Tuesday, 26 November 2013

Chronic obstructive pulmonary disease (COPD)– The Complications

Respiratory Disease is defined as medical conditions which affect the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and  muscles breathing , etc,.
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United State.
 1. Emphysema, a type of Chronic obstructive pulmonary disease (COPD), is defined as a long term and progressive condition cause of shortness of breath but depending to the stage of lung function as a result of damage to tissues of the air sacs (alveoli) in the lungs. In the study of 63 patients with stable COPD (spirometric GOLD stages 2–4) and 17 age- and comorbidity-matched controls, researchers found that in contrast to asthma, COPD is characterised by elevated concentrations of both BDNF and TGF-beta1 in serum. The stage-dependent association with lung function supports the hypothesis that these platelet mediators may play a role in the pathogenesis of COPD(1). In some cases, but rarely, Emphysema is caused by Alpha-1 antitrypsin deficiency emphysema.
2. Chronic bronchitis
Chronic bronchitis is a chronic inflammation of the lung’s bronchi cause of the increased production of mucus in the lung of that leading to difficult breathing.
D. Complications
1. Thickening of airway wall
In the study  to evaluate the relationship between small airway wall thickness and the lung function parameters in patients with asthma and COPD, shows that the thickening of airway wall in asthma is reflected by an increase in the indices of air trapping and in COPD this thickening results in a higher airway resistance and responsiveness. In COPD, the thickening of airway wall also is related to exposure to tobacco smoke(22).
2. Anatomic-functional alterations
Bronchial wall measurements differ between patients who have COPD with CB and those who have COPD without CB. The correlation between airway dimensions and indexes of airway obstruction in patients with COPD and CB indicates that the bronchial tree is the site of anatomic-functional alterations in this patient group(23).
3. Chronic hypoxia
Loss of body mass and exercise intolerance are common findings in chronic obstructive pulmonary disease and are often difficult to reverse despite optimal nutritional intake. In the study conducted by Department of Clinical Physiopathology, University of Florence, showed that malnutrition is a worsening factor in chronic obstructive pulmonary disease. Similarities between chronic obstructive pulmonary disease and altitude exposure point to the importance of hypoxia in this regard(24).
4. Infection
Chronic obstructive pulmonary disease (COPD), lower respiratory tract infections, both acute and chronic, occur with increased frequency. As these infections contribute considerably to the clinical course of the patient with COPD, they constitute a significant comorbidity in COPD. Recurrent acute infections by bacterial and/or viral pathogens are now clearly linked with the occurrence of exacerbations of COPD(25).

5. Pulmonary hypertension
Pulmonary hypertension (PH) is a common consequence of chronic obstructive pulmonary disease (COPD). There is a report of four patients with COPD and PH. Pulmonary arterial hypertension (PAH) associated diseases and pulmonary embolism were ruled out. PH persisted despite optimized treatment of underlying COPD and comorbidities(26).
6. Depression
In the study to evaluate the subjective assessment of sleep quality in stable COPD patients and its relationship with associated depression, found that the prevalence of poor sleep quality among COPD patients is high. Irrespective of severity of airflow obstruction, the presence of depression in COPD is a risk factor for poor sleep quality(27).
7. Heart diseases
In the study to explore the association of COPD and restrictive lung function impairment, respectively, with heart diseases in the general population, found that a strong association between COPD and cardiovascular diseases and indicates a strong association between restrictive lung function and heart diseases. Both obstructive and restrictive lung function impairments were common among subjects with heart diseases and vice versa(28).
8. Death
In the study of data measured change in six minute walk distance in the 12 month period before the event and also related change in six minute walk distance to lung function and St Georges Respiratory Questionnaire (health status), found that a fall in the six minute walk distance of 30m or more is associated with increased risk of death but not hospitalization due to exacerbation in patients with chronic obstructive pulmonary disease and represents a clinically significant minimally important difference(29).   
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(1) http://respiratory-research.com/content/13/1/116/abstract 
(22) http://www.ncbi.nlm.nih.gov/pubmed/20134043
(23) http://www.ncbi.nlm.nih.gov/pubmed/16304279
(24) http://www.ncbi.nlm.nih.gov/pubmed/15192444 
(25) http://www.ncbi.nlm.nih.gov/pubmed/20513910
(26) http://www.ncbi.nlm.nih.gov/pubmed/23258580
(27) http://www.ncbi.nlm.nih.gov/pubmed/23243346
(28) http://www.ncbi.nlm.nih.gov/pubmed/23127573
(29) http://www.ncbi.nlm.nih.gov/pubmed/23262518

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