Systemic manifestations in different stages of chronic obstructive pulmonary disease

Abstract

Aim. To reveal the systemic manifestations of chronic obstructive pulmonary disease and to match them with respiratory function parameters and extrapulmonary manifestations as the disease progresses. Methods. 160 patients were examined (128 patients with different stages of chronic obstructive pulmonary disease - the study group, and 32 healthy volunteers - the control group). Clinical examination, serum cytokine concentration measurement, lung function tests, airway resistance and lung volumes evaluation, assessment of hemodynamic parameters, bone mineral density assessment were conducted. Correlations between listed parameters were estimated. Results. It was found that the activation of systemic inflammation occurs at the early stages of the disease with the further increase as it progresses, as was shown by the increase of interleukin-6, interleukin-8, tumor necrosis factor alpha (TNF-α), C-reactive protein levels in the study group compared to the control. The relation between spirometry parameters and inflammatory markers confirmed the role of systemic inflammation in chronic obstructive pulmonary disease progression and cardiovascular complications development. A correlation between the C-reactive protein level and forced expiratory volume at 1st second (FEV 1), as well as between TNF-α level and FEV 1, TNF-α level and lung vital capacity was found. The study also confirmed the role of lung hyperinflation in pulmonary hypertension and chronic cor pulmonale occurrence and progression: mean pulmonary arterial pressure correlated with residual volume to total lung capacity ratio in patients with FEV 1 50% and in patients with FEV 1 50%. Significant correlations between lung function and parameters of pulmonary hemodynamics (FEV 1 with right ventricular end-diastolic dimension) were revealed. Correlations between femoral neck bone mineral density and residual lung volume and diffusing lung capacity confirmed the role of progressive emphysema and hypoxia in the pathogenesis of osteoporosis in patients with chronic obstructive pulmonary disease. Conclusion. Correlations between the severity of airway obstruction and systemic manifestations of chronic obstructive pulmonary disease were revealed.