TY - JOUR
T1 - COPD as a lung disease with systemic consequences - Clinical impact, mechanisms, and potential for early intervention
AU - Decramer, Marc
AU - Rennard, Stephen
AU - Troosters, Thierry
AU - Mapel, Douglas W.
AU - Giardino, Nicholas
AU - Mannino, David
AU - Wouters, Emiel
AU - Sethi, Sanjay
AU - Cooper, Christopher B.
N1 - Funding Information:
Keywords: COPD; Systemic consequences; Co-morbidities; Clinical course of COPD; Early intervention. The authors acknowledge the financial support of Boehringer Ingelheim (Ingelheim, Germany) and Pfizer Inc. (New York, USA) in the organization of the Round Table meeting held on 9–10 December 2006 from which this manuscript was developed. Abbreviations: ARIC, Atherosclerosis Risk in Communities (Study); BMD, bone mineral density; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; DALYS, disability-adjusted life years; DEXA, dual-energy x-ray absorptiometry; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease©R; HRQL, health-related quality of life; IL, interleukin; NHANES, National Health and Nutritional Examination Survey; PDE, phosphodiesterase; TLC, total lung capacity; TNF, tumor necrosis factor; TORCH, Towards a Revolution in COPD Health (Study); UPLIFT©R, Understanding Potential Long-term Impacts on Function with Tiotropium (Study); WHO, World Health Organization. Correspondence to: Marc Decramer, Respiratory Division and Department of Rehabilitation Science, University Hospital, Katholieke Universiteit, Leuven, Belgium phone: ; fax: +32 16 346 803 email: [email protected]
PY - 2008/8
Y1 - 2008/8
N2 - The natural course of chronic obstructive pulmonary disease (COPD) is complicated by the development of systemic consequences and co-morbidities. These may be major features in the clinical presentation of COPD, prompting increasing interest. Systemic consequences may be defined as non-pulmonary manifestations of COPD with an immediate cause-and-effect relationship, whereas co-morbidities are diseases associated with COPD. The major systemic consequences/co-morbidities now recognized are: deconditioning, exercise intolerance, skeletal muscle dysfunction, osteoporosis, metabolic impact, anxiety and depression, cardiovascular disease, and mortality. The mechanisms by which these develop are unclear. Probably many factors are involved. Two appear of paramount importance: systemic inflammation, which presents in some patients with stable disease and virtually all patients during exacerbations, and inactivity, which may be a key link to most COPD-related co-morbidities. Further studies are required to determine the role of inflammatory cells/mediators involved in systemic inflammatory processes in causing co-morbidities; the link between activity and co-morbidities; and how COPD therapy may affect activity. Both key mechanisms appear to be influenced significantly by COPD exacerbations. Importantly, although the prevalence of systemic consequences increases with increasing severity of airflow obstruction, both systemic consequences and co-morbidities are already present in the Global Initiative for Chronic Obstructive Lung Disease Stage II. This supports the concept of early intervention in chronic obstructive pulmonary disease. Although at present early intervention studies in COPD are lacking, circumstantial evidence suggests that current treatments may influence events leading to the systemic consequences and co-morbidities, and thus may affect the clinical manifestations of the disease.
AB - The natural course of chronic obstructive pulmonary disease (COPD) is complicated by the development of systemic consequences and co-morbidities. These may be major features in the clinical presentation of COPD, prompting increasing interest. Systemic consequences may be defined as non-pulmonary manifestations of COPD with an immediate cause-and-effect relationship, whereas co-morbidities are diseases associated with COPD. The major systemic consequences/co-morbidities now recognized are: deconditioning, exercise intolerance, skeletal muscle dysfunction, osteoporosis, metabolic impact, anxiety and depression, cardiovascular disease, and mortality. The mechanisms by which these develop are unclear. Probably many factors are involved. Two appear of paramount importance: systemic inflammation, which presents in some patients with stable disease and virtually all patients during exacerbations, and inactivity, which may be a key link to most COPD-related co-morbidities. Further studies are required to determine the role of inflammatory cells/mediators involved in systemic inflammatory processes in causing co-morbidities; the link between activity and co-morbidities; and how COPD therapy may affect activity. Both key mechanisms appear to be influenced significantly by COPD exacerbations. Importantly, although the prevalence of systemic consequences increases with increasing severity of airflow obstruction, both systemic consequences and co-morbidities are already present in the Global Initiative for Chronic Obstructive Lung Disease Stage II. This supports the concept of early intervention in chronic obstructive pulmonary disease. Although at present early intervention studies in COPD are lacking, circumstantial evidence suggests that current treatments may influence events leading to the systemic consequences and co-morbidities, and thus may affect the clinical manifestations of the disease.
KW - COPD
KW - Clinical course of COPD
KW - Co-morbidities
KW - Early intervention
KW - Systemic consequences
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U2 - 10.1080/15412550802237531
DO - 10.1080/15412550802237531
M3 - Review article
C2 - 18671149
AN - SCOPUS:48949089104
SN - 1541-2555
VL - 5
SP - 235
EP - 256
JO - COPD: Journal of Chronic Obstructive Pulmonary Disease
JF - COPD: Journal of Chronic Obstructive Pulmonary Disease
IS - 4
ER -