Systemic effects of COPD

Abstract

Chronic obstructive pulmonary disease (COPD) is characterised by a range of pathological changes of the respiratory system, including airflow limitation secondary to structural changes of the small airways and loss of alveolar attachments, inflammation, ciliary dysfunction, and increased mucous production. COPD also has significant systemic consequences. The relationships between these pulmonary and nonpulmonary morbidities are not fully understood, and this further complicates the assessment of disease severity and prognosis. Although improving lung function and disease symptoms have been the main focus of COPD management, these parameters alone do not reflect the full burden of disease. More recent endeavours have highlighted the potential role of addressing physical limitations imposed by systemic alterations. It is evident that systemic manifestations are common in COPD. Indeed, many patients demonstrate a gradual and significant weight loss that exacerbates the course and prognosis of disease. This weight loss is often accompanied by peripheral muscle dysfunction and weakness, which markedly contribute to exercise limitation and impaired quality of life. Weight loss has been postulated to be the result of a high metabolic rate that is not compensated for by increased dietary intake. The cause of this elevated metabolism is a matter of much debate, and several factors have been implicated. Similarly, the processes underlying depletion of muscle mass and function have not been fully delineated. The impact of the systemic manifestations of COPD is substantial, and although many attempts have been made to elucidate the mechanisms underlying these manifestations, there are important questions, which remain to be answered. An increase in our understanding in this field will doubtless highlight potential therapeutic targets, and assist in guiding future therapeutic development.

The Impact of Obesity and Metabolic Syndrome in COPD

“…The rationale was that systemic inflammation in the more advanced stages of disease would lead to cachexia [23] rather than overweight. However, in the most recent studies looking at the association of high BMI and COPD, approximately two thirds is overweight or obese [24].…”

“…The final results of these physiological abnormalities for the patients is increased dyspnea perception [31]. Another important systemic consequence of COPD is limb muscle atrophy which is observed especially in the more advanced stages of the disease [23,32]. Total as well as lower limb muscle mass is decreased leading to fatigue during exercise [33].…”

“…Published online 23 Lung parenchyma has been extensively investigated. Nevertheless, the study of bronchial small airways is much less common.…”

Elevated levels of serum sialic acid and C-reactive protein: markers of systemic inflammation in patients with chronic obstructive pulmonary disease

“…Importantly, low BMI is one of the independent predictors for mortality in patients with COPD. 35 Low BMI could be a consequence of COPD. Basal metabolic rate is increased in moderate to severe COPD.…”

Where current pharmacological therapies fall short in COPD: symptom control is not enough

“…Patients with COPD may also present with so-called ''systemic'' symptoms that may result from the chronic inflammatory nature of the disease [5]. Extrapulmonary manifestations that have been associated with COPD include systemic inflammation, nutritional depletion and weight loss, skeletal muscle dysfunction, cardiovascular disease, osteoporosis, anaemia and depression [5][6][7]. The relationship between COPD and cardiovascular disease may be particularly important since, in some studies, .50% of patients with COPD die from cardiovascular-related disease [5].…”