Influence of the tobacco smoking factor in the comorbid course of chronic obstructive pulmonary disease and ischemic heart disease

Abstract

Objective — to assess the clinical state, external respiration, structural and functional state of the heart and blood vessels, blood levels of NT-proBNP and factors of the systemic inflammatory response in patients with chronic obstructive pulmonary disease (COPD) with coronary heart disease (CHD), depending on the tobacco smoking factor.Materials and methods. The examinations involved 104 male patients aged 45 to 59 years with a diagnosis of COPD with phenotypes A and B in combination with CHD, postinfarction cardiosclerosis and signs of chronic heart failure (CHF) of the 2nd functional class. Patients were divided into two groups: the first included 29 non-smoking patients, the second sonsisted of 75 smoking patients. All patients were assessed by the tobacco smoking history, a 6-minute walk test, CAT and mMRC questionnaires, spirography, ultrasound investigation of the heart and blood vessels. Blood levels of the C-reactive protein (С-RP), fibrinogen, N-terminal fragment of the medullary natriuretic peptide (NT-proBNP) precursor were determined.Results and discussion. In patients with COPD with concomitant CHD, tobacco smoking was associated with more severe symptoms and severity of dyspnoea (CAT and mMRC questionnaires), worse tolerability of physical activity according to the 6-minute walking test. In the group of smokers, the median vital capacity was 1.26 times lower than in non-smoking patients. The forced vital capacity median in the group of patients with COPD with CHD (II group) was 59.49 % and was 1.18 times statistically significantly lower than in the group of non-smokers (I group) (t = 5.04, p < 0.05). The FEV1 index of smokers was 1.15 times statistically significantly lower than that of non-smokers with COPD with CHD (t = 4.13, p < 0.05). In patients of I group, the PEF index was 1.29 times (t = 6.38, p < 0.05), FEF25 — 1,39 times (t = 8.04, p < 0,01), FEF50 — in 1.45 times (t = 7.84, p < 0.01), FEF75 — 1.45 times (t = 5.73, p < 0.05) were statistically significantly higher than those in smokers (II group). MEF25—75 in II group was statistically significantly lower than in the group of non-smokers (I group) (1.25 times) (t = 5.60, p < 0.05). In the group of non-smokers (I group), the median diastolic sizes of the right (DSRA) and left (DSLA) atriums were 1.19 times and 1.04 times lower respectively than those of smokers (II group), respectively. The median thickness of the right ventricular wall (TW RV) was 1.17 times less in patients of Group I than in patients of II group. The values of median basal (B RV) and longitudinal (L RV) right ventricular size in non-smokers COPD and CHD n = 29) were less than those of smokers, at 1.16 and 1.07 times, respectively. The indicator of right ventricular ejection fraction in non-smokers was 1.11 times higher than that of smokers. In the group of smoking patients, pulmonary hypertension (26.9 % of the total observation group and 37.3 % of the smokers group) was detected in 28 patients. The values of the factors of the systemic inflammatory response in the group of smoking patients were higher than in non-smoking patients, namely: the median C-RP was 1.25 times, the median IL-6 1.6 times, the median FG 1.18 times. The concentration of NT-proBNP in smoking COPD patients with CHD was 1.23 times higher than for non-smokers.Conclusions. In patients with COPD with concomitant CHD, tobacco smoking was associated with worse tolerance to exercise, higher blood concentrations of systemic inflammatory response factors and NT-proBNP (p < 0.05); decrease in volumetric and velocity indices of HPV, more pronounced processes of remodelling of blood vessels and right heart.