changes in patients with chronic obstructive pulmonary disease (COPD) and non-COPD controls and to assess their relation to the level of airflow limitation. METHODS Study population included 120 subjects divided into two groups. Group 1 included 60 patients with COPD (52 male and 8 females, aged 40 to 80 years) initially diagnosed according to the actual recommendations. Group 2 included 60 subjects in whom COPD was excluded serving as a control. The study protocol consisted of completion of a questionnaire, pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray) and two dimensional (2D) Doppler echocardiography. RESULTS We found significantly higher mean right ventricle end-diastolic dimension (RVEDd) in COPD patients as compared to its dimension in controls (28.0 ± 4.8 mm vs. 24.4 ± 4.3 mm; P = 0.0000). Pulmonary hypertension (PH) was more frequent in COPD patients than in controls (33.3% vs. 0%; P = 0.0004) showing a linear relationship with the severity of airflow limitation. The mean value of left ventricular ejection fraction (LVEF%) was significantly lower in COPD patients than its mean value in controls (57.4 ± 6.9% vs 64.8 ± 2.7%; P = 0.0000) with no correlation with severity of airflow limitation. CONCLUSION Frequency of echocardiographic changes in COPD patients was significantly higher as compared to their frequency in controls in the most cases being significantly associated with the severity of airflow limitation. Echocardiography enables early, noninvasive, and accurate diagnosis of cardiac changes in COPD patients giving time for early intervention.
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Affiliation(s)
| | - Jordan Minov
- Institute for Occupational Health of Republic of Macedonia - WHO Collaborating Center, Skopje, Republic of Macedonia
| | | | | | | | | | - Marjan Baloski
- General Hospital, “8th September”, Skopje, Republic of Macedonia
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10
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Spilling CA, Jones PW, Dodd JW, Barrick TR. Disruption of white matter connectivity in chronic obstructive pulmonary disease. PLoS One 2019; 14:e0223297. [PMID: 31581226 PMCID: PMC6776415 DOI: 10.1371/journal.pone.0223297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022] Open
Abstract
Background Mild cognitive impairment is a common systemic manifestation of chronic obstructive pulmonary disease (COPD). However, its pathophysiological origins are not understood. Since, cognitive function relies on efficient communication between distributed cortical and subcortical regions, we investigated whether people with COPD have disruption in white matter connectivity. Methods Structural networks were constructed for 30 COPD patients (aged 54–84 years, 57% male, FEV1 52.5% pred.) and 23 controls (aged 51–81 years, 48% Male). Networks comprised 90 grey matter regions (nodes) interconnected by white mater fibre tracts traced using deterministic tractography (edges). Edges were weighted by the number of streamlines adjusted for a) streamline length and b) end-node volume. White matter connectivity was quantified using global and nodal graph metrics which characterised the networks connection density, connection strength, segregation, integration, nodal influence and small-worldness. Between-group differences in white matter connectivity and within-group associations with cognitive function and disease severity were tested. Results COPD patients’ brain networks had significantly lower global connection strength (p = 0.03) and connection density (p = 0.04). There was a trend towards COPD patients having a reduction in nodal connection density and connection strength across the majority of network nodes but this only reached significance for connection density in the right superior temporal gyrus (p = 0.02) and did not survive correction for end-node volume. There were no other significant global or nodal network differences or within-group associations with disease severity or cognitive function. Conclusion COPD brain networks show evidence of damage compared to controls with a reduced number and strength of connections. This loss of connectivity was not sufficient to disrupt the overall efficiency of network organisation, suggesting that it has redundant capacity that makes it resilient to damage, which may explain why cognitive dysfunction is not severe. This might also explain why no direct relationships could be found with cognitive measures. Smoking and hypertension are known to have deleterious effects on the brain. These confounding effects could not be excluded.
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Affiliation(s)
- Catherine A. Spilling
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Paul W. Jones
- Institute of Infection and Immunity, St George's, University of London, Tooting, London, United Kingdom
| | - James W. Dodd
- Academic Respiratory Unit, Second Floor, Learning and Research, Southmead Hospital, University of Bristol, Westbury-on-Trym, Bristol, United Kingdom
| | - Thomas R. Barrick
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Tooting, London, United Kingdom
- * E-mail:
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11
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Buklioska-Ilievska D, Minov J, Kochovska-Kamchevska N, Gigovska I, Doneva A, Baloski M. Carotid Artery Disease and Lower Extremities Artery Disease in Patients with Chronic Obstructive Pulmonary Disease. Open Access Maced J Med Sci 2019; 7:2102-2107. [PMID: 31456833 PMCID: PMC6698108 DOI: 10.3889/oamjms.2019.576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/05/2022] Open
Abstract
AIM To assess the frequency of carotid artery disease (CAD) and lower extremities artery disease (LEAD) in patients with chronic obstructive pulmonary disease (COPD) and their relation to the severity of airflow limitation and the level of C-reactive protein (CRP). METHODS We performed a cross-sectional study including 60 patients with COPD (52 male, 8 female), aged 40 to 80 years, initially diagnosed according to the actual criteria. Also, 30 subjects in whom COPD was excluded, matched to COPD patients by sex, age, body mass index and smoking status, served as controls. All study subjects completed questionnaire and underwent pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray), angiological evaluation by Doppler ultrasonography and measurement of serum CRP level. RESULTS We found a statistically significant difference between the frequency of carotid plaques in COPD patients as compared to their frequency in controls (65% vs 30%; P = 0.002). The mean value of intima-media thickness (IMT) in COPD patients with CAD was significantly higher than its mean value in controls (0.8 ± 0.2 vs. 0.7 ± 0.2; P = 0.049). IMT value in COPD patients with CAD was significantly related to the degree of airflow limitation, i.e. to the degree of FEV1 decline (P = 0.000), as well as to the serum CRP level (P = 0.001). We found a statistically significant difference between the frequency of COPD patients with LEAD as compared to the frequency of LEAD in controls (78.3% vs 43.3%; P = 0.001). According to the Fontaine classification, COPD patients with LEAD were categorized in the stages I, IIA and IIB (53.3%, 30% and 16.7%, respectively), whereas all controls with LEAD were categorized in the Fontaine stage I. Among COPD patients with LEAD there was significant association between disease severity and clinical manifestations due to the vascular changes (P = 0.001) and serum CRP level (P = 0.001). CONCLUSION Our findings suggest higher prevalence and higher severity of vascular changes in COPD patients as compared to their prevalence and severity in non-COPD subjects. Prevalence and severity of vascular changes in COPD patients were significantly related to the severity of airflow limitation and serum CRP levels.
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Affiliation(s)
- Daniela Buklioska-Ilievska
- Department of Pulmonology and Allergology, General Hospital "8th September", Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Jordan Minov
- Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia.,Institute for Occupational Health of Republic of Macedonia - WHO Collaborating Center, Skopje, Republic of Macedonia
| | - Nade Kochovska-Kamchevska
- Department of Pulmonology and Allergology, General Hospital "8th September", Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Irena Gigovska
- Department of Cardiology, General Hospital "8th September", Skopje, Republic of Macedonia
| | - Ana Doneva
- Neurology, General Hospital "8th September", Skopje, Republic of Macedonia
| | - Marjan Baloski
- Department of Pulmonology and Allergology, General Hospital "8th September", Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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12
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Kattih B, Elling LS, Weiss C, Bea M, Zwadlo C, Bavendiek U, Bauersachs J, Heineke J. Anti-androgenic therapy with finasteride in patients with chronic heart failure - a retrospective propensity score based analysis. Sci Rep 2019; 9:10139. [PMID: 31300720 PMCID: PMC6626053 DOI: 10.1038/s41598-019-46640-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/01/2019] [Indexed: 12/20/2022] Open
Abstract
Sex hormones influence the prevalence and the outcome of heart diseases. The conversion of testosterone to its more active metabolite dihydrotestosterone drives cardiac growth and dysfunction, while inhibition of this step by the anti-androgenic drug finasteride counteracts these pathological processes in preclinical models. In this retrospective, observational study, we aim to investigate whether finasteride, which is in clinical use mainly for prostate disease, might ameliorate cardiac hypertrophy and heart failure in patients. Retrospective chart review of 1041 medical cases with heart failure between 1995 and 2015 was conducted. Stratification was performed by concomitant prostate treatment status (tamsulosin versus finasteride). A propensity score analysis yielded a total of 328 matched medical cases without residual differences in the baseline patient characteristics. In this propensity score matched samples, anti-androgenic therapy with finasteride was associated with significantly reduced left ventricular hypertrophy (interventricular septal thickness 13.3 ± 2.4 mm control vs. 12.6 ± 2.1 mm finasteride group (p = 0.029); estimated average treatment effects on the treated: −0.7 mm, 95% CI mean difference −1.3 to −0.1). In this retrospective analysis anti-androgenic therapy with finasteride for prostate disease was associated with attenuated cardiac hypertrophy in patients with heart failure. Therefore, our data encourage further analysis of this approach in larger heart failure patient cohorts.
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Affiliation(s)
- Badder Kattih
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany. .,Department of Cardiovascular Research, European Center for Angioscience (ECAS), Medical Faculty Mannheim of Heidelberg University, University Medical Centre Mannheim, Ludolf-Krehl Street 7-11, 68167, Mannheim, Germany.
| | - Lukas Simon Elling
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Christel Weiss
- Department for Medical Statistics and Biomathematics, Medical Faculty Mannheim of Heidelberg University, University Medical Centre Mannheim, Ludolf-Krehl Street 9-13, 68167, Mannheim, Germany
| | - Marieke Bea
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Carolin Zwadlo
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Udo Bavendiek
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Joerg Heineke
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany. .,Department of Cardiovascular Research, European Center for Angioscience (ECAS), Medical Faculty Mannheim of Heidelberg University, University Medical Centre Mannheim, Ludolf-Krehl Street 7-11, 68167, Mannheim, Germany.
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13
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Houben-Wilke S, Triest FJJ, Franssen FME, Janssen DJA, Wouters EFM, Vanfleteren LEGW. Revealing Methodological Challenges in Chronic Obstructive Pulmonary Disease Studies Assessing Comorbidities: A Narrative Review. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:166-177. [PMID: 30974051 DOI: 10.15326/jcopdf.6.2.2018.0145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Beyond respiratory impairment, patients with chronic obstructive pulmonary disease (COPD) often suffer from comorbidities which are associated with worse health status, higher health care costs and worse prognosis. Reported prevalences of comorbidities largely differ between studies which might be explained by different assessment methods (objective assessment, self-reported assessment, or assessment by medical records), heterogeneous study populations, inappropriate control groups, incomparable methodologies, etc. This narrative review demonstrates and further evaluates the variability in prevalence of several comorbidities in patients with COPD and control individuals and discusses several shortcomings and pitfalls which need to be considered when interpreting comorbidity data. Like in other chronic organ diseases, the accurate diagnosis and integrated management of comorbidities is a key for outcome in COPD. This review highlights that there is a need to move from the starting point of an established index disease towards the concept of the development of multimorbidity in the elderly including COPD as an important and highly prevalent pulmonary component.
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Affiliation(s)
- Sarah Houben-Wilke
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Filip J J Triest
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits M E Franssen
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daisy J A Janssen
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Centre of Expertise for Palliative Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Emiel F M Wouters
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lowie E G W Vanfleteren
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,COPD Center, Sahlgrenska University Hospital and Institute of Medicine, Gothenburg University, Gothenburg, Sweden
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14
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Chazova IE, Lazareva NV, Oshchepkova EV. Arterial hypertension and chronic obstructive pulmonary disease: clinical characteristics and treatment efficasy (according to the national register of arterial hypertension). TERAPEVT ARKH 2019; 91:4-10. [PMID: 31094451 DOI: 10.26442/00403660.2019.03.000110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIM The objective of the research is studying of demographic and clinical profile as well as treatment effectiveness of patients with AH and COPD based on National Register of Arterial Hypertension. MATERIALS AND METHODS Among the analyzed selection, consisted of 32 571 patients with AH, who were followed up in the primary medical care, at the average age of 64±7 years old (there were 64% women of them), 5.4% patients with AH had COPD. The analysis of cardiovascular and cerebrovascular diseases frequency as well as treatment effectiveness was made. RESULTS According to National Register of Arterial Hypertension, cardiovascular [coronary heart disease, Q myocardial infarction, chronic heart failure (CHF), peripheral artery atherosclerosis] and cerebrovascular (stroke/transitory ischemic attack) diseases are accurately more often diagnosed at patients with AH and COPD. CONCLUSION Male sex and age are the strongest independent factor, contributing into the risk of development of cardiovascular diseases at these patients. COPD considerably increases the risk of CHF development. The conducted analysis has shown that treatment, prescribed to patients with AH and COPD meets modern recommendations.
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Affiliation(s)
- I E Chazova
- National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - N V Lazareva
- National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - E V Oshchepkova
- National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia
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15
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Cardiovascular Comorbidities in Chronic Obstructive Pulmonary Disease (COPD)-Current Considerations for Clinical Practice. J Clin Med 2019; 8:jcm8010069. [PMID: 30634565 PMCID: PMC6352261 DOI: 10.3390/jcm8010069] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 12/14/2022] Open
Abstract
In patients with chronic obstructive pulmonary disease (COPD), cardiovascular comorbidities are highly prevalent and associated with considerable morbidity and mortality. This coincidence is increasingly seen in context of a “cardiopulmonary continuum” rather than being simply attributed to shared risk factors such as cigarette smoking. Overlapping symptoms such as dyspnea or chest pain lead to a worse prognosis due to missed concomitant diagnoses. Moreover, medication is often withheld as a result of unfounded concerns about side effects. Despite the frequent coincidence, current guidelines are still mostly restricted to the management of the individual disease. Future diagnostic and therapeutic strategies should therefore be guided by an integrative perspective as well as a refined phenotyping of disease entities.
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16
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Arslan S, Yildiz G, Özdemir L, Kaysoydu E, Özdemir B. Association between blood pressure, inflammation and spirometry parameters in chronic obstructive pulmonary disease. Korean J Intern Med 2019; 34:108-115. [PMID: 30428648 PMCID: PMC6325439 DOI: 10.3904/kjim.2017.284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/19/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Many systems including the cardiovascular system (ischemic heart diseases, heart failure, and hypertension) may act as comorbidities that can be seen during the course of chronic obstructive pulmonary disease (COPD). Comorbidities affect the severity and prognosis of COPD negatively. Nearly 25% of patients with COPD die due to cardiovascular diseases. In this study, we aimed to evaluate the relationship between the blood pressure, inflammation, hypoxia, hypercapnia, and the severity of airway obstruction. METHODS We included 75 COPD patients in the study with 45 control cases. We evaluated age, sex, body mass index, smoking history, C-reactive protein levels, 24-hour ambulatory blood pressure Holter monitoring, arterial blood gas, and respiratory function tests of the patient and the control groups. RESULTS In COPD patients, the night time systolic, diastolic blood pressures and pulse per minute and the mean blood pressures readings were significantly elevated compared to the control group (p < 0.05). In the correlation analysis, night time systolic pressure was associated with all the parameters except forced expiratory volume in 1 second (FEV1%). Diastolic blood pressure was associated with pH and HCO3 levels. The mean night time, day time pulse pressures and 24- hour pulse per minute values were also associated with all the parameters except FEV1%. CONCLUSION In this study we found that parameters of systolic and diastolic blood pressures and pulse pressures were significantly elevated in COPD patients compared to the control groups. Blood pressure was associated blood gas parameters and inflammation parameters in COPD patients. This, in turn, may cause understanding of the pathophysiology of COPD and its complications.
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Affiliation(s)
- Sulhattin Arslan
- Department of Chest Diseases, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Gürsel Yildiz
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Okan University, Istanbul, Turkey
- Correspondence to Gürsel Yildiz, M.D. Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Okan University, İçmeler Mah., Aydınlı Yolu Cad., Aydemir Sk. No. 2, Istanbul 34947, Turkey Tel: +90-5055422909 Fax: +90-5055422909 E-mail:
| | - Levent Özdemir
- Department of Public Health, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Erdal Kaysoydu
- Department of Chest Diseases, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Bülent Özdemir
- Department of Cardiology, Faculty of Medicine, Uludag University, Bursa, Turkey
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17
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Izquierdo JL, Miravitlles M, Esquinas C, Pérez M, Calle M, López Campos JL, Rodríguez González-Moro JM, Casanova C, Esteban C, de Lucas P. Características de los pacientes con EPOC tratados en neumología en España según grupos GOLD y fenotipos clínicos GesEPOC. Arch Bronconeumol 2018; 54:559-567. [DOI: 10.1016/j.arbres.2018.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/15/2018] [Accepted: 03/18/2018] [Indexed: 10/14/2022]
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18
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Association of Metabolic Syndrome with the Severity of Airflow Obstruction in Patients with Chronic Obstructive Pulmonary Disease. J ASEAN Fed Endocr Soc 2018; 33:181-187. [PMID: 33442125 PMCID: PMC7784159 DOI: 10.15605/jafes.033.02.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022] Open
Abstract
Background Metabolic Syndrome (MetS) is common in Chronic Obstructive Pulmonary Disease (COPD) patients but their association is still an unsettled issue. The aim of this study was to determine the association of MetS with the severity of airflow obstruction. Methodology This was a cross-sectional analytic study of 157 patients with COPD. They were classified using the Global Initiative for Chronic Obstructive Lung Diseases (GOLD). MetS was assessed using two well-recognized criteria. Demographics, clinical data, lifestyle-related characteristics, fasting blood sugar (FBS) and lipid profile were obtained. Multiple logistic regression was used to determine the association of MetS with the severity of airflow obstruction. Results 40.13% and 17.20% of patients had MetS using the NCEP/ATP III-AHA/NHBLI and IDF criteria, respectively. MetS was not associated with severity of airflow obstruction. Of the MetS components, only elevated blood pressure (BP) was significantly associated with severity of airflow obstruction (GOLD II: OR=3.28, p<0.001; GOLD III: OR=4.04, p=0.2; GOLD IV: OR=6.21, p=0.04). Elevated FBS was also associated with GOLD IV (OR=16.09, p=0.02). Significant factors associated with MetS in COPD patients were body mass index, inhaled steroid, number of pack-years, and GOLD II. Conclusion MetS is not associated with severity of airflow obstruction. Only certain components of MetS showed significant associations such as elevated BP with GOLD II-IV and elevated FBS with GOLD IV.
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19
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Shayo FK, Lutale J. Albuminuria in patients with chronic obstructive pulmonary disease: a cross-sectional study in an African patient cohort. BMC Pulm Med 2018; 18:125. [PMID: 30064397 PMCID: PMC6066916 DOI: 10.1186/s12890-018-0694-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/20/2018] [Indexed: 01/25/2023] Open
Abstract
Background Cardiovascular disease (CVD) is remarkably frequent in patients with chronic obstructive pulmonary disease (COPD). Albuminuria is a marker of vascular endothelial dysfunction and predictor of CVD events. Albuminuria is prevalent in patients with COPD as it has been shown in Caucasian and Oriental populations with COPD. The objective of this study was to determine the prevalence of Albuminuria and COPD severity correlates among black patients with chronic obstructive pulmonary disease in order to see whether a similar trend of albuminuria is also prevalent in this population. Methods A total of 104 COPD patients were enrolled in the study. Lung functions were assessed by means of the Easy One™ spirometer. Albuminuria defined by urine albumin to creatinine ratio (ACR) was tested using CYBOW 12MAC microalbumin strips in a random spot urine collection. SPSS version 20 was used for data analysis. Results In the studied population, 25/104 (24%) patients had albuminuria and 16/104 (15.4%) patients had CVD. Abnormal urine albumin (Albuminuria and Proteinuria) was present in all patients with CVD. In the subset of 46 COPD patients assessed for severity, 60.9% (95%CIs 46.1–73.9) had moderate COPD and 30.4% (95% CIs, 17.9–49.0) severe COPD. Albuminuria was moderately significantly associated with COPD severity, p = 0.049; (0.049 < p < 0.05). Participants who ever smoked cigarettes had significantly likelihood of severe and very severe COPD (OR 11.5; 95% CIs, 1.3, 98.4) however, the significance was lost when adjusted for age and gender. Conclusion Albuminuria was prevalent in patients with COPD and it had a significant association with COPD severity.
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Affiliation(s)
- Festo K Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O BOX 65001, Dar es Salaam, Tanzania. .,Department of Internal Medicine, Muhimbili National Hospital, P.o box 14087, Dar es Salaam, Tanzania. .,Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Janet Lutale
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O BOX 65001, Dar es Salaam, Tanzania. .,Department of Internal Medicine, Muhimbili National Hospital, P.o box 14087, Dar es Salaam, Tanzania.
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20
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Mota IL, Sousa ACS, Almeida MLD, de Melo EV, Ferreira EJP, Neto JB, Matos CJO, Telino CJCL, Souto MJS, Oliveira JLM. Coronary lesions in patients with COPD (Global Initiative for Obstructive Lung Disease stages I-III) and suspected or confirmed coronary arterial disease. Int J Chron Obstruct Pulmon Dis 2018; 13:1999-2006. [PMID: 29983554 PMCID: PMC6027684 DOI: 10.2147/copd.s162713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Systemic inflammation is the pathophysiological link between coronary artery disease (CAD) and COPD. However, the influence of subclinical COPD on patients with suspected or diagnosed CAD is largely unknown. Thus, this study was designed to evaluate the degree of coronary involvement in patients with COPD and suspected or confirmed CAD. Methods In this cross-sectional study, carried out between March 2015 and June 2017, 210 outpatients with suspected or confirmed CAD were examined by both spirometry and coronary angiography or multidetector computed tomography. These patients were divided into two groups: with and without COPD. Size, site, extent, and calcification of the coronary lesions, and the severity of COPD were analyzed. Results COPD patients (n = 101) presented with a higher frequency of obstructive coronary lesions ≥50% (n = 72, 71.3%), multivessels (n = 29, 28.7%), more lesions of the left coronary trunk (n = 18, 17.8%), and more calcified atherosclerotic plaques and higher Agatston coronary calcium score than the patients without COPD (P < 0.0001). The more severe the COPD in the Global Initiative for Obstructive Lung Disease stages, the more severe the CAD and the more calcified coronary plaques (P < 0.0001). However, there was no difference between the two groups with respect to the main risk factors for CAD. In the univariate analysis, COPD was an independent predictor of obstructive CAD (odds ratio [OR] 4.78; 95% confidence interval: 2.21–10.34; P < 0.001). Conclusion In patients with suspected CAD, comorbid COPD was associated with increased severity and extent of coronary lesions, calcific plaques, and elevated calcium score independent of the established risk factors for CAD. In addition, the more severe the COPD, the greater the severity of coronary lesions and calcification present.
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Affiliation(s)
- Igor Larchert Mota
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil,
| | - Antônio Carlos Sobral Sousa
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Maria Luiza Doria Almeida
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil
| | - Enaldo Vieira de Melo
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil
| | - Eduardo José Pereira Ferreira
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - José Barreto Neto
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil
| | - Carlos José Oliveira Matos
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Caio José Coutinho Leal Telino
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Maria Júlia Silveira Souto
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Joselina Luzia Menezes Oliveira
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
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Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) has been identified as a risk factor for cardiovascular diseases such as myocardial infarction. The role of COPD in cerebrovascular disease is, however, less certain. Although earlier studies have suggested that the risk for stroke is also increased in COPD, more recent investigations have generated mixed results. OBJECTIVES The primary objective of our review was to quantify the magnitude of the association between COPD and stroke. We also sought to clarify the nature of the relationship between COPD and stroke by investigating whether the risk of stroke in COPD varies with age, sex, smoking history, and/or type of stroke and whether stroke risk is modified in particular COPD phenotypes. RESULTS The MEDLINE and EMBASE databases were searched in May 2016 to identify articles that compared stroke outcomes in people with and without COPD. Studies were grouped by study design to distinguish those that reported prevalence of stroke (cross-sectional studies) from those that estimated incidence (cohort or case-control studies). In addition, studies were stratified according to study population characteristics, the nature of COPD case definitions, and adjustment for confounding (smoking). Heterogeneity was assessed using the I2 statistic. We identified 5,493 studies, of which 30 met our predefined inclusion criteria. Of the 25 studies that reported prevalence ratios, 11 also estimated prevalence odds ratios. The level of heterogeneity among the included cross-sectional studies did not permit the calculation of pooled ratios, save for a group of four studies that estimated prevalence odds ratios adjusted for smoking (prevalence odds ratio, 1.51; 95% confidence interval, 1.09-2.09; I2 = 45%). All 11 studies that estimated relative risk for nonfatal incident stroke reported increased risk in COPD. Adjustment for smoking invariably reduced the magnitude of the associations. CONCLUSIONS Although both prevalence and incidence of stroke are increased in people with COPD, the weight of evidence does not support the hypothesis that COPD is an independent risk factor for stroke. The possibility remains that COPD is causal in certain subsets of patients with COPD and for certain stroke subtypes.
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Papaioannou O, Karampitsakos T, Barbayianni I, Chrysikos S, Xylourgidis N, Tzilas V, Bouros D, Aidinis V, Tzouvelekis A. Metabolic Disorders in Chronic Lung Diseases. Front Med (Lausanne) 2018; 4:246. [PMID: 29404325 PMCID: PMC5778140 DOI: 10.3389/fmed.2017.00246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/18/2017] [Indexed: 12/16/2022] Open
Abstract
Chronic lung diseases represent complex diseases with gradually increasing incidence, characterized by significant medical and financial burden for both patients and relatives. Their increasing incidence and complexity render a comprehensive, multidisciplinary, and personalized approach critically important. This approach includes the assessment of comorbid conditions including metabolic dysfunctions. Several lines of evidence show that metabolic comorbidities, including diabetes mellitus, dyslipidemia, osteoporosis, vitamin D deficiency, and thyroid dysfunction have a significant impact on symptoms, quality of life, management, economic burden, and disease mortality. Most recently, novel pathogenetic pathways and potential therapeutic targets have been identified through large-scale studies of metabolites, called metabolomics. This review article aims to summarize the current state of knowledge on the prevalence of metabolic comorbidities in chronic lung diseases, highlight their impact on disease clinical course, delineate mechanistic links, and report future perspectives on the role of metabolites as disease modifiers and therapeutic targets.
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Affiliation(s)
- Ourania Papaioannou
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Karampitsakos
- 5th Department of Respiratory Medicine, Hospital for Diseases of the Chest "Sotiria", Athens, Greece
| | - Ilianna Barbayianni
- Department of Internal Medicine, Section of Pulmonary Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Serafeim Chrysikos
- 5th Department of Respiratory Medicine, Hospital for Diseases of the Chest "Sotiria", Athens, Greece
| | - Nikos Xylourgidis
- Department of Internal Medicine, Section of Pulmonary Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Vasilis Tzilas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilis Aidinis
- Division of Immunology, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Argyrios Tzouvelekis
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Division of Immunology, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
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23
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Patterns of Oxygen Pulse Curve in Response to Incremental Exercise in Patients with Chronic Obstructive Pulmonary Disease - An Observational Study. Sci Rep 2017; 7:10929. [PMID: 28883532 PMCID: PMC5589739 DOI: 10.1038/s41598-017-11189-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/15/2017] [Indexed: 11/30/2022] Open
Abstract
In COPD, pulmonary hyperinflation causes decreased stroke volume thereby decreased oxygen pulse (O2P). While O2P flattening is related to myocardial ischemia in cardiac patients, O2P patterns have seldom been explored in COPD. The aims of the study were to investigate O2P-curve patterns and associated factors in COPD. Seventy-five patients with stable COPD were enrolled. The demographics, cardiac size, physiological measurements and stress EKG were compared among O2P-curve pattern groups. An algorithm to identify O2P-curve patterns was developed in 28 patients. In the remaining 45 patients after excluding two with poor effort, this algorithm revealed 20 (44%) flattening, 16 (36%) increasing, and nine (20%) decreasing patterns. The flattening-type group had lower body mass, cardiac size, and diffusing capacity, and larger lung volumes (p = 0.05–<0.0001) compared to the increasing-type group. During exercise, the flattening-type group had a lower operable O2P and more hyperventilation and dyspnea (p = 0.02–<0.01). None had ST-T changes. Most differences were related to body mass and mildly to inspiratory fraction. The decreasing-type group performed higher effort than the increasing-type group (p < 0.05). In conclusion, O2P flattening was common and was associated with reduced body mass and pulmonary hyperinflation rather than with myocardial ischemia. The decreasing-type may be caused by motivation to exercise.
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24
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Liu F, Zou Y, Huang Q, Zheng L, Wang W. Electronic health records and improved nursing management of chronic obstructive pulmonary disease. Patient Prefer Adherence 2015; 9:495-500. [PMID: 25848228 PMCID: PMC4376268 DOI: 10.2147/ppa.s76562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This paper identifies evolving trends in the diagnosis and treatment of chronic obstructive pulmonary disease (COPD), and recommends the integration of nursing strategies in COPD management via widespread implementation of electronic health records. COPD is a complex lung disease with diverse origins, both physical and behavioral, manifested in a wide range of symptoms that further increase the patient's risk for comorbidities. Early diagnosis and effective management of COPD require monitoring of a dizzying array of COPD symptoms over extended periods of time, and nurses are especially well positioned to manage potential progressions of COPD, as frontline health care providers who obtain, record, and organize patient data. Developments in medical technology greatly aid nursing management of COPD, from the deployment of spirometry as a diagnostic tool at the family practice level to newly approved treatment options, including non-nicotine pharmacotherapies that reduce the cravings associated with tobacco withdrawal. Among new medical technologies, electronic health records have proven particularly advantageous in the management of COPD, enabling providers to gather, maintain, and reference more patient data than has ever been possible before. Thus, consistent and widespread implementation of electronic health records facilitates the coordination of diverse treatment strategies, resulting in increased positive health outcomes for patients with COPD.
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Affiliation(s)
- Fengping Liu
- Yancheng Medical College, Yancheng, Jiangsu Province, People’s Republic of China
| | - Yeqing Zou
- Yancheng Medical College, Yancheng, Jiangsu Province, People’s Republic of China
| | - Qingmei Huang
- The First Affiliated College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Li Zheng
- The First Affiliated College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Wei Wang
- The First Affiliated College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China
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25
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Miravitlles M, Price D, Rabe KF, Schmidt H, Metzdorf N, Celli B. Comorbidities of patients in tiotropium clinical trials: comparison with observational studies of patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:549-64. [PMID: 25834416 PMCID: PMC4365745 DOI: 10.2147/copd.s71913] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is an ongoing debate on whether patients with chronic obstructive pulmonary disease (COPD) seen in real-life clinical settings are represented in randomized controlled trials (RCTs) of COPD. It is thought that the stringent inclusion and exclusion criteria of RCTs may prevent the participation of patients with specific characteristics or risk factors. METHODS We surveyed a database of patients recruited into 35 placebo-controlled tiotropium RCTs and also conducted a systematic literature review of large-scale observational studies conducted in patients with a documented diagnosis of COPD between 1990 and 2013. Patient demographics and comorbidities with a high prevalence in patients with COPD were compared between the two patient populations at baseline. Using the Medical Dictionary for Regulatory Activities (MedDRA; v 14.0), patient comorbidities in the pooled tiotropium RCTs were classified according to system organ class, pharmacovigilance (PV) endpoints, and Standardised MedDRA Queries to enable comparison with the observational studies. RESULTS We identified 24,555 patients in the pooled tiotropium RCTs and 61,361 patients among the 13 observational studies that met our search criteria. The Global initiative for chronic Obstructive Lung Disease (GOLD) staging of patients in the RCTs differed from that in observational studies: the proportion of patients with GOLD stages I+II disease ranged from 40.0% to 51.5% in the RCTs but 24.5% to 44.1% in the observational studies; for GOLD stage III or IV disease these ranges were 7.2%-45.8% (RCTs) and 13.7-42.1% (observational studies). The comorbidities with the highest prevalence reported in the RCTs and observational studies were: hypertension (39.4%-40.0% vs 40.1%-60.6%), other ischemic heart disease (12.3%-14.2% vs 12.5%-41.0%), diabetes (10.3%-10.9% vs 4.0%-38.9%), depression (8.5%-9.5% vs 17.0%-20.6%), and cardiac arrhythmia (7.8%-11.4% vs 11.3%-15.8%). CONCLUSION The clinical profile of COPD patients treated in the tiotropium trial program appears to be largely in the range of clinical characteristics, including cardiovascular comorbidities, reported for "real-life patients." The tiotropium RCTs tended to include patients with more severe disease than the observational studies.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - David Price
- Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Klaus F Rabe
- Department of Medicine, Christian-Albrechts-Universität zu Kiel (CAU), Großhansdorf, Germany ; LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Hendrik Schmidt
- Global Biometrics and Clinical Applications, Boehringer Ingelheim Pharma GmbH and Co KG, Ingelheim am Rhein, Germany
| | - Norbert Metzdorf
- TA Respiratory Diseases, Boehringer Ingelheim Pharma GmbH and Co KG, Ingelheim am Rhein, Germany
| | - Bartolome Celli
- Pulmonary Division, Brigham and Women's Hospital, Boston, MA, USA
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26
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Putcha N, Han MK, Martinez CH, Foreman MG, Anzueto AR, Casaburi R, Cho MH, Hanania NA, Hersh CP, Kinney GL, Make BJ, Steiner RM, Lutz SM, Thomashow BM, Williams AA, Bhatt SP, Beaty TH, Bowler RP, Ramsdell JW, Curtis JL, Everett D, Hokanson JE, Lynch DA, Sutherland ER, Silverman EK, Crapo JD, Wise RA, Regan EA, Hansel NN. Comorbidities of COPD have a major impact on clinical outcomes, particularly in African Americans. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2015; 1:105-114. [PMID: 25695106 PMCID: PMC4329763 DOI: 10.15326/jcopdf.1.1.2014.0112] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND COPD patients have a great burden of comorbidity. However, it is not well established whether this is due to shared risk factors such as smoking, if they impact patients exercise capacity and quality of life, or whether there are racial disparities in their impact on COPD. METHODS We analyzed data from 10,192 current and ex-smokers with (cases) and without COPD (controls) from the COPDGene® cohort to establish risk for COPD comorbidities adjusted for pertinent covariates. In adjusted models, we examined comorbidities prevalence and impact in African-Americans (AA) and Non-Hispanic Whites (NHW). RESULTS Comorbidities are more common in COPD compared to those with normal spirometry (controls), and the risk persists after adjustments for covariates including pack-years smoked. After adjustment for confounders, eight conditions were independently associated with worse exercise capacity, quality of life and dyspnea. There were racial disparities in the impact of comorbidities on exercise capacity, dyspnea and quality of life, presence of osteoarthritis and gastroesophageal reflux disease having a greater negative impact on all three outcomes in AAs than NHWs (p<0.05 for all interaction terms). CONCLUSIONS Individuals with COPD have a higher risk for comorbidities than controls, an important finding shown for the first time comprehensively after accounting for confounders. Individual comorbidities are associated with worse exercise capacity, quality of life, and dyspnea, in African-Americans compared to non-Hispanic Whites.
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Affiliation(s)
- Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Meilan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Marilyn G Foreman
- Divison of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Antonio R Anzueto
- Pulmonary Section, Department of Medicine, University of Texas Health Science Center, and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA
| | - Robert M Steiner
- Department of Radiology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sharon M Lutz
- Colorado School of Public Health, Aurora, Colorado, USA
| | - Byron M Thomashow
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, New York, USA
| | - Andre A Williams
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Terri H Beaty
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA
| | - Joe W Ramsdell
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas Everett
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA
| | | | - David A Lynch
- Division of Radiology, National Jewish Health, Denver, Colorado, USA
| | - E Rand Sutherland
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James D Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth A Regan
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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27
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Aliyali M, Mehravaran H, Abedi S, Sharifpour A, Yazdani Cherati J. Impact of Comorbid Ischemic Heart Disease on Short-Term Outcomes of Patients Hospitalized for Acute Exacerbations of COPD. TANAFFOS 2015; 14:165-71. [PMID: 26858761 PMCID: PMC4745184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Ischemic heart disease (IHD) is a leading cause of mortality and morbidity in patients with COPD. The contribution of IHD to acute outcomes in patients with acute exacerbation of COPD (AECOPD) is not known in detail. The present study assessed the effect of comorbid IHD on length of stay (LOS), risk of intensive care unit (ICU) admission and death as indicators of the short-term outcomes for patients hospitalized for AECOPD. MATERIALS AND METHODS Medical records of patients hospitalized for AECOPD from September 2008 to March 2014 were reviewed. Data extracted from patient records regarding the presence of comorbidities and the markers of disease severity were analyzed using logistic regression for ICU admission and mortality, the Kaplan-Meier method, log rank test and Cox regression for LOS. RESULTS Of 507 separate admissions, 146 episodes (28.8%) occurred in patients with IHD. The median LOS was 7 days [interquartile range (IQR) 6, 11] in patients with IHD versus 6 days (IQR 5, 8) for patients without IHD. After adjustment for confounders, LOS was found to be 26% longer (p=0.033) for patients with IHD. The adjusted odds ratio for the risk of ICU admission and death in patients with IHD was 2.97 and 3.86, respectively. CONCLUSION Patients hospitalized for AECOPD with comorbid IHD had longer LOS, greater risk for ICU admission and death. It seems that this group is a particular COPD subtype with a more severe degree of COPD and poorer acute outcomes that may influence optimal management.
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Affiliation(s)
- Masoud Aliyali
- Department of Internal Medicine, Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Mehravaran
- Department of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran,,Correspondence to: Mehravaran H, Address: Department of Internal Medicine, Imam Hospital, Mazandaran University of Medical Sciences, 48146-33131, Sari, Iran, Email address:
| | - Siavash Abedi
- Department of Internal Medicine, Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Sharifpour
- Department of Internal Medicine, Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jamshid Yazdani Cherati
- Departments of Biostatistics, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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28
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Izquierdo JL. Looking at the Heart of Patients with Chronic Obstructive Pulmonary Disease. Respiration 2015; 90:187-8. [DOI: 10.1159/000439229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Naik D, Joshi A, Paul TV, Thomas N. Chronic obstructive pulmonary disease and the metabolic syndrome: Consequences of a dual threat. Indian J Endocrinol Metab 2014; 18:608-616. [PMID: 25285275 PMCID: PMC4171881 DOI: 10.4103/2230-8210.139212] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The metabolic syndrome is found to be more frequent in chronic obstructive pulmonary disease (COPD). The presence of inflammatory markers in circulation, sputum, and broncho-alveolar fluid suggest systemic inflammation is one of the potential mechanisms responsible for both COPD and metabolic syndrome. Physical inactivity, skeletal muscle dysfunction, hypogonadism, and steroid use are also important causes of the metabolic syndrome in COPD. Obesity and insulin resistance is found to be more common in mild to moderate stages (I and II) of COPD. Patients with COPD and the metabolic syndrome have increase risk of morbidity and mortality due to cardiovascular disease. This review describes in details the various components of metabolic syndrome and its impact on long outcomes in COPD patients.
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Affiliation(s)
- Dukhabandhu Naik
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anjali Joshi
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
- Chellaram Diabetes Institute, Bavdhan, Pune, Maharashtra, India
| | - Thomas Vizhalil Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
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30
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Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis 2014; 9:871-88. [PMID: 25210449 PMCID: PMC4154888 DOI: 10.2147/copd.s49621] [Citation(s) in RCA: 234] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Comorbidities are frequent in chronic obstructive pulmonary disease (COPD) and significantly impact on patients’ quality of life, exacerbation frequency, and survival. There is increasing evidence that certain diseases occur in greater frequency amongst patients with COPD than in the general population, and that these comorbidities significantly impact on patient outcomes. Although the mechanisms are yet to be defined, many comorbidities likely result from the chronic inflammatory state that is present in COPD. Common problems in the clinical management of COPD include recognizing new comorbidities, determining the impact of comorbidities on patient symptoms, the concurrent treatment of COPD and comorbidities, and accurate prognostication. The majority of comorbidities in COPD should be treated according to usual practice, and specific COPD management is infrequently altered by the presence of comorbidities. Unfortunately, comorbidities are often under-recognized and under-treated. This review focuses on the epidemiology of ten major comorbidities in patients with COPD. Further, we emphasize the clinical impact upon prognosis and management considerations. This review will highlight the importance of comorbidity identification and management in the practice of caring for patients with COPD.
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Affiliation(s)
| | - Jeremy P Wrobel
- Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia
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31
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Bellocchia M, Masoero M, Ciuffreda A, Croce S, Vaudano A, Torchio R, Boita M, Bucca C. Predictors of cardiovascular disease in asthma and chronic obstructive pulmonary disease. Multidiscip Respir Med 2013; 8:58. [PMID: 24004921 PMCID: PMC3844573 DOI: 10.1186/2049-6958-8-58] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/29/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a common comorbidity in patients with chronic airway obstruction, and is associated with systemic inflammation and airway obstruction. The aim of this study was to evaluate the predictors of CVD in two different conditions causing chronic airway obstruction, asthma and COPD. METHODS Lung function tests, clinical and echocardiographic data were assessed in 229 consecutive patients, 100 with asthma and 129 with COPD. CVD was classified into: pressure overload (PO) and volume overload (VO). Sub-analysis of patients with ischemic heart disease (IHD) and pulmonary hypertension (PH) was also performed. RESULTS CVD was found in 185 patients (81%: 51% COPD and 30% asthmatics) and consisted of PO in 42% and of VO in 38% patients. COPD patients, as compared to asthmatics, had older age, more severe airway obstruction, higher prevalence of males, of smokers, and of CVD (91% vs 68%), either PO (46% vs 38%) or VO (45% vs 30%). CVD was associated with older age and more severe airway obstruction both in asthma and COPD. In the overall patients the predictive factors of CVD were age, COPD, and male sex; those of PO were COPD, BMI, VC, FEV1 and MEF50 and those of VO were age, VC and MEF50. In asthma, the predictors of CVD were VC, FEV1, FEV1 /VC%, and PaO2, those of PO were VC, FEV1 and FEV1 /VC%, while for VO there was no predictor. In COPD the predictors of CVD were age, GOLD class and sex, those of VO age, VC and MEF50, and that of PO was BMI. Sub-analysis showed that IHD was predicted by COPD, age, BMI and FEV1, while PH (found only in 25 COPD patients), was predicted by VO (present in 80% of the patients) and FEV1. In subjects aged 65 years or more the prevalence of CVD, PO and VO was similar in asthmatic and COPD patients, but COPD patients had higher prevalence of males, smokers, IHD, PH, lower FEV1 and higher CRP. CONCLUSIONS The results of this study indicate that cardiovascular diseases are frequent in patients with chronic obstructive disorders, particularly in COPD patients. The strongest predictors of CVD are age and airway obstruction. COPD patients have higher prevalence of ischemic heart disease and pulmonary hypertension. In the elderly the prevalence of PO and VO in asthma and COPD patients is similar.
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Affiliation(s)
- Michela Bellocchia
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Monica Masoero
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Antonio Ciuffreda
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Silvia Croce
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Arianna Vaudano
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Roberto Torchio
- Cardiorespiratory Pathophysiology Department, AOU S, Luigi, Gonzole Region 10, 10043 Orbassano, Turin, Italy
| | - Monica Boita
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Caterina Bucca
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
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Pathophysiologic mechanisms of cardiovascular disease in obstructive sleep apnea syndrome. Pulm Med 2013; 2013:521087. [PMID: 23936649 PMCID: PMC3712227 DOI: 10.1155/2013/521087] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/24/2013] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. This disease has many potential consequences including excessive daytime sleepiness, neurocognitive deterioration, endocrinologic and metabolic effects, and decreased quality of life. Patients with OSAS experience repetitive episodes of hypoxia and reoxygenation during transient cessation of breathing that provoke systemic effects. Furthermore, there may be increased levels of biomarkers linked to endocrine-metabolic and cardiovascular alterations. Epidemiological studies have identified OSAS as an independent comorbid factor in cardiovascular and cerebrovascular diseases, and physiopathological links may exist with onset and progression of heart failure. In addition, OSAS is associated with other disorders and comorbidities which worsen cardiovascular consequences, such as obesity, diabetes, and metabolic syndrome. Metabolic syndrome is an emerging public health problem that represents a constellation of cardiovascular risk factors. Both OSAS and metabolic syndrome may exert negative synergistic effects on the cardiovascular system through multiple mechanisms (e.g., hypoxemia, sleep disruption, activation of the sympathetic nervous system, and inflammatory activation). It has been found that CPAP therapy for OSAS provides an objective improvement in symptoms and cardiac function, decreases cardiovascular risk, improves insulin sensitivity, and normalises biomarkers. OSAS contributes to the pathogenesis of cardiovascular disease independently and by interaction with comorbidities. The present review focuses on indirect and direct evidence regarding mechanisms implicated in cardiovascular disease among OSAS patients.
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Chronic obstructive pulmonary disease. Indian J Med Res 2013; 137:251-69. [PMID: 23563369 PMCID: PMC3657849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The global prevalence of physiologically defined chronic obstructive pulmonary disease (COPD) in adults aged >40 yr is approximately 9-10 per cent. Recently, the Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in Adults had shown that the overall prevalence of chronic bronchitis in adults >35 yr is 3.49 per cent. The development of COPD is multifactorial and the risk factors of COPD include genetic and environmental factors. Pathological changes in COPD are observed in central airways, small airways and alveolar space. The proposed pathogenesis of COPD includes proteinase-antiproteinase hypothesis, immunological mechanisms, oxidant-antioxidant balance, systemic inflammation, apoptosis and ineffective repair. Airflow limitation in COPD is defined as a postbronchodilator FEV1 (forced expiratory volume in 1 sec) to FVC (forced vital capacity) ratio <0.70. COPD is characterized by an accelerated decline in FEV1. Co morbidities associated with COPD are cardiovascular disorders (coronary artery disease and chronic heart failure), hypertension, metabolic diseases (diabetes mellitus, metabolic syndrome and obesity), bone disease (osteoporosis and osteopenia), stroke, lung cancer, cachexia, skeletal muscle weakness, anaemia, depression and cognitive decline. The assessment of COPD is required to determine the severity of the disease, its impact on the health status and the risk of future events (e.g., exacerbations, hospital admissions or death) and this is essential to guide therapy. COPD is treated with inhaled bronchodilators, inhaled corticosteroids, oral theophylline and oral phosphodiesterase-4 inhibitor. Non pharmacological treatment of COPD includes smoking cessation, pulmonary rehabilitation and nutritional support. Lung volume reduction surgery and lung transplantation are advised in selected severe patients. Global strategy for the diagnosis, management and prevention of Chronic Obstructive Pulmonary Disease guidelines recommend influenza and pneumococcal vaccinations.
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