PDF Chronic Obstructive Pulmonary Disease: A Systemic Inflammatory Disease

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New to MyKarger? Click here to sign up. Submission Websites List. For the academic login, please select your organization on the next page. You will be redirected to verify your credentials. Keywords: Chronic obstructive pulmonary disease Cytokines Inflammation, systemic Proteins, phase reactive Bone marrow. I have read the Karger Terms and Conditions and agree. If you would like to redeem your KAB credit, please log in. Subcription rates. Chronic obstructive pulmonary disease COPD is characterized by chronic inflammation in both the airways causing airway obstruction and the lung tissues causing emphysema.

The disease is induced by inhalation of noxious gasses and particulate matter resulting in a chronic persistent inflammatory response in the lung, and the extent of the inflammatory reaction correlates with the severity of the disease. This chronic inflammatory response in the lung is also associated with a significant systemic inflammatory response with downstream adverse clinical health effects. The systemic response in COPD is associated with mortality, specifically cardiovascular mortality.

Background

This review describes the nature of the systemic inflammatory response in COPD and the clinical manifestations associated with the systemic response, with a focus on the potential mechanisms for these adverse health effects. Therefore, we conducted subgroup analyses to minimize heterogeneity among the included studies Table 2. Patients with COPD were not associated with elevated IL-8 level if the study was conducted in Europe, or participants were current or partial smokers. The objective of the present meta-analysis was to determine the relationship between systemic inflammatory markers and COPD pathogenesis.

Twenty-four observational studies were identified 22 case control studies, and 2 cross-sectional studies , and included a total of 10, COPD cases, and 28, controls. These results enable us to refine the definition of clinical phenotypes and monitor the response to existing and new therapeutic strategies, and assist physicians with accurate therapeutic decision-making.

A previous meta-analysis [ 24 ] suggested that reduced lung function was associated with increased levels of systemic inflammatory markers, which may have important pathophysiological and therapeutic implications for subjects with stable COPD. The inherent limitation of the previous review related to the small number of studies reporting several markers.

Two studies provided the outcomes with IL-8, which were not statistically significant, and the outcomes were unstable. Therefore, we conducted an updated meta-analysis to determine these associations, and evaluate the relationships in specific subpopulations. Most of our findings were consistent with previous studies. However, several studies reported inconsistent results. Further, Fattouh et al [ 17 ] indicated that elevated levels of CRP, fibrinogen and leukocytes in individuals with COPD were associated with increased risk of exacerbation, but no significant difference when COPD patients were compared with controls.

The result could be explained by the study design exploring systemic inflammatory markers in patients with different COPD status, and the different stages of COPD across included studies. CRP and leukocyte levels may be markers of significant bacterial infection providing a rationale for antibiotic treatment. However, several studies included in our study reported inconsistent results. The inconsistent findings may be related to the inclusion of studies with different baseline characteristics and early stages of COPD that are insensitive to systemic inflammatory markers.

Previous study suggested that fibrinogen was probably a useful biomarker to stratify individuals with a high or low risk of COPD exacerbation [ 40 ]. In our study, individuals with COPD were associated with elevated fibrinogen levels. Fibrinogen might represent a potentially useful biomarker and requires large observational studies for further validation. In comparison, in our current meta-analysis, 10 of the included studies reported this relationship. Similarly, substantial heterogeneity and variance observed in the included studies preclude any unequivocal conclusion.

Our comparative study provides a comprehensive analytical review. The strengths of our study relate to the large sample size allowing us to quantitatively evaluate the relationship of systemic inflammation with the pathogenesis of COPD.

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Balance impairment and systemic inflammation in chronic obstructive pu | COPD

Therefore, our findings are potentially more robust than those of any individual study. Further, we summarized six important markers and their potential role in COPD, and explored the relationships in several specific subpopulations. The limitations of our meta-analysis relate to the use of pooled data. Individual data were not available, which precluded a more detailed and comprehensive analysis. In addition, meta-analyses always use published studies, and publication bias is inevitable.

Introduction

In conclusion, the results of our study indicate that systemic inflammatory markers play an important role in the pathogenesis of COPD. Further large-scale studies are needed to corroborate the findings, before providing recommendations for identifying clinical phenotypes and monitoring therapeutic response. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Systemic inflammatory factors are inconsistently associated with the pathogenesis of chronic obstructive pulmonary disease COPD.

Materials and Methods Data sources, search strategy, and selection criteria Our study was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement issued in S1 Checklist [ 25 ]. Data collection and quality assessment Data extraction and assessment were performed independently by two reviewers. Statistical analysis We examined the relationship between markers of systemic inflammation and COPD pathogenesis on the basis of the mean, standard deviation, and sample size in each group, published in each study.

Results The primary search produced 3, records. Download: PPT. Fig 1. Flow diagram outlining the literature search strategy and study selection process. Fig 4. Discussion The objective of the present meta-analysis was to determine the relationship between systemic inflammatory markers and COPD pathogenesis. Conclusion In conclusion, the results of our study indicate that systemic inflammatory markers play an important role in the pathogenesis of COPD.

Supporting Information.

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S1 Checklist. References 1. Global burden of COPD: risk factors, prevalence, and future trends. Local and systemic inflammation in patients with chronic obstructive pulmonary disease: soluble tumor necrosis factor receptors are increased in sputum. Connors AF Jr. Outcomes following acute exacerbation of severe chronic obstructive lung disease.

Systemic effects of chronic obstructive pulmonary disease. Eur Respir J. Agusti AG.


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