BPCO - Fabbri

7/25/2019 BPCO - Fabbri

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SYSTEMIC INFLAMMATION LEADING TOSYSTEMIC INFLAMMATION LEADING TO

COMORBIDITIES ASSOCIATED WITH COPDCOMORBIDITIES ASSOCIATED WITH COPD

Leonardo M. Fabbri

Comorbidities and systemic effects of COPD

Cardiovascular diseases in COPD

COPD in Chronic Heart Failure

Cardiovascular drugs in COPD


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CHRONIC DISEASE IN THE ELDERLY:

Back to the Future of Internal Medcne

LM Fabbri and R Ferrari, Breathe, 2!, in "re

T!o or "ore chronc d#ea#e# al"o#t n$ara%l& de$elo' to(ether

the #a"e 'atent) 'artcularl& n the elderl&) often "akn( t dffcult

e#ta%l#h a 'ro'er da(no## and a##e##"ent of #e$ert&

*atent+orented a''roach that take# nto account the #e$eralcoe,#tn( co"'onent# of chronc d#ea#e # re-ured

Th# .chan(e of conce't/ "'le# the need for "edcal #'ecal#t#

e,tend ther e,'ert#e to %roader da(no#tc and treat"ent

a''roache# that are tradtonall& the 'ur$e! of nternal "edcne


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Leading Causes of

Death in U.S.

#1. MI#2. CA

#3. CVA

#4. COPD

Cigarette Related Dise

Leading Causes of

Death Worldide !"


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0hat do CO*D *atent# De Fro"1

Mannino D.M.,Mannino D.M., et al.et al. Respiratory Medicine 2006; 100:115Respiratory Medicine 2006; 100:115


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Chronic diseases re$resent a huge

$ro$ortion of human illness

%& million deaths in !""%'

Cardiovascular disease (")

Cancer #()

chronic res$iratory diseases *)

Diabetes !)

Horton R. Lancet, 2006


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COPD +, + ,-,/M0C D0,/+,/COPD +, + ,-,/M0C D0,/+,/

COPD + COMPO1/1 OF H/ CHRO10C D0,/+,/COPD + COMPO1/1 OF H/ CHRO10C D0,/+,/

COPD + ,-,/M0C D0,/+,/

,ystemic inflammationCache2ia

,3eletal muscle astingOsteo$orosis

COPD + COMOR40D0- OF

Chronic heart failure

Coronary and $eri$heral arterial diseasesLung cancer

Metabolic syndrome


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5

=

5

5


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0nhaled $articles'

$ulmonary and heart co6morbidity


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Leonardo M2 Fa%%r


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Cardo$a#cular "ortalt& nCardo$a#cular "ortalt& n

CO*DCO*D

For e$er& 345 decrea#e n FE6For e$er& 345 decrea#e n FE633))

cardo$a#cular "ortalt& ncrea#e# %&cardo$a#cular "ortalt& ncrea#e# %&

a''ro,"atel& 785 and non+fatal coronar&a''ro,"atel& 785 and non+fatal coronar&

e$ent ncrea#e# %& a''ro,"atel& 745 ne$ent ncrea#e# %& a''ro,"atel& 745 n

"ld to "oderate CO*D2"ld to "oderate CO*D2

Anth$ni#en et a%, A& ' Re#"ir Crit Care Med 22Anth$ni#en et a%, A& ' Re#"ir Crit Care Med 22


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Curkendall et al. Ann Epidem

COPD

CA!E! O" #O!P$%A& AD'$!!$O(

CA!E! O" DEA%#


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*re$enton of E,acer%aton# of Chronc O%#truct$

*ul"onar& D#ea#e !th Totro'u") a Once+Da

Inhaled Antcholner(c Bronchodlator

Niewoehner,et al, Ann Intern Med. 2005;143:317-3

COE9ISTIN ILLNESSES

6a#cular ;ncludn( h&'erten#on< =>5

Cardac ?85

a#tronte#tnal >85

Mu#culo#keletal or connect$e t##ue >=5

Meta%olc or nutrtonal >@5

Re'roduct$e or urnar& 7@5Neurolo(c 775


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Coronar) Arter) Cal*i+*ation in OlderAdult,

Newman AB et al irc!lati

O d P ti


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O**urren*e and Pro-no,ti*!i-ni+*an*e o /entri*ular Arr)tmia$, elated to Pulmonar) "un*tion

En(#tr$& G et a% Cir)*%ati$n 2

>47 "en) =8 &r# old 3> &r# follo!+u'

C tid Pl $ ti ' di %i k


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Carotid Plaue $ntima 'edia %i*kne,,Cardio4a,*ular i,k "a*tor, and Pre4alenCardio4a,*ular Di,ea,e in 'en and 5omen

6. 8

9.28

0.8

Per*entualedi,o--

etti:ma,*0i;*on

unapla**a*arotidea

08

FE63ter media 66 anni

"#ra$im % et al %tro&


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"E/1e ri,k o ,troke:te Copena-en !troke !tud)

?1008 90@998 0@98 70@798 60@698 0@98 08

Per*entuale "E/1ri,petto al pre4i,to

1i,*0io

1elati4o

2

1.

0.

1

per ma,*i e emmine per ma,*i per emmi

(r!elsen ( et al )nt * "pidem

P&'O(AB E'O&$!' $( PA%$E(%! 5$%#


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P&'O(AB E'O&$!' $( PA%$E(%! 5$%#(EP&A$(ED EACEA%$O( O" C#O($C

O!%C%$/E P&'O(AB D$!EA!E:PE/A&E(CE A(D $! "AC%O!

Tlle+Le%lond et al) Ann Intern Med2 744=3>>:?4+?=2

75 'ul"onar& e"%ol#" n 'atent#

!th CO*D ho#'taled for #e$ere

e,acer%aton of unkno!n or(n

*re$ou# TE*) "al(nanc&) lo! *aCO7


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Cardo$a#cular "or%dt& nCardo$a#cular "or%dt& n

CO*DCO*D

H(h CR*H(h CR* Se$ereSe$ereo%#tructono%#tructon

H(h CR*H(h CR*and #e$ereand #e$ere

o%#tructono%#tructon

Cardacnfarct

onnFurcore

Cardacnfarcton

nFurcore

*G4)443*G4)443

Sin and Man, Cir)*%ati$n 2Sin and Man, Cir)*%ati$n 2

0nflammation atherosclerosis and coronary artery disease0nflammation atherosclerosis and coronary artery disease


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0nflammation7 atherosclerosis and coronary artery disease0nflammation7 atherosclerosis and coronary artery disease

Hansson GK, N Engl J Med. 2005;352(16!16"5#$5Hansson GK, N Engl J Med. 2005;352(16!16"5#$5

%ct&'at&on o a t)*e 1 &++ne res*onse &n at-ero+a or+at&on%ct&'at&on o a t)*e 1 &++ne res*onse &n at-ero+a or+at&on


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Cross6sectional study7 $atients 8% years of age

Of 9"% $artici$ating $atients ith a diagnosis of chronic

obstructive $ulmonary disease7 &( 2!."$ %" CI 1&.'(24.)*

had $reviously unrecogni:ed heart failure

RECONISIN HEART FAILRE IN ELDERLY *ATIENTS


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RECONISIN HEART FAILRE IN ELDERLY *ATIENTS

0ITH STABLE CHRONIC OBSTRCTI6E *LMONARY

DISEASE IN *RIMARY CARE

F H R*tten et a%, BM' 2-, De).+/01+3456+

A l"ted nu"%er of te"# ea#l&

a$ala%le fro" h#tor& and 'hcal e,a"naton)!th

addton of NT+'roBN* and electrocardo(ra'h&) canhel' (eneral 'racttoner# to dentf& conco"tant

heart falure n nd$dual 'atent# !th #ta%le CO*D

P tidi t i ti i k


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Peptidi natriuretici come markerdello scompenso cardiaco cronico

AN*

C*$re n$r&a%eC*$re n$r&a%e C*$re #)$&"en#aC*$re #)$&"en#a

AN*

BN*

AN*AN*

Pe"tide natri*reti)$ atria%ePe"tide natri*reti)$ atria%e

BN*

*e'td natruretc*e'td natruretc

BN*BN*

Pe"tide natri*reti)$ )erebra%ePe"tide natri*reti)$ )erebra%e


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4reathing 1ot Pro$erly Multinational ,tudy

Mcllog- et al. &rc 20

#%&8 $artici$ants ho $resented ith acute dys$nea

#%(& ; (* ) COPD comorbidity


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4reathing 1ot Pro$erly ;41P= Multinational ,tudy

Mcllog- et al. &rc 20

?tility of 41P in Differentiating Heart Failure from Lu


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Disease in Patients Presenting

ith Dys$nea

Morr&son et al. J% 20



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Disease in Patients Presenting

ith Dys$nea

Morr&son et al. J% 20



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Leonardo M2 Fa%%r


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/r&+ar) End*o&nt! +ll6Cause Mortality

econdar) End*o&nts! C@ Death7 M07 or HF

t-er End*o&nts! ,afety and olerability

Ca$to$ril %" mg tid;n A 9


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/A&$A(% %rial:Pre4alen*e o COPD

14703 patients included in the trial

1258 clinical diagnosis of COPD (8!"#


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@alsartanHeartFailure rial


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!tud) De,i-n

F. (. Con et. al F. Card. "ail. 1999; : 1@160

#" patient, 1 )r; (B#A $$$/

&/$DDG 2.9 *mHmI !A; E"08

/al,artan0 m- Jid titrated

to160 m- Jid

$0! deaths (e%ents reported#

&ando'ied to

&ecei%ing )tandard *herap+including ,C- inhi.itors / diuretdigoin / .locers

Pla*eJo


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/al@#e"% %rial:Pre4alen*e o COPD

5010 patients included in the trial

!28 clinical disgnosis of COPD (125"#

/al@#e"% %rial


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/al #e"% %rialClini*al e4ent, at 2 )ear olloK@up


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Contributors to e2ercise intolerance in

COPD and CHF

Goser et al. %JN 1



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Leonardo M2 Fa%%r


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METHODS

Ca#e+control #tud& of t!o 'o'ulaton+%a#ed retro#'ect$e cohort#

3< CO*D 'atent# ha$n( under(one coronar& re$a#cularaton

;h(h C6 r#k cohort

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