Systemic manifestations and comorbidities of COPD

Abstract

Increasing evidence indicates that chronic obstructive pulmonary disease (COPD) is a complex disease involving more than airflow obstruction. Airflow obstruction has profound effects on cardiac function and gas exchange with systemic consequences. In addition, as COPD results from inflammation and/or alterations in repair mechanisms, the ''spill-over'' of inflammatory mediators into the circulation may result in important systemic manifestations of the disease, such as skeletal muscle wasting and cachexia. Systemic inflammation may also initiate or worsen comorbid diseases, such as ischaemic heart disease, heart failure, osteoporosis, normocytic anaemia, lung cancer, depression and diabetes. Comorbid diseases potentiate the morbidity of COPD, leading to increased hospitalisations, mortality and healthcare costs. Comorbidities complicate the management of COPD and need to be evaluated carefully. Current therapies for comorbid diseases, such as statins and peroxisome proliferator-activated receptor-agonists, may provide unexpected benefits for COPD patients. Treatment of COPD inflammation may concomitantly treat systemic inflammation and associated comorbidities. However, new broad-spectrum anti-inflammatory treatments, such as phosphodiesterase 4 inhibitors, have significant side-effects so it may be necessary to develop inhaled drugs in the future. Another approach is the reversal of corticosteroid resistance, for example with effective antioxidants. More research is needed on COPD comorbidities and their treatment.

Skeletal muscle dysfunction and oxidative stress in patients with chronic obstructive lung disease

“…As mentioned earlier, skeletal muscle dysfunction is one of the main extra-pulmonary manifestations of COPD 8) . Muscle dysfunction is usually reflected by loss of muscle strength and/or endurance.…”

“…tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-8] 7,8) . Cytokines are produced in many different cells, such as macrophages, neutrophils, monocytes, lymphocytes, endothelial cells, and fibroblasts, and play key roles in inflammatory and other responses to injury 62) .…”

“…Furthermore, this inflammation may lead to comorbidities, such as ischemic heart disease, heart failure, osteoporosis, lung cancer, depression, and diabetes 7,8) . Skeletal muscle dysfunction is another important extra-pulmonary manifestation of COPD caused by systemic inflammation.…”

“…Skeletal muscle dysfunction is another important extra-pulmonary manifestation of COPD caused by systemic inflammation. Muscular dysfunction is reflected in reduced limb muscle strength and exercise endurance, and poor health status and quality of life 7,8) .…”

Heart–Lung Interaction via Infection

“…The coexistence of COPD and CVD is acknowledged as an important clinical syndrome that is likely stimulated by common inflammatory pathways and is associated with poor outcomes, including increased use of health resources and mortality (1)(2)(3)(4)(5). COPD is associated with adverse cardiovascular effects, including increases in endothelial dysfunction, arterial stiffness, and atherogenesis, which are independent of the effects of cigarette smoking (1,(6)(7)(8). FEV 1 is an important independent predictor of CVD even in nonsmokers, and smokers with COPD are more likely to have CVD than smokers without COPD (9).…”