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SYSTEMIC INFLAMMATION LEADING TOSYSTEMIC INFLAMMATION LEADING TO
COMORBIDITIES ASSOCIATED WITH COPDCOMORBIDITIES ASSOCIATED WITH COPD
Leonardo M. Fabbri
Comorbidities and systemic effects of COPD
Cardiovascular diseases in COPD
COPD in Chronic Heart Failure
Cardiovascular drugs in COPD
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CHRONIC DISEASE IN THE ELDERLY:
Back to the Future of Internal Medcne
LM Fabbri and R Ferrari, Breathe, 2!, in "re
T!o or "ore chronc d#ea#e# al"o#t n$ara%l& de$elo' to(ether
the #a"e 'atent) 'artcularl& n the elderl&) often "akn( t dffcult
e#ta%l#h a 'ro'er da(no## and a##e##"ent of #e$ert&
*atent+orented a''roach that take# nto account the #e$eralcoe,#tn( co"'onent# of chronc d#ea#e # re-ured
Th# .chan(e of conce't/ "'le# the need for "edcal #'ecal#t#
e,tend ther e,'ert#e to %roader da(no#tc and treat"ent
a''roache# that are tradtonall& the 'ur$e! of nternal "edcne
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Leading Causes of
Death in U.S.
#1. MI#2. CA
#3. CVA
#4. COPD
Cigarette Related Dise
Leading Causes of
Death Worldide !"
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0hat do CO*D *atent# De Fro"1
Mannino D.M.,Mannino D.M., et al.et al. Respiratory Medicine 2006; 100:115Respiratory Medicine 2006; 100:115
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Chronic diseases re$resent a huge
$ro$ortion of human illness
%& million deaths in !""%'
Cardiovascular disease (")
Cancer #()
chronic res$iratory diseases *)
Diabetes !)
Horton R. Lancet, 2006
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COPD +, + ,-,/M0C D0,/+,/COPD +, + ,-,/M0C D0,/+,/
COPD + COMPO1/1 OF H/ CHRO10C D0,/+,/COPD + COMPO1/1 OF H/ CHRO10C D0,/+,/
COPD + ,-,/M0C D0,/+,/
,ystemic inflammationCache2ia
,3eletal muscle astingOsteo$orosis
COPD + COMOR40D0- OF
Chronic heart failure
Coronary and $eri$heral arterial diseasesLung cancer
Metabolic syndrome
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5
=
5
5
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0nhaled $articles'
$ulmonary and heart co6morbidity
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Comorbidities and systemic effects of COPD
Cardiovascular diseases in COPD
COPD in Chronic Heart Failure
Cardiovascular drugs in COPD
SYSTEMIC INFLAMMATION LEADING TOSYSTEMIC INFLAMMATION LEADING TO
COMORBIDITIES ASSOCIATED WITH COPDCOMORBIDITIES ASSOCIATED WITH COPD
Leonardo M2 Fa%%r
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Cardo$a#cular "ortalt& nCardo$a#cular "ortalt& n
CO*DCO*D
For e$er& 345 decrea#e n FE6For e$er& 345 decrea#e n FE633))
cardo$a#cular "ortalt& ncrea#e# %&cardo$a#cular "ortalt& ncrea#e# %&
a''ro,"atel& 785 and non+fatal coronar&a''ro,"atel& 785 and non+fatal coronar&
e$ent ncrea#e# %& a''ro,"atel& 745 ne$ent ncrea#e# %& a''ro,"atel& 745 n
"ld to "oderate CO*D2"ld to "oderate CO*D2
Anth$ni#en et a%, A& ' Re#"ir Crit Care Med 22Anth$ni#en et a%, A& ' Re#"ir Crit Care Med 22
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Curkendall et al. Ann Epidem
COPD
CA!E! O" #O!P$%A& AD'$!!$O(
CA!E! O" DEA%#
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*re$enton of E,acer%aton# of Chronc O%#truct$
*ul"onar& D#ea#e !th Totro'u") a Once+Da
Inhaled Antcholner(c Bronchodlator
Niewoehner,et al, Ann Intern Med. 2005;143:317-3
COE9ISTIN ILLNESSES
6a#cular ;ncludn( h&'erten#on< =>5
Cardac ?85
a#tronte#tnal >85
Mu#culo#keletal or connect$e t##ue >=5
Meta%olc or nutrtonal >@5
Re'roduct$e or urnar& 7@5Neurolo(c 775
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Coronar) Arter) Cal*i+*ation in OlderAdult,
Newman AB et al irc!lati
O d P ti
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O**urren*e and Pro-no,ti*!i-ni+*an*e o /entri*ular Arr)tmia$, elated to Pulmonar) "un*tion
En(#tr$& G et a% Cir)*%ati$n 2
>47 "en) =8 &r# old 3> &r# follo!+u'
C tid Pl $ ti ' di %i k
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Carotid Plaue $ntima 'edia %i*kne,,Cardio4a,*ular i,k "a*tor, and Pre4alenCardio4a,*ular Di,ea,e in 'en and 5omen
6. 8
9.28
0.8
Per*entualedi,o--
etti:ma,*0i;*on
unapla**a*arotidea
08
FE63ter media 66 anni
"#ra$im % et al %tro&
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"E/1e ri,k o ,troke:te Copena-en !troke !tud)
?1008 90@998 0@98 70@798 60@698 0@98 08
Per*entuale "E/1ri,petto al pre4i,to
1i,*0io
1elati4o
2
1.
0.
1
per ma,*i e emmine per ma,*i per emmi
(r!elsen ( et al )nt * "pidem
P&'O(AB E'O&$!' $( PA%$E(%! 5$%#
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P&'O(AB E'O&$!' $( PA%$E(%! 5$%#(EP&A$(ED EACEA%$O( O" C#O($C
O!%C%$/E P&'O(AB D$!EA!E:PE/A&E(CE A(D $! "AC%O!
Tlle+Le%lond et al) Ann Intern Med2 744=3>>:?4+?=2
75 'ul"onar& e"%ol#" n 'atent#
!th CO*D ho#'taled for #e$ere
e,acer%aton of unkno!n or(n
*re$ou# TE*) "al(nanc&) lo! *aCO7
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Cardo$a#cular "or%dt& nCardo$a#cular "or%dt& n
CO*DCO*D
H(h CR*H(h CR* Se$ereSe$ereo%#tructono%#tructon
H(h CR*H(h CR*and #e$ereand #e$ere
o%#tructono%#tructon
Cardacnfarct
onnFurcore
Cardacnfarcton
nFurcore
*G4)443*G4)443
Sin and Man, Cir)*%ati$n 2Sin and Man, Cir)*%ati$n 2
0nflammation atherosclerosis and coronary artery disease0nflammation atherosclerosis and coronary artery disease
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0nflammation7 atherosclerosis and coronary artery disease0nflammation7 atherosclerosis and coronary artery disease
Hansson GK, N Engl J Med. 2005;352(16!16"5#$5Hansson GK, N Engl J Med. 2005;352(16!16"5#$5
%ct&'at&on o a t)*e 1 &++ne res*onse &n at-ero+a or+at&on%ct&'at&on o a t)*e 1 &++ne res*onse &n at-ero+a or+at&on
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Cross6sectional study7 $atients 8% years of age
Of 9"% $artici$ating $atients ith a diagnosis of chronic
obstructive $ulmonary disease7 &( 2!."$ %" CI 1&.'(24.)*
had $reviously unrecogni:ed heart failure
RECONISIN HEART FAILRE IN ELDERLY *ATIENTS
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RECONISIN HEART FAILRE IN ELDERLY *ATIENTS
0ITH STABLE CHRONIC OBSTRCTI6E *LMONARY
DISEASE IN *RIMARY CARE
F H R*tten et a%, BM' 2-, De).+/01+3456+
A l"ted nu"%er of te"# ea#l&
a$ala%le fro" h#tor& and 'hcal e,a"naton)!th
addton of NT+'roBN* and electrocardo(ra'h&) canhel' (eneral 'racttoner# to dentf& conco"tant
heart falure n nd$dual 'atent# !th #ta%le CO*D
P tidi t i ti i k
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Peptidi natriuretici come markerdello scompenso cardiaco cronico
AN*
C*$re n$r&a%eC*$re n$r&a%e C*$re #)$&"en#aC*$re #)$&"en#a
AN*
BN*
AN*AN*
Pe"tide natri*reti)$ atria%ePe"tide natri*reti)$ atria%e
BN*
*e'td natruretc*e'td natruretc
BN*BN*
Pe"tide natri*reti)$ )erebra%ePe"tide natri*reti)$ )erebra%e
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4reathing 1ot Pro$erly Multinational ,tudy
Mcllog- et al. &rc 20
#%&8 $artici$ants ho $resented ith acute dys$nea
#%(& ; (* ) COPD comorbidity
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4reathing 1ot Pro$erly ;41P= Multinational ,tudy
Mcllog- et al. &rc 20
?tility of 41P in Differentiating Heart Failure from Lu
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?tility of 41P in Differentiating Heart Failure from Lu
Disease in Patients Presenting
ith Dys$nea
Morr&son et al. J% 20
?tility of 41P in Differentiating Heart Failure from Lu
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?tility of 41P in Differentiating Heart Failure from Lu
Disease in Patients Presenting
ith Dys$nea
Morr&son et al. J% 20
SYSTEMIC INFLAMMATION LEADING TOSYSTEMIC INFLAMMATION LEADING TO
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Comorbidities and systemic effects of COPD
Cardiovascular diseases in COPD
COPD in Chronic Heart Failure
Cardiovascular drugs in COPD
SYSTEMIC INFLAMMATION LEADING TOSYSTEMIC INFLAMMATION LEADING TO
COMORBIDITIES ASSOCIATED WITH COPDCOMORBIDITIES ASSOCIATED WITH COPD
Leonardo M2 Fa%%r
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/r&+ar) End*o&nt! +ll6Cause Mortality
econdar) End*o&nts! C@ Death7 M07 or HF
t-er End*o&nts! ,afety and olerability
Ca$to$ril %" mg tid;n A 9
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/A&$A(% %rial:Pre4alen*e o COPD
14703 patients included in the trial
1258 clinical diagnosis of COPD (8!"#
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@alsartanHeartFailure rial
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!tud) De,i-n
F. (. Con et. al F. Card. "ail. 1999; : 1@160
#" patient, 1 )r; (B#A $$$/
&/$DDG 2.9 *mHmI !A; E"08
/al,artan0 m- Jid titrated
to160 m- Jid
$0! deaths (e%ents reported#
&ando'ied to
&ecei%ing )tandard *herap+including ,C- inhi.itors / diuretdigoin / .locers
Pla*eJo
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/al@#e"% %rial:Pre4alen*e o COPD
5010 patients included in the trial
!28 clinical disgnosis of COPD (125"#
/al@#e"% %rial
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/al #e"% %rialClini*al e4ent, at 2 )ear olloK@up
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Contributors to e2ercise intolerance in
COPD and CHF
Goser et al. %JN 1
SYSTEMIC INFLAMMATION LEADING TOSYSTEMIC INFLAMMATION LEADING TO
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Comorbidities and systemic effects of COPD
Cardiovascular diseases in COPD
COPD in Chronic Heart Failure
Cardiovascular drugs in COPD
COMORBIDITIES ASSOCIATED WITH COPDCOMORBIDITIES ASSOCIATED WITH COPD
Leonardo M2 Fa%%r
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METHODS
Ca#e+control #tud& of t!o 'o'ulaton+%a#ed retro#'ect$e cohort#
3< CO*D 'atent# ha$n( under(one coronar& re$a#cularaton
;h(h C6 r#k cohort