Complex chronic comorbidities of COPD

TLDR

COPD is characterized by fixed airflow limitation and systemic inflammation from smoking, which can trigger comorbidities such as heart failure and metabolic syndrome, showing that the disease extends beyond the lungs and is often overlooked in guidelines. The authors aim to elucidate the origins and consequences of systemic inflammation in COPD and to develop comprehensive assessment strategies that incorporate lung function, cardiovascular and metabolic evaluations, and inflammatory markers to guide preventive and therapeutic interventions. The study proposes using lung function tests, noninvasive cardiovascular and metabolic assessments, and circulating inflammatory markers such as C‑reactive protein to better characterize COPD patients.

Abstract

Chronic obstructive pulmonary disease (COPD) is defined by fixed airflow limitation associated with an abnormal pulmonary and systemic inflammatory response of the lungs to cigarette smoke. The systemic inflammation induced by smoking may also cause chronic heart failure, metabolic syndrome and other chronic diseases, which may contribute to the clinical manifestations and natural history of COPD. Thus COPD can no longer be considered a disease only of the lungs, as it is often associated with a wide variety of systemic consequences. A better understanding of the origin and consequences of systemic inflammation, and of potential therapies, will most likely lead to better care of patients with COPD. Medical textbooks and clinical guidelines still largely ignore the fact that COPD seldom occurs in isolation. As the diagnosis and assessment of severity of COPD may be greatly affected by the presence of comorbid conditions, the current authors believe that lung function measurement, noninvasive assessment of cardiovascular and metabolic functions, and circulating inflammatory markers ( e.g. C-reactive protein) might help to better characterise these patients. Similarly, preventive and therapeutic interventions should address the patient in their complexity.