Sleszycka Justyna, Woźniak Krzysztof, Banaszek Marta, Wiechno Wiesław, Domagała-Kulawik Joanna
Medical University of Warsaw, Department and Clinic of Internal Medicine, Pulmonology and Allergology, Poland.
Pol Merkur Lekarski. 2009 Aug;27(158):92-6.
Cigarette smoking is the most prominent risk factor for chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD). Prevalence of COPD among cigarette smokers is about 23% in Poland. Effort dyspnea which develops in advanced stage of COPD is the leading cause of seeking medical advice. Physical activity among patients with PAD is reduced due to intermittent claudication. It may cause delayed COPD diagnosis in this group of patients.
To estimate the prevalence of COPD among patients suffering from severe PAD who were hospitalized in surgery department due to critical limb ischemia and to evaluate difficulties during COPD diagnosis in this group of patients.
We examined 64 patients suffering from severe PAD (at least IIb stage according to Fontaine's scale). Patients were asked about the typical symptoms of COPD: chronic cough, regular sputum production and dyspnea. To evaluate the intensity of dyspnea we used British Medical Research Council scale. Spirometry was performed to every patient. Patients with airways obstruction underwent spirometry after the administration of inhaled bronchodilator. Every patient who had the post-bronchodilator value of FEV,/FVC ratio below the lower limit of normal values was diagnosed with COPD.
It was not possible to evaluate the dyspnea intensity using MRC scale in 44% of 34 patients who reported dyspnea. During the study we diagnosed 16 patients with COPD (9 pts had 1st stage of COPD according to GOLD classification, 7 pts--2nd). 9 patients had been formerly diagnosed with COPD (2 pts--1st stage, 5 pts--2nd, and 2 pts--3rd). Spirometry-defined COPD was present in 39% of study group. The analysis of data from patients with PAD coexistent COPD revealed that 60% of them were current cigarette smokers and 28% of them declared passive smoking exposure. The other known negative prognostic factors in patients with COPD such as BMI lower than 21 kg/mr2, FEV1% of predicted value below 65% and X-rays photograph visible emphysema were observed in 40%, 32% and 12% of patients with PAD and coexistent COPD respectively. Hypertension was present in 52% of patients with PAD and coexistent COPD, cardiac arterial disease in 52% and chronic heart failure due to cardiac arterial disease in 36%. Further analysis of laboratory tests revealed dyslipidemia and chronic kidney disease in 52% and 60% of these patients respectively.
COPD diagnosis among patients suffering from severe PAD involves several difficulties such as uselessness of MRC dyspnea scale and frequent heart diseases which delay the COPD diagnosis being considered as primary dyspnea reason. Many factors which have been proven to be responsible for worse prognosis due to COPD were observed in patients with PAD and coexistent COPD. High prevalence of COPD among patients suffering from PAD suggests the spirometry as a COPD screening would be justified in that group.
吸烟是慢性阻塞性肺疾病（COPD）和外周动脉疾病（PAD）最主要的危险因素。在波兰，吸烟者中COPD的患病率约为23%。COPD晚期出现的劳力性呼吸困难是就医的主要原因。由于间歇性跛行，PAD患者的体力活动减少。这可能导致该组患者的COPD诊断延迟。
评估因严重肢体缺血而入住外科的重度PAD患者中COPD的患病率，并评估该组患者在COPD诊断过程中遇到的困难。
我们检查了64例重度PAD患者（根据Fontaine分级至少为IIb期）。询问患者COPD的典型症状：慢性咳嗽、咳痰规律和呼吸困难。为评估呼吸困难的强度，我们使用了英国医学研究委员会量表。对每位患者进行肺活量测定。气道阻塞患者在吸入支气管扩张剂后进行肺活量测定。每位支气管扩张剂后FEV₁/FVC比值低于正常值下限的患者被诊断为COPD。
在报告有呼吸困难的34例患者中，44%的患者无法使用MRC量表评估呼吸困难强度。在研究过程中，我们诊断出16例COPD患者（根据GOLD分类，9例为COPD 1期，7例为2期）。9例患者之前已被诊断为COPD（2例为1期，5例为2期，2例为3期）。研究组中肺活量测定定义的COPD患病率为39%。对合并COPD的PAD患者数据的分析显示，其中60%为当前吸烟者，28%宣称有被动吸烟暴露。在合并COPD的PAD患者中，其他已知的COPD负面预后因素，如体重指数低于21kg/m²、预测值的FEV₁%低于65%以及X线片可见肺气肿，分别在40%、32%和12%的患者中观察到。合并COPD的PAD患者中52%有高血压，52%有心脏动脉疾病，36%因心脏动脉疾病导致慢性心力衰竭。对实验室检查的进一步分析显示，这些患者中分别有52%和60%存在血脂异常和慢性肾病。
重度PAD患者的COPD诊断存在一些困难，如MRC呼吸困难量表无用以及常见的心脏病导致将COPD诊断延迟视为主要呼吸困难原因。在合并COPD的PAD患者中观察到许多已被证明会导致COPD预后更差的因素。PAD患者中COPD的高患病率表明，对该组患者进行肺活量测定作为COPD筛查是合理的。
