COPD AS Systemic disease

BY

Dr/Sami EL-Dahdouh (MD)Lecturer of Pulmonary & Critical care

Faculty of Medicine, Menofia University

PATHOGENSIS

Release of mediators & cytokines e.g. IL6, TNF alpha.

hypoxemia and its effect on tissues. oxidative stress. increase acute phase proteins.

Manifestations

Wt loss and muscle wasting. Endocrinal manifestations. Effect on other systems as heart,

GIT, Neuro- psychiatry, sleep disorders, kidney.

Wt loss & Muscle Weakness

Is due to 1-imbalance between increase catabolism

(TNF alpha, IL1&6) and decrease anabolic hormones( GH, Insulin & Testerone).

2-Decrease caloric intake due to dyspnea, anorexia and GIT disturbances.

Wt loss & muscle weakness lead to impaired excises intolerance & poor outcome of the patients .

This is demonstrated by BODE index.

The BODE IndexThe BODE Index

Predicts survival based on Body mass index (< 21 is associated with

greater mortality) FEV1 (airflow obstruction) Degree of dyspnea (MRC grade) Capacity for exercise (6-minute walk distance)

Can Fam Physician 2008;54:706-11Can Fam Physician 2008;54:706-11

The BODE Index ScorePoints Used To Calculate The BODE Index ScorePoints Used To Calculate

Can Fam Physician 2008;54:706-11Can Fam Physician 2008;54:706-11

Medical Research Council dyspnoea scale

Grade Degree of breathlessness related to activities 0 Not troubled by breathlessness except on

strenuous exercise 1 Short of breath when hurrying or walking up a

slight hill 2 Walks slower than contemporaries on level

ground because of breathlessness, or has to stop for breath when walking at own pace

3 Stops for breath after walking about 100m or after a few minutes on level ground

4 Too breathless to leave the house, or breathless when dressing or undressing

If score more than 7 associated with 30% mortality in 2 years.

If score 5-6 associated with 15% mortality in 2 years.

If less than 5 associated with less than 10% mortality in 2 years.

Endocrinal manifestations

1- Hypogonadism & impotence due to hypoxemia, steroid used, increase s. leptin &

decrease s. testerone.

2- Salt &water retention is due to increase renin –angiotensin system. vasopressin. increase ADH. Hypercapnia ++CAE salt and water

retention.

3- Osteoporosis is due to: mal nutrition, Steroid use, Hypoxemia increase renal exertion of

ca+2 and Acidosis decrease absorption of ca +2.

Other system affections

CVS: cor pulomnale, lt sided dystolic

dysfunction, IHD.GIT: -Reflux oesphgitis due to hypoxemia.

Hypercapnia, hyperinflation, also coughing lead to increase in intra abdominal pressure.

- Peptic ulcer effect of hypoxia and hypercapnia and effect of drugs.

Sleep disturbances is due to Hypoxemia, Nocturnal bronchospasm, Drugs as theophylline, Anxiety , depression & Sleep apnea syndromes may be

associated with COPD (overlap syndrome), or complication of sever air flow obstruction.

Neuro- psychiatric disorders in the form of

depression

psychosis

anxiety

panic disorders.

• High BODE index

• Multiple severe exacerbations

• CVD

• Decreased FEV1

• Dyspnea

• Hyperinflation (IC/TLC = 25%)

• Pulmonary hypertension

• Impaired Exercise Performance

• Depression

• Low BMI

Predictors of COPD Mortality

Treatment

Nutritional problems - high fat diet ( increase caloric intake) - decrease CHO intake. - give anabolic hormone. - give appetizer e.g. megastrol.

O2 therapy. Antioxidants. Anti mediators asTNF alpha

antagonist. Rehabilitation. All COPD patients

benefit from exercise training programs, improving with respect to both exercise tolerance and symptoms of dyspnea and fatigue.