ERS Congress 2017

  • Aanvrager: Mevrouw A. Lenferink

European Respiratory Society (ERS ) 2017, 9 tm 12 september 2017, Milaan 3.4.11.061 CO

Associations between COPD and cardiovascular diseases
Anke Lenferink, Medisch Spectrum Twente
European Respiratory Society 2017 Congress Milan

Chronic Obstructive Pulmonary Disease (COPD) is a complex and heterogeneous disease. However, COPD is often treated according to COPD-specific measures (e.g., level of airflow limitation, symptoms, frequency of previous exacerbations) and not on survival or disease progression.1,2 By contrast, treatment of the concomitant diseases are focused on prolonging life and survival (e.g., prevention of hospitalisations). A better understanding of the complex disease mechanisms resulting in COPD is needed.3 To address this complexity and to move towards precision medicine in COPD, we need to integrate (bioinformatics) and interpret (clinical science) the information that existing technology provides.1 The use of systems biology and network medicine might help to clarify the complex pathophysiology of COPD, including its pulmonary and extrapulmonary components.1,2 Appropriate clinical studies in better-defined subgroups of patients (identified by validated biomarkers of specific endotypes) are needed.1,2 The diagnosis, stratification, and treatment of patients with COPD will then become more patient-tailored. COPD and cardiovascular diseases are components of multimorbidity.4 30% of the patients with heart failure do have COPD.3 The clinical phenotype of COPD and heart failure can be similar (e.g., for dyspnea symptoms) and therefore the treatment algorithms can be similar.2 However, it is difficult to relieve dyspnea symptoms in COPD and heart failure.2 About 50% of the patients with heart failure do not have a reduction in ejection fraction, but do have clinical symptoms. Furthermore, there are interactions between the heart and the lungs,5 also during exacerbations. Since there is an overlap in dysfunctional cells and cardiac factors can be increased during acute exacerbations of COPD, the role of biomarkers in patients with COPD and cardiovascular diseases was discussed.6 There is a need to find a combination of biomarkers as for e.g., BNP there is no association found with COPD severity, but levels are higher during an acute exacerbation of COPD.6 Another important issue are patient perceptions, because they need to know what to do with the markers.6 Conclusion Due to the same risk factors (e.g., ageing, smoking, diet, inactivity) COPD is almost invariably associated with concomitant chronic diseases, particularly cardiovascular diseases. Comorbidities significantly contribute to the severity of the individual patients, and increase the risk of exacerbations, complications and mortality. COPD exacerbations are complex clinical events, and the causes of symptoms, particularly dyspnea, should be always properly assessed. The treatment of COPD should always consider the complexity of the COPD patient and include treatment of the pulmonary components as well as the concomitant diseases. It is important to treat the patient with COPD, not the disease. Therefore, an integrated approach is needed. According to the GOLD 2017 guidelines7, while waiting for the evidence, we should treat the patient for COPD and concomitant chronic diseases according to current disease guidelines for COPD and for the individual concomitant chronic diseases. References
1. Agusti A, et al. What does endotyping mean for treatment in chronic obstructive pulmonary disease? Lancet 2017;390(10098):980-987. 2. Fabbri LM. Association between COPD and cardiovascular disorders. Oral presentation ERS Congress 2017 Milan. 3. Rabe KF, et al. Chronic obstructive pulmonary disease. Lancet 2017;389(10082):1931-1940. 4. Vanfleteren LEGW, et al. Management of chronic obstructive pulmonary disease beyond the lungs. Lancet Respir Med 2016;4(11):911-924. 5. Watz H, et al. Decreasing cardiac chamber sizes and associated heart dysfunction in COPD: role of hyperinflation. Chest 2010;138(1):32-38. 6. Stolz D. Biomarkers in COPD and cardiovascular diseases. Oral presentation ERS Congress 2017 Milan. 7. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of Chronic Obstructive Pulmonary Disease. 2017. Available online: http://www.goldcopd.org. Keywords: COPD, cardiovascular events, multimorbidity