Clinical heterogeneity of a population of patients admitted to the Emergency Department with a diagnosis of COPD-exacerbation: Relevance of cardiovascular comorbidities
FEV1-based Chronic Obstructive Pulmonary Disease (COPD) severity does not account for the complexity of the disease. Recent studies point to the high frequency of comorbidities responsible for unfavorable outcomes. There is a lack of data on this concerning the patient evaluated in the emergency setting. Aim of the study was to prospectively evaluate patients admitted to the ED for “exacerbated COPD” to describe their clinical heterogeneity and the influence that it may have on outcomes: death, length of hospitalization, exacerbation recurrence. The following data were recorded: history, symptoms, blood gas analysis, laboratory and radiological findings and comorbidities. Each patient underwent electrocardiography, echocardiography and spirometry. In order to identify a correlation between these variables and the selected outcomes, a multivariate linear logistic regression analysis was carried out. This study was conducted on 41 eligible patients consecutively admitted to the emergency room for exacerbated COPD. A consistent proportion showed ECG, Echocardiographic and laboratory abnormalities. At spirometry a FEV1 <30% of predicted was detected in 37% of patients. Cardiovascular comorbidities came out to be very frequent (hypertension, heart failure and coronary artery disease in particular). The history of heart failure was related to the risk of re-hospitalization within three months, while pneumonia, a low pH and a low FEV1 predicted a hospital stay >7 days. Our study shows that the term “exacerbated COPD” underscores a heterogeneous population, with a high prevalence of cardiovascular comorbidities, which significantly influence outcomes. Multicenter studies are needed to better investigate the clinical relevance of these findings.
Global Initiative for Chronic Obstructive Lung Disease: Global Strategy for the diagnosis, management and prevention on Chronic Obstructive Pulmonary Disease, 2020 Report.
Agusti A, Calverley PM, Celli B, et al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res 2010;11:122. DOI: https://doi.org/10.1186/1465-9921-11-122
Miravitlles M, Calle M, Soler-Cataluña JJ. Clinical phenotypes of COPD: identification, definition and implications for guidelines. Arch Bronconeumol 2012;48:86-98. DOI: https://doi.org/10.1016/j.arbres.2011.10.007
Pinto LM, Alghamdi M, Benedetti A, et al. Derivation and validation of clinical phenotypes for COPD: a systematic review. Respir Res 2015;16:50. DOI: https://doi.org/10.1186/s12931-015-0208-4
Cavaillès A, Brinchault-Rabin G, Dixmier A, et al. Comorbidities of COPD. Eur Respir Rev 2013;22:454-75. DOI: https://doi.org/10.1183/09059180.00008612
Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis 2014;9:871-88.
Burgel PR, Paillasseur JL, Caillaud D, et al. Initiatives BPCO Scientific Committee. Clinical COPD phenotypes: a novel approach using principal component and cluster analyses. Eur Respir J 2010;36:531-9. DOI: https://doi.org/10.1183/09031936.00175109
Vanfleteren LE, Spruit MA, Groenen M, et al. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013;187:728-35. DOI: https://doi.org/10.1164/rccm.201209-1665OC
Garcia-Aymerich J, Gómez FP, Benet M, et al. Identification and prospective validation of clinically relevant chronic obstructive pulmonary disease (COPD) subtypes. Thorax 2011;66:430-7. DOI: https://doi.org/10.1136/thx.2010.154484
Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry Eur Respir J 2005;26:319-38. DOI: https://doi.org/10.1183/09031936.05.00034805
Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests Eur Respir J 2005;26:948-68. DOI: https://doi.org/10.1183/09031936.05.00035205
Official Statement of the European Respiratory Society ( No authors listed). Standardized Lung function testing. Eur Respir J Suppl. 1993 Mar;16:1-100.
Rodriguez Roisin R. Towards a consensus definition for COPD exacerbation. Chest 2000;117:398s-401s. DOI: https://doi.org/10.1378/chest.117.5_suppl_2.398S
Lou P, Zhu Y, Chen P et al. Vulnerability, beliefs, treatment and economic burden of chronic obstructive pulmonary disease in rural areas in China: a cross sectional study BMC Public Health 2012;12:287. DOI: https://doi.org/10.1186/1471-2458-12-287
Ko FW, Chan KP, Hui DS, et al. Acute exacerbation of COPD. Respirology 2016;21:1152-65. DOI: https://doi.org/10.1111/resp.12780
Decramer M, Iassens W. Chronic pulmonary disease and comorbidities. Lancet Respir Med 2013;1:73-83. DOI: https://doi.org/10.1016/S2213-2600(12)70060-7
Brown JP, Martinez CH. Chronic obstructive pulmonary disease comorbidities. Current Opinion Pulm Med 2016;22:113-18. DOI: https://doi.org/10.1097/MCP.0000000000000241
Hawkins NM, Virani S, Ceconi C. Heart failure and chronic obstructive pulmonary disease: the challenges facing physicians and health services. Eur Heart J 2013;34:2795-803. DOI: https://doi.org/10.1093/eurheartj/eht192
Bernardo I, Bozinovski S, Vlahos R. Targeting oxidant-dependent mechanisms for the treatment of COPD and its comorbidities. Pharmacol Ther 2015;155:60-79. DOI: https://doi.org/10.1016/j.pharmthera.2015.08.005
Morgan AD, Zakeri R, Quint JK. Defining the relationship between COPD and CVD: What are the implications for clinical practice? Ther Adv Respir Dis 2018;12:1-16. DOI: https://doi.org/10.1177/1753465817750524
Rabe KF, Hurst JR, Suissa S. Cardiovascular disease and COPD: dangerous liaisons? Eur Respir Rev 2018;27:180057. DOI: https://doi.org/10.1183/16000617.0057-2018
Brassington K, Selemidis S, Brozinovski S, Vlahos R. New frontiers in the treatment of comorbid cardiovascular disease in chronic obstructive pulmonary disease. Clin Sci 2019;133:885-904. DOI: https://doi.org/10.1042/CS20180316
Neder JA, Rocha A, Alencar MCN, et al. Current Challenges in managing comorbid Heart failure and COPD. Expert Rev Cardiovasc Ther 2018;16:653-73. DOI: https://doi.org/10.1080/14779072.2018.1510319
Portillo K, Abad-Capa J, Ruiz-Manzano J. Chronic Obstructive Pulmonary Disease and Left Ventricle. Arch Bronconeumol 2015;51:227-34. DOI: https://doi.org/10.1016/j.arbres.2014.03.012
Buchan A, Bennet R, Coad A, et al. The role of cardiac biomarkers for predicting left ventricle disfunction and cardiovascular mortality in acute exacerbations of COPD. Open Heart 2015;2:e000052. DOI: https://doi.org/10.1136/openhrt-2014-000052
Almagro P, Boixeda R, Diez-Manglano J, et al. Insights into Chronic Obstructive Pulmonary Disease as Critical Risk Factor for Cardiovascular Disease. Int J Chronic Obst Pulmonary Disease 2020;15:755-64. DOI: https://doi.org/10.2147/COPD.S238214
Rowe BH, Bhutani M, Stickland MK, Cydulka R. Assessement and management of Chronic obstructive pulmonary disease in the emergency department and beyond. Expert Rev Respir Med 2011;5:549-59. DOI: https://doi.org/10.1586/ers.11.43
Andre S, Conde B, HìFragoso E et al. COPD and Cardiovascular Disease. Pulmonol 2019;25:168-76. DOI: https://doi.org/10.1016/j.pulmoe.2018.09.006
Canepa M, Franssen FME, Olschewski H, et al. Diagnostic and Therapeutic gaps in patients With heart failure and chronic obstructive pulmonary disease. J Am Coll Cardiol HF 2019;7:823-33. DOI: https://doi.org/10.1016/j.jchf.2019.05.009
Zhou A, Zhou Z, Zhao Y, Chen P. The recent advances of Phenotypes in acute exacerbations of COPD. Int J COPD 2017;12:1009-101. DOI: https://doi.org/10.2147/COPD.S128604
Lange P, Halpin DM, O'Donnell DE, MacNee W. Diagnosis, assessment, and phenotyping of COPD: beyond FEV₁. Int J Chron Obstruct Pulmon Dis 2016;11:3-12.
Miravittles M, Calle M, Soler-Cataluna JJ. Clinical phenotypes of COPD: identification, definiton and implications for guidelines. Arch Bronconeumol 2012;48:86-9. DOI: https://doi.org/10.1016/j.arbr.2012.01.003
Santos S, Marin A, Serra Battles J, et al. Treatment of patients with COPD and recurrent exacerbations: the role of infection and inflammation. Int J COPD 2016;11:515-25. DOI: https://doi.org/10.2147/COPD.S98333
Van Fleteren LEGS, Private MA, Wouters EFM, Franssen FME. Management of chronic obstructive pulmonary disease beyond the lungs. Lancet Respir Med 2016;4:911-24. DOI: https://doi.org/10.1016/S2213-2600(16)00097-7
Hillas G, Periklos F, Tsiligianni I, Yzanakis N. Managing comorbidities in COPD. Int J COPD 2015;10:95-109.
Lipworth B, Wedzicha J, Devereux G, et al. Beta-blockers in COPD: time for reappraisal Eur Respir J 2016;48:600-3. DOI: https://doi.org/10.1183/13993003.01222-2016
Zanobetti M, Scorpiniti M, Gigli C, et al. Point-of-care ultrasonography for evaluation of Acute dyspnea in the Emergency Department. Chest 2017;151:1295-1301. DOI: https://doi.org/10.1016/j.chest.2017.02.003
Sriram KB, Singh M. Lung ultrasound B-lines in exacerbations of chronic obstructive Pulmonary disease. Intern Med J 2017;47:324-27. DOI: https://doi.org/10.1111/imj.13370
Corradi F, Brusasco C, Brusasco V. When, Where and How to use lung ultrasonography in Patients with chronic obstructive pulmonary disease. Arch Bronconeumol 2017;53:229–30. DOI: https://doi.org/10.1016/j.arbres.2016.10.019
Nielsen M, Boslev-Barnes C, Ulrik CS. Clinical characteristics of the asma-COPD overlap syndrome- a systematic review. Int J COPD 2015;10:1443-54.
Ding B, Enstone A. Asthma and chronic obstructive pulmonary disease overlap syndrome-ACOS: structured literature review and physicians insights. Expert Rev Res Med 2016;10: 363-71. DOI: https://doi.org/10.1586/17476348.2016.1144476
- Abstract views: 904
- PDF: 133
Copyright (c) 2021 The Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.