Batura-Gabryel Halina, Grabicki Marcin
Pneumonol Alergol Pol. 2014;82(6):590-6. doi: 10.5603/PiAP.2014.0078.
Chronic obstructive pulmonary disease (COPD) is characterised by persistent airflow limitation and extrapulmonary comorbidities, which contribute to the overall severity. Some risk factors, with tobacco smoking as the most serious one, lead to a chronic, systemic inflammation that plays the main role in the pathogenesis of COPD and comorbidities, including cardiovascular diseases (CVD). The course of COPD is diverse; it depends on pathologies in the respiratory system and on other organ dysfunctions. CVDs are the most commonly recognised comorbidities in COPD patients. The severity and natural course of COPD, as well as quality of the patient's life, are influenced by them. CVDs are frequently the reason for hospitalisation and may lead to death. They are also an important prognostic factor. Comorbidities may prolong exacerbation of COPD. On the other hand, COPD is an independent risk factor of CVD. The prevalence of COPD is high in patients suffering from coronary artery disease, and airflow limitation is a major risk factor for chronic heart failure. These complex interactions between heart and lung can be denoted as 'cardiopulmonary continuum'. These dependencies are not recognised in detail. Currently research is being done, which attempts to explain these complicated relations. For many years COPD and CVD were not connected. Today it is known that patients suffering from COPD must be provided comprehensive care. It is necessary to monitor the risk of CVD and their influence on the COPD course. Careful and proper treatment of all diseases is essential. An interdisciplinary team with good cooperation should prepare a plan of COPD treatment with simultaneous therapy of comorbidities.
慢性阻塞性肺疾病(COPD)的特征是持续性气流受限和肺外合并症,这些因素会加重整体病情的严重程度。一些风险因素,其中吸烟是最严重的因素,会导致慢性全身性炎症,这种炎症在COPD及包括心血管疾病(CVD)在内的合并症的发病机制中起主要作用。COPD的病程多种多样,它取决于呼吸系统的病理状况以及其他器官功能障碍。心血管疾病是COPD患者中最常见的合并症,它们会影响COPD的严重程度和自然病程以及患者的生活质量。心血管疾病常常是住院的原因,可能导致死亡,也是一个重要的预后因素。合并症可能会延长COPD的急性加重期。另一方面,COPD是心血管疾病的独立危险因素。冠状动脉疾病患者中COPD的患病率很高,气流受限是慢性心力衰竭的主要危险因素。心肺之间的这些复杂相互作用可被称为“心肺连续体”。这些相关性尚未得到详细认识。目前正在进行研究,试图解释这些复杂的关系。多年来,COPD和心血管疾病并未关联起来。如今已知,必须为COPD患者提供全面护理,有必要监测心血管疾病的风险及其对COPD病程的影响。对所有疾病进行仔细且恰当的治疗至关重要。一个合作良好的跨学科团队应制定COPD治疗计划,并同时治疗合并症。