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TERZA SESSIONE L’ANZIANO CARDIOPATICO CON CO-MORBILITÀ Infarto miocardico e Broncopneumopatia

TERZA SESSIONE L’ANZIANO CARDIOPATICO CON CO-MORBILITÀ Infarto miocardico e Broncopneumopatia Ostruttiva Daniele Bertoli. COPD. The 4 th leading cause of death in the USA (behind heart desease, cancer, cerebrovascular disease)

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TERZA SESSIONE L’ANZIANO CARDIOPATICO CON CO-MORBILITÀ Infarto miocardico e Broncopneumopatia

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  1. TERZA SESSIONE L’ANZIANO CARDIOPATICO CON CO-MORBILITÀ Infarto miocardico e Broncopneumopatia Ostruttiva Daniele Bertoli

  2. COPD • The 4th leading cause of death in the USA (behind heart desease, cancer, cerebrovascular disease) • In 1990, COPD was ranked 12th as a burden of disease; by 2020 it is projected to rank 5° • The majority of patients with COPD die from cardiovascular disorders or cancer, not respiratory disease

  3. COPD: Definition • lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. • The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs. • The more familiar terms 'chronic bronchitis' and 'emphysema' are no longer used, but are now included within the COPD diagnosis. • COPD is not simply a "smoker's cough" but an under-diagnosed, life-threatening lung disease.

  4. COPD: Definition • diagnosis is confirmed by spirometry • COPD should be considered in any patient who has symptoms of cough, sputum production, or dyspnea and/or a history of exposure to risk factors for the disease • Chronic cough and sputum production often precede the development of airflow limitation by many years, although not all individuals with cough and sputum production go on to develop COPD

  5. PARAMETRI SPIROMETRICI • FEV1 o VEMS (Volume espiratorio forzato in 1 secondo) = quantità di aria emessa nel primo secondo di espirazione forzata • FVC (Capacità Vitale Forzata) = quantità massima di aria (misurata in litri) che può essere espulsa in un’espirazione forzata dopo un’ispirazione completa. • FEV1/FVC = Un valore inferiore al 70% indica un deficit ostruttivo e alta probabilità di BPCO.

  6. Spirometria Normale e TracciatoSpirometrico di Pazienti con BPCO

  7. Classificazione spirometrica di gravitàdella BPCO basata sul VEMSpost-broncodilatatore

  8. Heart disease and COPD • The most common cardiac abnormalities in patients with COPD are cor pulmonale and pulmonary hypertension • The prevalence of atrial fibrillation, atherosclerosis, and CHF is also high among patients with COPD

  9. Atherosclerosis and COPD • Although some of the association between COPD and atherosclerosis may be the result of common risk factors such as tobacco use, epidemiological evidence suggests that impaired lung function is a risk factor for increased cardiovascular death independent of tobacco use

  10. The Relationship Between Reduced Lung Function and Cardiovascular Mortality - A Population-Based Study and a Systematic Review of the LiteratureChest 2005;127;1952-1959

  11. The Relationship Between Reduced Lung Function and Cardiovascular Mortality - A Population-Based Study and a Systematic Review of the LiteratureChest 2005;127;1952-1959

  12. Metaanalysis of studies that reported RR of cardiovascular mortality based on FEV1 quintiles. Chest 2005;127;1952-1959

  13. Metaanalysis of studies that reported RR of cardiovascular mortality among nonsmokers Chest 2005;127;1952-1959

  14. Relationship between FEV 1, smoking status, and OR for cardiovascular mortality for current smoker (dark grey squares), ex-smoker (white squares), and never smoker (light grey squares) Young RP , Hopkins R , Eaton TE . Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes . Eur Respir J . 2007; 30(4): 616- 622

  15. Circulation 2003;107:1514-1519

  16. Circulation 2003;107:1514-1519

  17. Association between chronic obstructive pulmonary diseaseand systemic inflammation: a systematic review and a metaanalysis Thorax 2004;59:574–580Relationship between C-reactive protein (CRP) and COPD

  18. Association between chronic obstructive pulmonary diseaseand systemic inflammation: a systematic review and a metaanalysis Thorax 2004;59:574–580Relationship between fibrinogen and COPD

  19. Association between chronic obstructive pulmonary diseaseand systemic inflammation: a systematic review and a metaanalysis Thorax 2004;59:574–580Relationship between leucocytes and COPD

  20. C-reactive Protein As a Predictor of Prognosis in ChronicObstructive Pulmonary Disease Am J Respir Crit Care Med 175. 250–255, 2007

  21. COPD could be considered as part of a “chronic systemic inflammatory syndrome.” • cardiovascular diseases • lung cancer • peripheral skeletal muscle dysfunction • nutritional abnormalities • osteoporosis • increased prevalence of diabetes • chronic kidney disease CHEST 2011; 139(1):165–173

  22. Cardiovascular Safety of Tiotropium in Patients With COPD Chest 2010;137;20-30

  23. Cardiovascular Safety of Tiotropium in Patients With COPD Chest 2010;137;20-30

  24. J. Am. Coll. Cardiol. 2006;47;2554-2560;

  25. Long-term mortality according to COPD and statin use in patients with peripheral arterial disease van Gestel YR , Hoeks SE , Sin DD , et al . Effect of statin therapy on mortality in patients with peripheral arterial disease and comparison of those with versus without associated chronic obstructive pulmonary disease . Am J Cardiol . 2008 ; 102 ( 2 ): 192 - 196

  26. Beta-Blockers • Patients with COPD are at increased risk of CAD, and ß-blockers play a pivotal role in the management of cardiovascular diseases. • There is a general reluctance to use these substances in patients with COPD because of an unfounded fear of inducing bronchospasm. • A large Cochrane review revealed that cardioselective beta-blockers did not adversely affect the FEV1 or induce respiratory symptoms compared with placebo, independent of the severity of the COPD. • Given the demonstrated efficacy of b -blockers in treating CAD and CHF, the benefit of these medicaments outweighs the side effects and they should not be withheld from patients with COPD

  27. Chronic obstructive pulmonary disease is an independent predictor of death but not atherosclerotic events in patients with myocardial infarction: analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT) European Journal of Heart Failure (2009) 11, 292–298

  28. Arch Intern Med. 2010;170(10):880-887

  29. Arch Intern Med. 2010;170(10):880-887

  30. Arch Intern Med. 2010;170(10):880-887

  31. Take Home Messages • La BPCO è un fattore di rischio cardiovascolare • E’ probabile che meccanismi fisiopatologici simili, di tipo infiammatorio, siano presenti nella BPCO e nella malattia aterosclerotica • Le terapie pneumologiche più efficaci (tiotropio in particolare) sono efficaci anche per ridurre il rischio CV dei pazienti con BPCO • Le terapie cardiologiche più efficaci (statine, beta-bloccanti, inibitori RAAS) sono efficaci anche nella BPCO

  32. OSPEDALE SAN BARTOLOMEO DI SARZANA

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