Comorbid conditions at chronic obstructive pulmonary disease: the questions under investigation and discussion

Abstract

Today, chronic obstructive pulmonary disease is considered as a multifactorial disease with systemic extrapulmonary manifestations and a high level of comorbidity. Differentiation of the polymorbidity and comorbidity concepts for patients with this pathology is very important. The common trigger factors and/or pathogenetic mechanisms lay in the basis of comorbid conditions, and their progression is comparable in time with the underlying disease. This determines the necessity for appropriate integrated management of such patients. The presence of other diseases that are not related to the main pathological process through common causative factors and/or pathogenetic mechanisms should be regarded as concomitant and lying in the basis for polymorbidity. The domestic and foreign scientific literature data on the mechanisms of potential comorbid pathology in this group of patients have been summarized. Information concerning the leading role of oxidative stress and systemic inflammatory process of low intensity in the development of comorbidity in chronic obstructive pulmonary disease is presented. The mechanisms of their influence, relationship, discussion questions and actual data on genetic and molecular mechanisms of development of these pathological processes are highlighted. Special attention is paid to the metabolic processes that develop as a result of oxidative stress and systemic inflammation. In particular, it has been shown that systemic inflammation leads to the development of insulin resistance, diabetes and other metabolic disorders. Data is outlined, supporting rationale for stratification of the metabolic profiles or phenotypes, as well as the pathogenetic significance of endotoxemia. Endothelial dysfunction and associated diseases of the cardiovascular system are also the consequences of oxidative stress and systemic inflammation. The analysis has been performed for the peculiarities of the manifestations of some of them in this group of patients.