Acute exacerbation of chronic obstructive pulmonary disease: cardiovascular links

Abstract

Chronic obstructive pulmonary disease (COPD) is a chronic, progressive lung disease resulting from exposure to cigarette smoke, noxious gases, particulate matter, and air pollutants. COPD is exacerbated by acute inflammatory insults such as lung infections (viral and bacterial) and air pollutants which further accelerate the steady decline in lung function. The chronic inflammatory process in the lung contributes to the extrapulmonary manifestations of COPD which are predominantly cardiovascular in nature. Here we review the significant burden of cardiovascular disease in COPD and discuss the clinical and pathological links between acute exacerbations of COPD and cardiovascular disease.

Figures

Figure 1

Presence of an electrocardiogram (ECG) abnormality and length of stay (LOS) of subjects admitted with an AECOPD to St. Paul's Hospital or Mount St. Joseph's Hospital between 2007 and 2008. The presence of ECG abnormalities did not influence LOS (11.7 ± 1.4 versus 13.2 ± 1.5, (a) P = NS). Subjects with ischemic changes on ECG had a longer LOS (11.2 ± 1.0 versus 16.6 ± 3.0, (b) P = 0.031).

Figure 2

Acute inflammatory events in the lungs provoke a cascade of systemic inflammation that starts in the lung, with hematologic spread to other organs, activating the systemic inflammatory response, and thereby promoting the development of atherosclerosis and vascular events.

Figure 3

AECOPD is associated with an acute lung injury initiating the local and systemic inflammatory pathways that cause endothelial injury and vascular dysfunction, a prothrombotic environment, and instability in vascular plaques that may predispose to coronary and cerebrovascular events.