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COMMENTARY
Year : 2016  |  Volume : 33  |  Issue : 6  |  Page : 678-679  

Obese COPD is associated with higher systemic inflammation – A new COPD phenotype


Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India

Date of Web Publication27-Oct-2016

Correspondence Address:
P A Mahesh
Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-2113.192853

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How to cite this article:
Mahesh P A. Obese COPD is associated with higher systemic inflammation – A new COPD phenotype. Lung India 2016;33:678-9

How to cite this URL:
Mahesh P A. Obese COPD is associated with higher systemic inflammation – A new COPD phenotype. Lung India [serial online] 2016 [cited 2017 Jun 22];33:678-9. Available from: http://www.lungindia.com/text.asp?2016/33/6/678/192853

Chronic obstructive pulmonary disorder (COPD) is the third most common cause of death in the world and fifth in South Asia and ninth on the list of years of life lost.[1],[2] The total mortality due to COPD continues to increase in most parts of the world.[1] The prevalence of COPD is increasing in many parts of the world and a systematic review estimated the prevalence between 6.5 to 7.7% in India.[3]

Biomass smoke exposure [4] and Tobacco smoking are both important risk factors for COPD with 3 billion people in the world exposed to biomass fuels and about 1 billion exposed to tobacco smoke.[5] Biomass exposure leads to COPD with similar symptoms, lung function abnormalities, quality of life scores, exercise capacity and health care utilization similar to COPD secondary to tobacco smoke including similar survival.[6] An elegant study demonstrated that the lung morphology in necropsies of COPD due to biomass fuel exposure or tobacco smoking in women are very similar with minor differences; tobacco smokers had more emphysema and goblet cell metaplasia and biomass fuel exposure led to greater fibrosis and scarring in small airway walls and pigment deposition.[7]

It is believed that systemic inflammation is an important aspect of COPD that is associated with deleterious outcomes. A large study including 1755 COPD patients, 297 smokers without COPD and 202 normal subjects that evaluated 6 important inflammatory mediators (including IL6, IL8, TNF – alpha, fibrinogen, CRP, WBC counts) observed that there were specific phenotypes among COPD patients that was associated with systemic inflammation.[8] An important aspect of this study was a repeat of the levels of inflammatory mediators a second time during the study and a longitudinal follow-up of 3 years. The study revealed important learning points. For similar levels of airflow limitation, there are some patients with COPD who do not have systemic inflammation as evidenced by normal levels of these six inflammatory markers. Patients with systemic inflammation were more likely to be obese and have higher dyspnea scores, poorer quality of Life, higher BODE index, poorer exercise capacity, higher exacerbation rates, higher cardiovascular disease and higher all-cause mortality than COPD patients who did not have systemic inflammation.

Agusti et al in the ECLIPSE study observed that 30% of COPD patients did not have any systemic inflammation both at baseline and on follow-up after one year. These COPD patients had similar levels of airflow limitation as COPD patients with systemic inflammation. Systemic inflammation was observed more commonly in COPD patients who were obese. Non-obese patients without systemic inflammation are therefore likely to be one of the COPD phenotypes with better outcomes. The ECLIPSE study found higher levels of inflammatory markers were associated with poorer exercise capacity as evidenced by the 6-minute walk distance (6MWD), but found higher levels of inflammation in obese COPD patients. Obesity itself is associated with higher levels of inflammatory markers [9],[10] and ECLIPSE study confirmed that BMI is significantly associated with persistent systemic inflammation.

 
   References Top

1.
Burney P, Jarvis D, Perez-Padilla R. The global burden of chronic respiratory disease in adults. Int J Tuberc Lung Dis 2015;19:10-20.  Back to cited text no. 1
    
2.
Gupta D, Agarwal R, Aggarwal AN, Maturu VN, Dhooria S, Prasad KT, et al. Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations. Lung India 2013;30:228-67.  Back to cited text no. 2
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3.
McKay AJ, Mahesh PA, Fordham JZ, Majeed A. Prevalence of COPD in India: A systematic review. Prim Care Respir J 2012;21:313-21.  Back to cited text no. 3
    
4.
Mahesh PA, Jayaraj BS, Prabhakar AK, Chaya SK, Vijaysimha R. Identification of a threshold for biomass exposure index for chronic bronchitis in rural women of Mysore district, Karnataka, India. Indian J Med Res 2013;137:87-94.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Salvi SS, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. Lancet 2009;374(9691):733-43.  Back to cited text no. 5
    
6.
Ramirez-Venegas A, Sansores RH, Perez-Padilla R, Regalado J, Velazquez A, Sanchez C, et al. Survival of patients with chronic obstructive pulmonary disease due to biomass smoke and tobacco. Am J Respir Crit Care Med 2006;173:393-7.  Back to cited text no. 6
    
7.
Rivera RM, Cosio MG, Ghezzo H, Salazar M, Perez-Padilla R. Comparison of lung morphology in COPD secondary to cigarette and biomass smoke. Int J Tuberc Lung Dis 2008;12:972-7.  Back to cited text no. 7
    
8.
Agusti A, Edwards LD, Rennard SI, MacNee W, Tal-Singer R, Miller BE, et al. Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype. PLoS One 2012;7:e37483.  Back to cited text no. 8
    
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Koul PA. Metabolic syndrome and chronic obstructive pulmonary disease. Lung India 2016;33:359-61.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
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Acharyya A, Shahjahan MD, Mesbah FB, Dey SK, Ali L. Association of metabolic syndrome with chronic obstructive pulmonary disease in an Indian population. Lung India 2016;33:385-90.  Back to cited text no. 10
[PUBMED]  Medknow Journal  




 

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