COPD as a Lung Disease with Systemic Consequences – Clinical Impact, Mechanisms, and Potential for Early Intervention

Figures & data

Figure 1 Interrelationships between COPD, systemic consequences, and co-morbidities.

Table 1 Potential mechanisms of systemic consequences in COPD

Inactivity/deconditioning
a. Direct consequence of exertional dyspnea
b. Genetic factors
c. Behavorial factors
Systemic inflammation
a. Spillover of inflammation from the lung to the systemic circulation
b. Presence of inflammation in other organs in systemic inflammatory disease
Blood gas disturbances
a. Hypoxemia
b. Hypercapnia
c. pH changes
Electrolyte disturbances
a. Fluid imbalance
b. Malnutrition
Risk factors for COPD
a. Smoking
b. Genetic pre-disposition
c. Genetic pre-disposition for smoking, addiction to food
Side-effects of treatments given for COPD
a. Inhaled corticosteroids
b. Systemic steroids
c. Bronchodilators
Endocrine disturbances
a. Low testosterone levels
b. Growth hormone-resistance
c. Low insulin-like growth factor-I levels
d. Insulin resistance
Suppression of erythropoiesis
Unknown factors

Figure 2 The clinical course of COPD, showing the vicious cycle that ensues and some of the associations with systemic consequences and co-morbidities. See text for an explanation.

Figure 3 Reduced activity (A), prevalence of osteopenia/osteoporosis (B), depletion in fat-free mass (C), prevalence of anxiety/depression (D), cause of death (E) as a function of severity of disease (GOLD stage). Modified from ([14], [59], [118], [143], [177]).

Figure 4 Interrelationships between activity and co-morbidities in COPD. See text for an explanation.

Figure 5 Schematic representation of the primary and potential effects of a bronchodilator on the systemic consequences (A) and co-morbidities (B) of COPD.

Sin D D, Man J P, Man S F. The risk of osteoporosis in Caucasian men and women with obstructive airways disease. Am J Med 2003; 114: 10–14

 PubMed Web of Science ®Google Scholar

Pitta F, Troosters T, Spruit M A, Probst V S, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005; 171: 972–977

 PubMed Web of Science ®Google Scholar

Schols A M, Broekhuizen R, Weling-Scheepers C A, Wouters E F. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr 2005; 82: 53–59

 PubMed Web of Science ®Google Scholar

Di Marco F, Verga M, Reggente M, Maria Casanova F, Santus P, Blasi F, Allegra L, Centanni S. Anxiety and depression in COPD patients: The roles of gender and disease severity. Respir Med 2006; 100: 1767–1774

 PubMed Web of Science ®Google Scholar

Mannino D M, Doherty D E, Sonia B A. Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study. Respir Med 2006; 100: 115–122

 PubMed Web of Science ®Google Scholar