COPD as a lung disease with systemic consequences - Clinical impact, mechanisms, and potential for early intervention

Marc Decramer, Stephen Rennard, Thierry Troosters, Douglas W. Mapel, Nicholas Giardino, David Mannino, Emiel Wouters, Sanjay Sethi, Christopher B. Cooper

Research output: Contribution to journalReview article

192 Citations (Scopus)

Abstract

The natural course of chronic obstructive pulmonary disease (COPD) is complicated by the development of systemic consequences and co-morbidities. These may be major features in the clinical presentation of COPD, prompting increasing interest. Systemic consequences may be defined as non-pulmonary manifestations of COPD with an immediate cause-and-effect relationship, whereas co-morbidities are diseases associated with COPD. The major systemic consequences/co-morbidities now recognized are: deconditioning, exercise intolerance, skeletal muscle dysfunction, osteoporosis, metabolic impact, anxiety and depression, cardiovascular disease, and mortality. The mechanisms by which these develop are unclear. Probably many factors are involved. Two appear of paramount importance: systemic inflammation, which presents in some patients with stable disease and virtually all patients during exacerbations, and inactivity, which may be a key link to most COPD-related co-morbidities. Further studies are required to determine the role of inflammatory cells/mediators involved in systemic inflammatory processes in causing co-morbidities; the link between activity and co-morbidities; and how COPD therapy may affect activity. Both key mechanisms appear to be influenced significantly by COPD exacerbations. Importantly, although the prevalence of systemic consequences increases with increasing severity of airflow obstruction, both systemic consequences and co-morbidities are already present in the Global Initiative for Chronic Obstructive Lung Disease Stage II. This supports the concept of early intervention in chronic obstructive pulmonary disease. Although at present early intervention studies in COPD are lacking, circumstantial evidence suggests that current treatments may influence events leading to the systemic consequences and co-morbidities, and thus may affect the clinical manifestations of the disease.

Original languageEnglish (US)
Pages (from-to)235-256
Number of pages22
JournalCOPD: Journal of Chronic Obstructive Pulmonary Disease
Volume5
Issue number4
DOIs
StatePublished - Aug 1 2008

Fingerprint

Chronic Obstructive Pulmonary Disease
Lung Diseases
Morbidity
Osteoporosis
Disease Progression
Skeletal Muscle
Cardiovascular Diseases
Anxiety
Exercise
Depression
Inflammation
Mortality
Therapeutics

Keywords

  • COPD
  • Clinical course of COPD
  • Co-morbidities
  • Early intervention
  • Systemic consequences

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

COPD as a lung disease with systemic consequences - Clinical impact, mechanisms, and potential for early intervention. / Decramer, Marc; Rennard, Stephen; Troosters, Thierry; Mapel, Douglas W.; Giardino, Nicholas; Mannino, David; Wouters, Emiel; Sethi, Sanjay; Cooper, Christopher B.

In: COPD: Journal of Chronic Obstructive Pulmonary Disease, Vol. 5, No. 4, 01.08.2008, p. 235-256.

Research output: Contribution to journalReview article

Decramer, M, Rennard, S, Troosters, T, Mapel, DW, Giardino, N, Mannino, D, Wouters, E, Sethi, S & Cooper, CB 2008, 'COPD as a lung disease with systemic consequences - Clinical impact, mechanisms, and potential for early intervention', COPD: Journal of Chronic Obstructive Pulmonary Disease, vol. 5, no. 4, pp. 235-256. https://doi.org/10.1080/15412550802237531
Decramer, Marc ; Rennard, Stephen ; Troosters, Thierry ; Mapel, Douglas W. ; Giardino, Nicholas ; Mannino, David ; Wouters, Emiel ; Sethi, Sanjay ; Cooper, Christopher B. / COPD as a lung disease with systemic consequences - Clinical impact, mechanisms, and potential for early intervention. In: COPD: Journal of Chronic Obstructive Pulmonary Disease. 2008 ; Vol. 5, No. 4. pp. 235-256.
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