Chronic Obstructive Pulmonary Disease and Stroke

Abstract

Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the world and its incidence and prevalence is on the rise. It is evident that COPD is linked to cardiovascular disease. In the last years, several studies demonstrated that COPD may also be a risk factor for stroke, another major cause of death worldwide. Taking in consideration that COPD has multiple comorbidities it is hard to say whether COPD is an independent risk factor for stroke or it is due to confounding effect. This review is aimed to discuss current data on COPD and stroke, potential links, therapy, and prevention. Current data suggest that COPD may increase the risk of hemorrhagic stroke. The incidence of other stroke subtypes may also be increased in COPD or may be due to confounding effect. However, COPD patients who have stroke are at risk for pulmonary and extrapulmonary complications. We conclude that more studies are needed to further clarify the links between COPD and stroke. The management of COPD as well as the use of prevention therapy is essential to decrease the risk for stroke and should be at special attention in pulmonary medicine and neurology.

Long-Term Mortality and Medical Burden of Patients with Chronic Obstructive Pulmonary Disease with and without Subsequent Stroke Episodes

“…The study design did not take into account the financial burden on the patients' families or the type and severity level of the patients' COPD and stroke. As we known, it is hard to say whether COPD in severer status is associated a higher risk for developing stroke by current evidences [11,25]. However, those could be confounding factors for a higher mortality risk in patients with COPD with or without stroke.…”

<p>Clinical Impact of Multidisciplinary Outpatient Care on Outcomes of Patients with COPD</p>

“…12 While this review shows significant improvement in health-related quality of life, 6MWD, respiratory-related hospital admissions and allcause hospital days per patient, other prospective trials with IMDM show no changes in primary outcomes (healthrelated QOL) and secondary outcomes (MMRC, smoking behaviors, and health care usage including COPD exacerbations and admissions). 12,13 Our study, while small in size, provides more insights into the reasons for these conflicting reports. It is likely that patients with COPD may have individually defined paths to their clinical courses regardless of the IMDM.…”

“…2,11 As COPD becomes more severe, a number of pathologic derangements start to contribute to mortality that are not reflected by forced expiratory volume in 1 s (FEV 1 ) alone. [12][13][14][15][16] BODE index, composed of four clinically relevant and modifiable variables, body mass index (BMI), FEV 1 , modified medical research council (mMRC) dyspnea scale, and 6 min walk distance (6MWD), has been shown to predict survival of patients with COPD by capturing complex pathophysiology. 17,18 Severity of symptoms has been found to be weakly correlating with airflow limitation, and two distinctive clinical subphenotypes of patients with COPD, ones experiencing frequent exacerbation and severe symptoms vs others with infrequent exacerbations and less symptom, have been appreciated in recent GOLD statements.…”

Scavenger Receptor Class B type 1 (SR-B1) and the modifiable risk factors of stroke

“…Dysfunction in a pulmonary surfactant caused by cigarette smoke unsurprisingly contributes to pathological dysfunction in other conditions of the lung as well, such as chronic obstructive pulmonary disease (COPD) [77,79]. Additionally, a recent article suggests that COPD could contribute to the pathogenesis of stroke [80]. This avenue could be an area of interest in the future to determine if SR-B1's role in facilitating vitamin E uptake in type II pneumocytes, which is then used to create pulmonary surfactant, plays a protective role in the presence of risk factors.…”