Comorbidities of chronic obstructive pulmonary disease
Comorbidities of chronic obstructive pulmonary disease
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DOI：
10.1097/01.mcp.0000410744.75216.d0
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发表时间：
2011-12-01
影响因子：
3.3
通讯作者：
Lattanzio, Fabrizia
中科院分区：
文献类型：
--
作者：
Corsonello, Andrea;Incalzi, Raffaele Antonelli;Lattanzio, Fabrizia
综述目的定义慢性阻塞性肺疾病（COPD）与其他慢性疾病之间的关联性质对于通过合并症的最佳护理来改善 COPD 患者的健康状况至关重要。我们的目的是从共病向多病转变的角度，为理解、识别和治疗慢性阻塞性肺病的共病提供合理的指导。最近的研究结果表明，动脉粥样硬化性疾病、抑郁症、慢性肾病、认知障碍、阻塞性睡眠呼吸暂停综合征、肺癌、骨质疏松症、糖尿病、心力衰竭、肌少症、主动脉瘤、心律失常和肺栓塞等特定合并症的发生率很高。多见于老年慢性阻塞性肺病患者。有几个问题可能会影响患有合并症的老年慢性阻塞性肺病患者的治疗（例如，患有慢性阻塞性肺病和心血管疾病的患者使用β受体阻滞剂或担心吸入性慢性阻塞性肺病药物的心血管安全性）。总结证据表明，全身炎症可能是慢性阻塞性肺病与合并症之间的联系，但这个问题仍然存在争议。无论 COPD 合并症的潜在机制是什么，它都具有重要的临床、预后和治疗影响。然而，临床实践指南的建议中并未考虑合并症。此外，也明显缺乏在多发病背景下调查慢性阻塞性肺病治疗并考虑老年结局的临床试验。
Purpose of reviewDefining the nature of the association between chronic obstructive pulmonary disease (COPD) and other chronic conditions is of primary importance to improve the health status of COPD patients through the optimal care of comorbidities. We aimed at providing a reasoned guide to understand, recognize and treat comorbidity of COPD with the perspective of shifting from comorbidity to multimorbidity.Recent findingsSelect comorbidities, such as atherosclerotic disease, depression, chronic kidney disease, cognitive impairment, obstructive sleep apnea syndrome, lung cancer, osteoporosis, diabetes, heart failure, sarcopenia, aortic aneurysm, arrhythmias and pulmonary embolism are highly prevalent among older COPD patients. Several concerns may affect the management of older COPD patients with comorbidity (e.g. the use of beta-blockers in patients with COPD and cardiovascular diseases or concerns about the cardiovascular safety of inhaled COPD drugs).SummaryEvidence suggests that systemic inflammation may be the link between COPD and comorbidities, but this issue is still debated. Whatever the mechanism underlying comorbidities in COPD may be, it has an important clinical, prognostic and therapeutic impact. Nevertheless, clinical practice guidelines do not take into account comorbidities in their recommendations. Additionally, clinical trials investigating COPD treatment in the context of multimorbidity and considering geriatric outcomes are also distinctly lacking.