Small airway dysfunction in smokers with stable ischemic heart disease.

Claudia Llontop,Cristina Garcia-Quero,Raquel Casitas,Almudena Castro,Raúl Galera,Elisabet Martinez-Ceron,Joan B Soriano,Alberto Iglesias,Regina Dalmau,Francisco García-Río

doi:10.1371/journal.pone.0182858

Abstract

BackgroundA higher prevalence of airflow limitation (AL) has been described in patients with ischemic heart disease (IHD). Although small airway dysfunction (SAD) is an early feature of AL, there is little information about its occurrence in IHD patients. Our objective was to describe the prevalence of SAD in IHD patients, while comparing patient-related outcomes and future health risk among IHD patients with AL, SAD and normal lung function.MethodsIn 118 consecutive smoking patients with stable IHD, comorbidities, utilization of healthcare resources, current treatment, blood biochemistry and health status were recorded. SAD was evaluated by impulse oscillometry, and pre- and post-bronchodilator spirometry was performed.ResultsThe prevalence of AL and SAD were 20.3 (95% CI, 13.1–27.6%) and 26.3% (95% CI, 18.3–34.2%), respectively. Compared to the normal lung function group, patients with SAD and without AL had lower spirometric values, poorer quality of life and higher levels of C-reactive protein (CRP), as well as increased cardiovascular risk and more vascular age. In patients with normal spirometry, the presence of SAD was independently associated with pack-years, HDL-cholesterol and CRP levels.ConclusionIn patients with IHD, the presence of SAD is common and that it is associated with reduced health status and increased future cardiac risk.

Highlights

Cigarette smoke is a major contributor to the pathogenesis of both chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) [1,2], two of the most common causes of death in the world [3]
In patients with normal spirometry, the presence of small airway dysfunction (SAD) was independently associated with packyears, high-density lipoprotein (HDL)-cholesterol and C-reactive protein (CRP) levels
In patients with IHD, the presence of SAD is common and that it is associated with reduced health status and increased future cardiac risk

Summary

Introduction

Cigarette smoke is a major contributor to the pathogenesis of both chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) [1,2], two of the most common causes of death in the world [3]. Some studies have reported a higher prevalence of airflow limitation compatible with COPD in patients with cardiovascular disease than in the general population [4,5,6], in patients with IHD [4]. Because the small airways are the major site of obstruction in patients with COPD,[9] the term small airway dysfunction (SAD) has been used in reference to abnormalities occurring secondary to cigarette smoking as an early feature of COPD that might account for the initial progression of airflow limitation in these patients [9,10,11]. There is no specific information about the prevalence of SAD in smoking patients with IHD who they have not yet developed COPD, nor of its clinical or prognostic implications. Our objective was to describe the prevalence of SAD in IHD patients, while comparing patient-related outcomes and future health risk among IHD patients with AL, SAD and normal lung function

Objectives

Methods

Conclusion