COPD - Aristea

TERZA SESSIONE
L’ANZIANO CARDIOPATICO CON
CO-MORBILITÀ
Infarto miocardico e
Broncopneumopatia
Ostruttiva
Daniele Bertoli
SC Cardiologia Clinica Riabilitativa
Sarzana
1/33
db 7/5/2011
COPD
• The 4th leading cause of death in the USA
(behind heart desease, cancer, cerebrovascular
disease)
• In 1990, COPD was ranked 12th as a burden of
disease; by 2020 it is projected to rank 5°
• The majority of patients with COPD die from
cardiovascular disorders or cancer, not
respiratory disease
SC Cardiologia Clinica Riabilitativa
Sarzana
2/33
db 7/5/2011
SC Cardiologia Clinica Riabilitativa
Sarzana
3/33
db 7/5/2011
COPD: Definition
• lung disease characterized by chronic obstruction of
lung airflow that interferes with normal breathing and is
not fully reversible.
• The airflow limitation is usually both progressive and
associated with an abnormal inflammatory response of
the lungs.
• The more familiar terms 'chronic bronchitis' and
'emphysema' are no longer used, but are now included
within the COPD diagnosis.
• COPD is not simply a "smoker's cough" but an underdiagnosed, life-threatening lung disease.
SC Cardiologia Clinica Riabilitativa
Sarzana
4/33
db 7/5/2011
COPD: Definition
• diagnosis is confirmed by spirometry
• COPD should be considered in any patient
who has symptoms of cough, sputum
production, or dyspnea and/or a history of
exposure to risk factors for the disease
• Chronic cough and sputum production
often precede the development of airflow
limitation by many years, although not all
individuals with cough and sputum
production go on to develop COPD
SC Cardiologia Clinica Riabilitativa
Sarzana
5/33
db 7/5/2011
PARAMETRI SPIROMETRICI
• FEV1 o VEMS (Volume espiratorio forzato in 1
secondo) = quantità di aria emessa nel primo
secondo di espirazione forzata
• FVC (Capacità Vitale Forzata) = quantità massima
di aria (misurata in litri) che può essere espulsa in
un’espirazione forzata dopo un’ispirazione
completa.
• FEV1/FVC = Un valore inferiore al 70% indica
un deficit ostruttivo e alta probabilità di BPCO.
SC Cardiologia Clinica Riabilitativa
Sarzana
6/33
db 7/5/2011
Spirometria Normale e Tracciato
Spirometrico di Pazienti con BPCO
SC Cardiologia Clinica Riabilitativa
Sarzana
7/33
db 7/5/2011
Classificazione spirometrica di gravità
della BPCO basata sul VEMS
post-broncodilatatore
SC Cardiologia Clinica Riabilitativa
Sarzana
8/33
db 7/5/2011
Heart disease and COPD
• The most common cardiac abnormalities in
patients with COPD are cor pulmonale and
pulmonary hypertension
• The prevalence of atrial fibrillation,
atherosclerosis, and CHF is also high
among patients with COPD
SC Cardiologia Clinica Riabilitativa
Sarzana
9/33
db 7/5/2011
Atherosclerosis and COPD
• Although some of the association between
COPD and atherosclerosis may be the result
of common risk factors such as tobacco use,
epidemiological evidence suggests that
impaired lung function is a risk factor for
increased cardiovascular death independent
of tobacco use
SC Cardiologia Clinica Riabilitativa
Sarzana
10/33
db 7/5/2011
The Relationship Between Reduced Lung Function and
Cardiovascular Mortality - A Population-Based Study and
a Systematic Review of the Literature
Chest 2005;127;1952-1959
SC Cardiologia Clinica Riabilitativa
Sarzana
11/33
db 7/5/2011
The Relationship Between Reduced Lung Function and
Cardiovascular Mortality - A Population-Based Study and a
Systematic Review of the Literature
Chest 2005;127;1952-1959
SC Cardiologia Clinica Riabilitativa
Sarzana
12/33
db 7/5/2011
Metaanalysis of studies that reported RR of
cardiovascular mortality based on FEV1 quintiles.
Chest 2005;127;1952-1959
SC Cardiologia Clinica Riabilitativa
Sarzana
13/33
db 7/5/2011
Metaanalysis of studies that reported RR of
cardiovascular mortality among nonsmokers
Chest 2005;127;1952-1959
SC Cardiologia Clinica Riabilitativa
Sarzana
14/33
db 7/5/2011
Relationship between FEV 1, smoking status, and OR for cardiovascular
mortality for current smoker (dark grey squares), ex-smoker (white
squares), and never smoker (light grey squares)
Young RP , Hopkins R , Eaton TE . Forced expiratory volume in one second: not just a lung function test but
a marker of premature death from all causes . Eur Respir J . 2007; 30(4): 616- 622
SC Cardiologia Clinica Riabilitativa
Sarzana
15/33
db 7/5/2011
SC Cardiologia Clinica Riabilitativa
Sarzana
Circulation 2003;107:1514-1519
16/33
db 7/5/2011
SC Cardiologia Clinica Riabilitativa
Sarzana
Circulation 2003;107:1514-1519
17/33
db 7/5/2011
Association between chronic obstructive pulmonary disease
and systemic inflammation: a systematic review and a
metaanalysis
Thorax 2004;59:574–580
Relationship between C-reactive protein (CRP) and COPD
SC Cardiologia Clinica Riabilitativa
Sarzana
18/33
db 7/5/2011
Association between chronic obstructive pulmonary disease
and systemic inflammation: a systematic review and a
metaanalysis
Thorax 2004;59:574–580
Relationship between fibrinogen and COPD
SC Cardiologia Clinica Riabilitativa
Sarzana
19/33
db 7/5/2011
Association between chronic obstructive pulmonary disease
and systemic inflammation: a systematic review and a
metaanalysis
Thorax 2004;59:574–580
Relationship between leucocytes and COPD
SC Cardiologia Clinica Riabilitativa
Sarzana
20/33
db 7/5/2011
C-reactive Protein As a Predictor of Prognosis in Chronic
Obstructive Pulmonary Disease
Am J Respir Crit Care Med 175. 250–255, 2007
SC Cardiologia Clinica Riabilitativa
Sarzana
21/33
db 7/5/2011
COPD could be considered as part of a
“chronic systemic inflammatory syndrome.”
•
•
•
•
•
•
•
cardiovascular diseases
lung cancer
peripheral skeletal muscle dysfunction
nutritional abnormalities
osteoporosis
increased prevalence of diabetes
chronic kidney disease
SC Cardiologia Clinica Riabilitativa
Sarzana
CHEST 2011; 139(1):165–173
22/33
db 7/5/2011
Cardiovascular Safety of Tiotropium
in Patients With COPD
Chest 2010;137;20-30
SC Cardiologia Clinica Riabilitativa
Sarzana
23/33
db 7/5/2011
Cardiovascular Safety of Tiotropium
in Patients With COPD
Chest 2010;137;20-30
SC Cardiologia Clinica Riabilitativa
Sarzana
24/33
db 7/5/2011
J. Am. Coll. Cardiol. 2006;47;2554-2560;
SC Cardiologia Clinica Riabilitativa
Sarzana
25/33
db 7/5/2011
Long-term mortality according to COPD and statin use
in patients with peripheral arterial disease
van Gestel YR , Hoeks SE , Sin DD , et al . Effect of statin therapy on mortality in patients with
peripheral arterial disease and comparison of those with versus without associated chronic
obstructive pulmonary disease . Am J Cardiol . 2008 ; 102 ( 2 ): 192 - 196
SC Cardiologia Clinica Riabilitativa
Sarzana
26/33
db 7/5/2011
SC Cardiologia Clinica Riabilitativa
Sarzana
27/33
db 7/5/2011
Beta-Blockers
• Patients with COPD are at increased risk of CAD, and ßblockers play a pivotal role in the management of cardiovascular
diseases.
• There is a general reluctance to use these substances in patients
with COPD because of an unfounded fear of inducing
bronchospasm.
• A large Cochrane review revealed that cardioselective betablockers did not adversely affect the FEV1 or induce respiratory
symptoms compared with placebo, independent of the severity of
the COPD.
• Given the demonstrated efficacy of b -blockers in treating CAD
and CHF, the benefit of these medicaments outweighs the side
effects and they should not be withheld from patients with
COPD
SC Cardiologia Clinica Riabilitativa
Sarzana
28/33
db 7/5/2011
Chronic obstructive pulmonary disease is an independent predictor of death
but not atherosclerotic events in patients with myocardial infarction: analysis
of the Valsartan in Acute Myocardial Infarction Trial (VALIANT)
European Journal of Heart Failure (2009) 11, 292–298
SC Cardiologia Clinica Riabilitativa
Sarzana
29/33
db 7/5/2011
SC Cardiologia Clinica Riabilitativa
Sarzana
Arch Intern Med. 2010;170(10):880-887
30/33
db 7/5/2011
SC Cardiologia Clinica Riabilitativa
Sarzana
Arch Intern Med. 2010;170(10):880-887
31/33
db 7/5/2011
SC Cardiologia Clinica Riabilitativa
Sarzana
Arch Intern Med. 2010;170(10):880-887
32/33
db 7/5/2011
Take Home Messages
• La BPCO è un fattore di rischio cardiovascolare
• E’ probabile che meccanismi fisiopatologici simili,
di tipo infiammatorio, siano presenti nella BPCO e
nella malattia aterosclerotica
• Le terapie pneumologiche più efficaci (tiotropio in
particolare) sono efficaci anche per ridurre il
rischio CV dei pazienti con BPCO
• Le terapie cardiologiche più efficaci (statine, betabloccanti, inibitori RAAS) sono efficaci anche
nella BPCO
SC Cardiologia Clinica Riabilitativa
Sarzana
33/33
db 7/5/2011
OSPEDALE SAN BARTOLOMEO DI SARZANA
SC Cardiologia Clinica Riabilitativa
Sarzana
34/33
db 7/5/2011