COPD Management: Look Beyond the Airway Obstruction, Chronic Bronchitis and Emphysema

Shekhar      A. Ghamande; Harakh      V. Dedhia

Abstract

Chronic medical conditions occur in more than half of the patients with COPD. They contribute to COPDrelated hospitalizations and they have been shown to prolong length of stay in patients with COPD. The presence of COPD can adversely impacts patients admitted to hospital with other conditions including pneumonia. Cardiovascular diseases are the leading causes of death in patients with COPD. Pharmacological treatment of COPD may adversely affect heart disease and diabetes. Recent studies highlight systemic morbidity with use of inhaled medications. Pulmonary hypert Musculoskeletal dysfunction, a systemic manifestation of COPD, contributes to exercise limitation. Osteoporosis occurs in patients with COPD even independent of oral steroid use. Gastro esophageal reflux symptoms are more common in patients with an FEV1 < 50%. Mortality is higher with poor glycemic control during a COPD exacerbation. Systemic inflammation in COPD is mediated by IL-6, IL-8, CRP and TNF α with the latter two contributing to anemia. CRP levels in COPD patients are associated with poor quality of life, reduced exercise endurance and correlate inversely with the 6 minute walk test. Clinicians needs to be aware of these co-morbidities and must evaluate their COPD patients accordingly. Early intervention can decrease intensity of the co-morbidity and improve quality of life in COPD patients.

Keywords: COPD, mortality, co-morbidities, multi system disease, cardiovascular disease, pulmonary embolism, osteoporosis, Airway Obstruction, Chronic Bronchitis, Emphysema, pneumonia, diabetes, Pulmonary hypertension, cardiac dysrhythmias, Systemic inflammation, TNF, Lung cancer, metabolic syndrome, coronary artery disease (CAD), congestive heart failure (CHF), fibrinogen, leucocytes, lipopolysaccharide binding protein, atherosclerotic process, atheroma, low density lipoproteins, cytokines, Tumor necrotic factor (TNF), osteoclastogenesis, atherogenesis, proteolysis, Reactive oxygen species (ROS), Hypoxia, Right Ventricular (RV) Dysfunction, heart catheterization, pulmonary artery pressure (PAP), brain natriuretic peptide (BNP), Long term oxygen therapy (LTOT), acute myocardial infarctions, Hyperinflation, Multifocal atrial tachycardia (MAT), Premature ventricular contractions (PVC's), randomized control trials (RCTs), atrial fibrillation, theophylline, tiotropium, angiography, deep venous thrombosis, inhaled glucocorticoid, bone mineral density, meta-analysis, squamous cell carcinoma, Skeletal muscle dysfunction, contractile protein metabolism, oxidative stress, pulmonary rehabilitation, fluticasonesalmeterol, hyperglycemia, catecholamine, glucocorticoid, Anemia, erythropoietin, Gastro Esophageal Reflux (GERD), insomnia, Rhythmic eye movement (REM), Obstructive sleep apnea (OSA), ipratropium bromide, Benzodiazepine receptor antagonists