Pneumologie 2009; 63(9): 526-537
DOI: 10.1055/s-0029-1214943
Übersicht

© Georg Thieme Verlag Stuttgart · New York

COPD und Begleiterkrankungen

Ergebnisse des Expertentreffens Luftschlösser 2008
Tremsbüttel, 28. – 29. November 2008
Sponsor: Boehringer Ingelheim Pharma GmbH & Co KG
COPD and Concomitant DiseasesR.  Dierkesmann1 , A.  Gillissen2 , T.  Köhnlein3 , J.  Lorenz4 , H.  Magnussen5 , H.  Morr6 , M.  Pfeifer7 , G.  Schultze-Werninghaus8 , G.  Steinkamp9 , C.  Taube10 , H.  Teschler11 , C.  Vogelmeier12 , H.  Worth13
  • 1Ehem. Direktor der Klinik Schillerhöhe, Gerlingen/Stuttgart
  • 2Robert-Koch-Klinik, Thoraxzentrum des Klinikums St. Georg, Leipzig
  • 3Abt. Pneumologie, Medizinische Hochschule Hannover
  • 4Klinik für Pneumologie und Intensivmedizin, Klinikum Lüdenscheid
  • 5Krankenhaus Großhansdorf, Zentrum für Pneumologie und Thoraxchirurgie, Großhansdorf, Lehrstuhl für Innere Medizin-Pneumologie, Großhansdorf, Universität zu Lübeck
  • 6Pneumologische Klinik Waldhof Elgershausen, Greifenstein/Hessen
  • 7Klinik Donaustauf, Universität Regensburg
  • 8Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Medizinische Klinik III – Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, Bochum
  • 9Medizinisch-wissenschaftliches Publizieren, Hannover
  • 10III. Med. Klinik, Johannes Gutenberg-Universität Mainz
  • 11Ruhrlandklinik Essen
  • 12Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Universitätsklinikum Gießen und Marburg, Standort Marburg
  • 13Medizinische Klinik I, Klinikum Fürth
Weitere Informationen

Publikationsverlauf

eingereicht 17. 6. 2009

akzeptiert 22. 6. 2009

Publikationsdatum:
11. September 2009 (online)

Einleitung

„Outcomes we did not anticipate” – Mit dieser Bewertung fassten Calverley und Rennard 2007 die unerwarteten Resultate umfangreicher neuerer Studien zur COPD zusammen [1]. Zu diesen unerwarteten Resultaten gehörten nicht nur die begrenzte Nützlichkeit von Reversibilitätstests, die Häufigkeit von Pneumonien unter inhalativen Glukokortikosteroiden und die Erkenntnis, dass Studienteilnehmer nicht unbedingt repräsentativ für das Krankheitsbild der COPD sind. Patienten mit erheblichen Komorbiditäten, wie der koronaren Herzkrankheit, der Linksherzinsuffizienz oder Krebsleiden, werden meistens aus klinischen COPD-Studien ausgeschlossen. Diese Erkrankungen sind bei COPD jedoch für die Prognose mitentscheidend [2]. Auch in Studien, in denen Komorbiditäten nicht ausgeschlossen wurden, weil bei diesen keine rasche Mortalität angenommen wurde [3] [4], verstarben mehr als 25 % der Studienteilnehmer an kardiovaskulären Ursachen und 20 % an Tumoren, davon die Hälfte an Lungenkrebs. Obwohl die gemeinsame Noxe, das Zigarettenrauchen, eine naheliegende Erklärung dieser Assoziationen ist, stellt die COPD offenbar ein zusätzliches Risiko dar.

Für zukünftige COPD-Studien ist daher der Parameter „Tod durch alle Ursachen” (all-cause mortality) als primärer Endpunkt besonders geeignet. Die COPD muss in Studien als Erkrankung mit gewichtigen Komorbiditäten betrachtet werden, die für den Verlauf und die Prognose mitentscheidend sind. Es ist die besonders bedeutsame Erkenntnis der Datenlage, dass Studien ohne den Einschluss von Patienten mit Komorbiditäten als Studien bei nicht-repräsentativen Subgruppen zu bewerten sind.

Das Thema COPD und Begleiterkrankungen wurde daher von einer Expertengruppe am 28. und 29.11.2008 erörtert, mit dem Ziel, die Bedeutung der komplexen gesundheitlichen Situation von Patienten mit COPD zu analysieren. Dieser Beitrag stellt die Zusammenfassung der wesentlichen Ergebnisse dar.

Literatur

  • 1 Calverley P M, Rennard S I. What have we learned from large drug treatment trials in COPD?.  Lancet. 2007;  370 774-785
  • 2 Sin D D, Anthonisen N R, Soriano J B, Agusti A G. Mortality in COPD: Role of comorbidities.  Eur Respir J. 2006;  28 1245-1257
  • 3 Calverley P, Pauwels R, Vestbo J. et al . Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial.  Lancet. 2003;  361 449-456
  • 4 Calverley P M, Anderson J A, Celli B. et al . Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease.  N Engl J Med. 2007;  356 775-789
  • 5 Jones P W, Agusti A G. Outcomes and markers in the assessment of chronic obstructive pulmonary disease.  Eur Respir J. 2006;  27 822-832
  • 6 Fletcher C, Peto R. The natural history of chronic airflow obstruction.  Br Med J. 1977;  1 1645-1648
  • 7 Casanova C, Cote C, de Torres J P. et al . Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2005;  171 591-597
  • 8 Soler-Cataluna J J, Martinez-Garcia M A, Roman S P. et al . Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease.  Thorax. 2005;  60 925-931
  • 9 Hogg J C, Chu F S, Tan W C. et al . Survival after lung volume reduction in chronic obstructive pulmonary disease: insights from small airway pathology.  Am J Respir Crit Care Med. 2007;  176 454-459
  • 10 Pinto-Plata V M, Cote C, Cabral H. et al . The 6-min walk distance: change over time and value as a predictor of survival in severe COPD.  Eur Respir J. 2004;  23 28-33
  • 11 Casanova C, Cote C, Marin J M. et al . Distance and oxygen desaturation during the 6-min walk test as predictors of long-term mortality in patients with COPD.  Chest. 2008;  134 746-752
  • 12 Martinez F J, Foster G, Curtis J L. et al . Predictors of mortality in patients with emphysema and severe airflow obstruction.  Am J Respir Crit Care Med. 2006;  173 1326-1334
  • 13 Celli B R, Cote C G, Marin J M. et al . The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.  N Engl J Med. 2004;  350 1005-1012
  • 14 Cote C G, Pinto-Plata V M, Marin J M. et al . The modified BODE index: validation with mortality in COPD.  Eur Respir J. 2008;  32 1269-1274
  • 15 Minai O A, Benditt J, Martinez F J. Natural history of emphysema.  Proc Am Thorac Soc. 2008;  5 468-474
  • 16 Dirksen A, Piitulainen E, Parr D G. et al . Exploring the role of CT densitometry: a randomised study of augmentation therapy in alpha-1 antitrypsin deficiency.  Eur Respir J. 2009;  33 1345-1353
  • 17 Dawkins P A, Dawkins C L, Wood A M. et al . Rate of progression of lung function impairment in alpha1-antitrypsin deficiency.  Eur Respir J. 2009;  33 1338-1344
  • 18 Anthonisen N R, Connett J E, Kiley J P. et al . Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study.  JAMA. 1994;  272 1497-1505
  • 19 Scanlon P D, Connett J E, Waller L A. et al . Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. The Lung Health Study.  Am J Respir Crit Care Med. 2000;  161 381-390
  • 20 Simmons M S, Connett J E, Nides M A. et al . Smoking reduction and the rate of decline in FEV(1): results from the Lung Health Study.  Eur Respir J. 2005;  25 1011-1017
  • 21 Godtfredsen N S, Lam T H, Hansel T T. et al . COPD-related morbidity and mortality after smoking cessation: status of the evidence.  Eur Respir J. 2008;  32 844-853
  • 22 Nakanishi N, Nakamura K, Matsuo Y. et al . Cigarette smoking and risk for impaired fasting glucose and type 2 diabetes in middle-aged Japanese men.  Ann Intern Med. 2000;  133 183-191
  • 23 Baker E H, Janaway C H, Philips B J. et al . Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease.  Thorax. 2006;  61 284-289
  • 24 Davis W A, Knuiman M, Kendall P. et al . Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes: the Fremantle Diabetes Study.  Diabetes Care. 2004;  27 752-757
  • 25 Baik I, Kim J, Abbott R D. et al . Association of snoring with chronic bronchitis.  Arch Intern Med. 2008;  168 167-173
  • 26 McNicholas W T, FitzGerald M X. Nocturnal deaths among patients with chronic bronchitis and emphysema.  Br Med J (Clin Res Ed). 1984;  289 878
  • 27 Ip M S, Lam B, Ng M M. et al . Obstructive sleep apnea is independently associated with insulin resistance.  Am J Respir Crit Care Med. 2002;  165 670-676
  • 28 Punjabi N M, Shahar E, Redline S. et al . Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study.  Am J Epidemiol. 2004;  160 521-530
  • 29 Vgontzas A N. Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance?.  Arch Physiol Biochem. 2008;  114 211-223
  • 30 Poulain M, Doucet M, Drapeau V. et al . Metabolic and inflammatory profile in obese patients with chronic obstructive pulmonary disease.  Chron Respir Dis. 2008;  5 35-41
  • 31 Mora S, Cook N, Buring J E. et al . Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms.  Circulation. 2007;  116 2110-2118
  • 32 Garcia-Aymerich J, Lange P, Benet M. et al . Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study.  Thorax. 2006;  61 772-778
  • 33 Garcia-Aymerich J, Lange P, Benet M. et al . Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population-based cohort study.  Am J Respir Crit Care Med. 2007;  175 458-463
  • 34 Ainsworth B E, Haskell W L, Whitt M C. et al . Compendium of physical activities: an update of activity codes and MET intensities.  Med Sci Sports Exerc. 2000;  32 498-504
  • 35 Watz H, Waschki B, Meyer T, Magnussen H. Physical activity in patients with chronic obstructive pulmonary disease.  Eur Respir J. 2009;  33 262-272
  • 36 Watz H, Waschki B, Boehme C. et al . Extrapulmonary effects of chronic obstructive pulmonary disease on physical activity: a cross-sectional study.  Am J Respir Crit Care Med. 2008;  177 743-751
  • 37 Langer D. Physical activities in lung transplant candidates.  Eur Respir J. 2006;  Suppl 50 331
  • 38 Le Jemtel T H, Padeletti M, Jelic S. Diagnostic and therapeutic challenges in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure.  J Am Coll Cardiol. 2007;  49 171-180
  • 39 Wouters E F. Chronic obstructive pulmonary disease. 5: systemic effects of COPD.  Thorax. 2002;  57 1067-1070
  • 40 Agusti A G, Sauleda J, Miralles C. et al . Skeletal muscle apoptosis and weight loss in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2002;  166 485-489
  • 41 Richardson R S, Leek B T, Gavin T P. et al . Reduced mechanical efficiency in chronic obstructive pulmonary disease but normal peak VO2 with small muscle mass exercise.  Am J Respir Crit Care Med. 2004;  169 89-96
  • 42 Guttridge D C, Mayo M W, Madrid L V. et al . NF-kappaB-induced loss of MyoD messenger RNA: possible role in muscle decay and cachexia.  Science. 2000;  289 2363-2366
  • 43 Vogiatzis I, Stratakos G, Simoes D C. et al . Effects of rehabilitative exercise on peripheral muscle TNFalpha, IL-6, IGF-I and MyoD expression in patients with COPD.  Thorax. 2007;  62 950-956
  • 44 Vandenbergh E, Van de Woestijne K P, Gyselen A. Weight changes in the terminal stages of chronic obstructive pulmonary disease. Relation to respiratory function and prognosis.  Am Rev Respir Dis. 1967;  95 556-566
  • 45 Landbo C, Prescott E, Lange P. et al . Prognostic value of nutritional status in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1999;  160 1856-1861
  • 46 Donahoe M, Rogers R M, Wilson D O, Pennock B E. Oxygen consumption of the respiratory muscles in normal and in malnourished patients with chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1989;  140 385-391
  • 47 Marquis K, Debigare R, Lacasse Y. et al . Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2002;  166 809-813
  • 48 Bernard S, LeBlanc P, Whittom F. et al . Peripheral muscle weakness in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1998;  158 629-634
  • 49 Pitta F, Troosters T, Spruit M A. et al . Characteristics of physical activities in daily life in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2005;  171 972-977
  • 50 Schols A M, Slangen J, Volovics L, Wouters E F. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1998;  157 1791-1797
  • 51 Schols A M, Wouters E F. Nutritional abnormalities and supplementation in chronic obstructive pulmonary disease.  Clin Chest Med. 2000;  21 753-762
  • 52 Creutzberg E C, Schols A MWJ, Weling-Schepers C APM. et al . Characterization of nonresponse to high caloric oral nutritional therapy in depleted patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2000;  161 745-752
  • 53 Bernard S, Whittom F, LeBlanc P. et al . Aerobic and strength training in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1999;  159 896-901
  • 54 Sala E, Roca J, Marrades R M. et al . Effects of endurance training on skeletal muscle bioenergetics in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1999;  159 1726-1734
  • 55 Schols A M, Soeters P B, Mostert R. et al . Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial.  Am J Respir Crit Care Med. 1995;  152 1268-1274
  • 56 Burdet L, de Muralt B, Schutz Y. et al . Administration of growth hormone to underweight patients with chronic obstructive pulmonary disease. A prospective, randomized, controlled study.  Am J Respir Crit Care Med. 1997;  156 1800-1806
  • 57 Anker S D, John M, Pedersen P U. et al . ESPEN Guidelines on Enteral Nutrition: Cardiology and pulmonology.  Clin Nutr. 2006;  25 311-318
  • 58 Snell N, Newbold P. The clinical utility of biomarkers in asthma and COPD.  Curr Opin Pharmacol. 2008;  8 222-235
  • 59 Sin D D, Man S F. Systemic inflammation and mortality in chronic obstructive pulmonary disease.  Can J Physiol Pharmacol. 2007;  85 141-147
  • 60 Sarir H, Henricks P A, van Houwelingen A H. et al . Cells, mediators and Toll-like receptors in COPD.  Eur J Pharmacol. 2008;  585 346-353
  • 61 Sin D D, Man S F, Marciniuk D D. et al . The effects of fluticasone with or without salmeterol on systemic biomarkers of inflammation in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2008;  177 1207-1214
  • 62 Beeh K M, Kornmann O, Buhl R. et al . Neutrophil chemotactic activity of sputum from patients with COPD: role of interleukin 8 and leukotriene B4.  Chest. 2003;  123 1240-1247
  • 63 D’Silva L, Cook R J, Allen C J. et al . Changing pattern of sputum cell counts during successive exacerbations of airway disease.  Respir Med. 2007;  101 2217-2220
  • 64 Groenewegen K H, Postma D S, Hop W C. et al . Increased systemic inflammation is a risk factor for COPD exacerbations.  Chest. 2008;  133 350-357
  • 65 Traves S L, Culpitt S V, Russell R E. et al . Increased levels of the chemokines GROalpha and MCP-1 in sputum samples from patients with COPD.  Thorax. 2002;  57 590-595
  • 66 Gibson P G, Fujimura M, Niimi A. Eosinophilic bronchitis: clinical manifestations and implications for treatment.  Thorax. 2002;  57 178-182
  • 67 Pizzichini E, Pizzichini M M, Gibson P. et al . Sputum eosinophilia predicts benefit from prednisone in smokers with chronic obstructive bronchitis.  Am J Respir Crit Care Med. 1998;  158 1511-1517
  • 68 Hollander C, Sitkauskiene B, Sakalauskas R. et al . Serum and bronchial lavage fluid concentrations of IL-8, SLPI, sCD14 and sICAM-1 in patients with COPD and asthma.  Respir Med. 2007;  101 1947-1953
  • 69 Gillissen A, Bartling A, Rasche K. Bronchoalveoläre Lavage.  Klinikarzt. 1997;  26 50-56
  • 70 Dalaveris E, Kerenidi T, Katsabeki-Katsafli A. et al . VEGF, TNF-alpha and 8-isoprostane levels in exhaled breath condensate and serum of patients with lung cancer.  Lung Cancer. 2009;  64 219-225
  • 71 Kharitonov S A, Barnes P J. Exhaled biomarkers.  Chest. 2006;  130 1541-1546
  • 72 Nowak D, Kasielski M, Antczak A. et al . Increased content of thiobarbituric acid-reactive substances and hydrogen peroxide in the expired breath condensate of patients with stable chronic obstructive pulmonary disease: no significant effect of cigarette smoking.  Respir Med. 1999;  93 389-396
  • 73 Jorres R A. Modelling the production of nitric oxide within the human airways.  Eur Respir J. 2000;  16 555-560
  • 74 Kharitonov S A, Barnes P J. Clinical aspects of exhaled nitric oxide.  Eur Respir J. 2000;  16 781-792
  • 75 Vestbo J, Anderson W, Coxson H O. et al . Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE).  Eur Respir J. 2008;  31 869-873
  • 76 Donaldson G C, Seemungal T A, Patel I S. et al . Airway and systemic inflammation and decline in lung function in patients with COPD.  Chest. 2005;  128 1995-2004
  • 77 Dahl M, Vestbo J, Lange P. et al . C-reactive protein as a predictor of prognosis in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2007;  175 250-255
  • 78 Wouters E F, Groenewegen K H, Dentener M A, Vernooy J H. Systemic inflammation in chronic obstructive pulmonary disease: the role of exacerbations.  Proc Am Thorac Soc. 2007;  4 626-634
  • 79 Culpitt S V, Maziak W, Loukidis S. et al . Effect of high dose inhaled steroid on cells, cytokines, and proteases in induced sputum in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1999;  160 1635-1639
  • 80 Loppow D, Schleiss M B, Kanniess F. et al . In patients with chronic bronchitis a four week trial with inhaled steroids does not attenuate airway inflammation.  Respir Med. 2001;  95 115-121
  • 81 Barnes N C, Qiu Y S, Pavord I D. et al . Antiinflammatory effects of salmeterol/fluticasone propionate in chronic obstructive lung disease.  Am J Respir Crit Care Med. 2006;  173 736-743
  • 82 Sin D D, Lacy P, York E, Man S F. Effects of fluticasone on systemic markers of inflammation in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2004;  170 760-765
  • 83 Pinto-Plata V M, Mullerova H, Toso J F. et al . C-reactive protein in patients with COPD, control smokers and non-smokers.  Thorax. 2006;  61 23-28
  • 84 Donaldson G C, Seemungal T A, Bhowmik A, Wedzicha J A. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.  Thorax. 2002;  57 847-852
  • 85 Burgel P R, Nesme-Meyer P, Chanez P. et al . Cough and sputum production are associated with frequent exacerbations and hospitalization in COPD.  Chest. 2009;  135 975-982
  • 86 Celli B R, Barnes P J. Exacerbations of chronic obstructive pulmonary disease.  Eur Respir J. 2007;  29 1224-1238
  • 87 Saetta M, di SA , Maestrelli P. et al . Airway eosinophilia in chronic bronchitis during exacerbations.  Am J Respir Crit Care Med. 1994;  150 1646-1652
  • 88 Sethi S. Infectious etiology of acute exacerbations of chronic bronchitis.  Chest. 2000;  117 380S-385S
  • 89 Hurst J R, Perera W R, Wilkinson T M. et al . Systemic and upper and lower airway inflammation at exacerbation of chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2006;  173 71-78
  • 90 Rohde G, Borg I, Wiethege A. et al . Inflammatory response in acute viral exacerbations of COPD.  Infection. 2008;  36 427-433
  • 91 Pinto-Plata V M, Livnat G, Girish M. et al . Systemic cytokines, clinical and physiological changes in patients hospitalized for exacerbation of COPD.  Chest. 2007;  131 37-43
  • 92 Perera W R, Hurst J R, Wilkinson T M. et al . Inflammatory changes, recovery and recurrence at COPD exacerbation.  Eur Respir J. 2007;  29 527-534
  • 93 Bourne S, Fingleton J. Brain natriuretic peptide (BNP) levels during acute exacerbations of COPD – a novel biomarker.  Eur Respir J. 2008;  32 401
  • 94 Tashkin D, Decramer M, Mannino D. et al . Elevated incidence of serious non-respiratory adverse events following COPD exacerbations in clinical trials.  American Journal of Respiratory and Critical Care Medicine. 2008;  177 A132
  • 95 Washko G R, Fan V S, Ramsey S D. et al . The effect of lung volume reduction surgery on chronic obstructive pulmonary disease exacerbations.  Am J Respir Crit Care Med. 2008;  177 164-169
  • 96 Kasahara Y, Tuder R M, Taraseviciene-Stewart L. et al . Inhibition of VEGF receptors causes lung cell apoptosis and emphysema.  J Clin Invest. 2000;  106 1311-1319
  • 97 Kasahara Y, Tuder R M, Cool C D. et al . Endothelial cell death and decreased expression of vascular endothelial growth factor and vascular endothelial growth factor receptor 2 in emphysema.  Am J Respir Crit Care Med. 2001;  163 737-744
  • 98 Crookshank A D, Travaline J M, Ciccolella D E. et al . Endothelial dysfunction in acute exacerbations of COPD and at baseline.  Am J Respir Crit Care Med. 2007;  175 A514
  • 99 Lee S H, Goswami S, Grudo A. et al . Antielastin autoimmunity in tobacco smoking-induced emphysema.  Nat Med. 2007;  13 567-569
  • 100 Frey U, Suki B. Complexity of chronic asthma and chronic obstructive pulmonary disease: implications for risk assessment, and disease progression and control.  Lancet. 2008;  372 1088-1099
  • 101 Mapel D W, Dedrick D, Davis K. Trends and cardiovascular co-morbidities of COPD patients in the Veterans Administration Medical System, 1991 – 1999.  COPD. 2005;  2 35-41
  • 102 Sheifer S E, Rathore S S, Gersh B J. et al . Time to presentation with acute myocardial infarction in the elderly: associations with race, sex, and socioeconomic characteristics.  Circulation. 2000;  102 1651-1656
  • 103 Holguin F, Folch E, Redd S C, Mannino D M. Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001.  Chest. 2005;  128 2005-2011
  • 104 Scharf S M, Iqbal M, Keller C. et al . Hemodynamic characterization of patients with severe emphysema.  Am J Respir Crit Care Med. 2002;  166 314-322
  • 105 Rutten F H, Cramer M J, Zuithoff N P. et al . Comparison of B-type natriuretic peptide assays for identifying heart failure in stable elderly patients with a clinical diagnosis of chronic obstructive pulmonary disease.  Eur J Heart Fail. 2007;  9 651-659
  • 106 Sin D D, Man S F. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease.  Circulation. 2003;  107 1514-1519
  • 107 Zacho J, Tybjaerg-Hansen A, Jensen J S. et al . Genetically elevated C-reactive protein and ischemic vascular disease.  N Engl J Med. 2008;  359 1897-1908
  • 108 Salpeter S R, Ormiston T M, Salpeter E E. Cardiovascular effects of beta-agonists in patients with asthma and COPD: a meta-analysis.  Chest. 2004;  125 2309-2321
  • 109 Lee T A, Pickard A S, Au D H. et al . Risk for death associated with medications for recently diagnosed chronic obstructive pulmonary disease.  Ann Intern Med. 2008;  149 380-390
  • 110 Singh S, Loke Y K, Furberg C D. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.  JAMA. 2008;  300 1439-1450
  • 111 Tashkin D P, Celli B, Senn S. et al . A 4-year trial of tiotropium in chronic obstructive pulmonary disease.  N Engl J Med. 2008;  359 1543-1554
  • 112 Chen J, Radford M J, Wang Y. et al . Effectiveness of beta-blocker therapy after acute myocardial infarction in elderly patients with chronic obstructive pulmonary disease or asthma.  J Am Coll Cardiol. 2001;  37 1950-1956
  • 113 Dransfield M T, Rowe S M, Johnson J E. et al . Use of beta blockers and the risk of death in hospitalised patients with acute exacerbations of COPD.  Thorax. 2008;  63 301-305
  • 114 Mancini G B, Etminan M, Zhang B. et al . Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease.  J Am Coll Cardiol. 2006;  47 2554-2560
  • 115 Sidney S, Sorel M, Quesenberry Jr. C P. et al . COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program.  Chest. 2005;  128 2068-2075
  • 116 Mannino D M, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD.  Eur Respir J. 2008;  32 962-969
  • 117 Ozge C, Ozge A, Yilmaz A. et al . Cranial optic nerve involvements in patients with severe COPD.  Respirology. 2005;  10 666-672
  • 118 Jann S, Gatti A, Crespi S. et al . Peripheral neuropathy in chronic respiratory insufficiency.  J Peripher Nerv Syst. 1998;  3 69-74
  • 119 Di Marco F, Verga M, Reggente M. et al . Anxiety and depression in COPD patients: The roles of gender and disease severity.  Respiratory Medicine. 2008;  100 1767-1774
  • 120 Almagro P, Calbo E, Ochoa d E. et al . Mortality after hospitalization for COPD.  Chest. 2002;  121 1441-1448
  • 121 Gudmundsson G, Gislason T, Lindberg E. et al . Mortality in COPD patients discharged from hospital: the role of treatment and co-morbidity.  Respir Res. 2006;  7 109
  • 122 Lee T A, Shields A E, Vogeli C. et al . Mortality rate in veterans with multiple chronic conditions.  J Gen Intern Med. 2007;  22 Suppl 3 403-407
  • 123 Steinkamp G, Dierkesmann R, Gillissen A. et al . COPD und Psyche – ein Überblick.  Pneumologie. 2005;  59 819-830

Prof. Dr. G. Schultze-Werninghaus

Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH
Medizinische Klinik III – Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin

Bürkle-de-la-Camp-Platz 1
44789 Bochum

eMail: gerhard.schultze-werninghaus@bergmannsheil.de