الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 2 |  |  |
| | | from | 2 | | |
Abstract
Chronic obstructive pulmonary disease (COPD) is a major burden of morbidity worldwide.
COPD is now considered as a multi-component disease and attention has focused on the role of comorbidities as part of the natural history of the disease process.
Cigarette smoking is the main risk factor for COPD and it is also a risk factor for other major diseases, such as cancer and cardiovascular disease, which are also more common with increasing age.
The most frequent comorbid diseases are cardiac and cerebrovascular diseases, diabetes, hypertension, depression and anxiety, osteoporosis, lung cancer and weight loss. These comorbidities will have an influence on the severity of COPD, and need to be addressed in severity and impact scores for COPD.
Our study was done at chest department of sohag university hospital during the period from March 2013 to February 2014 and included two hundred COPD patients, 68.5% were males and 31.5% were females with mean age 61years.
Regarding smoking among the studied patients 35.5% were current smokers, 35% were ex-smokers and 29.5% were non smokers.
Accoring to body mass index (BMI), 75.5% of COPD patients were normal, 10% were overweight ad 9% were underweight. 51.5% of the patients developed 2 or more excacerbations in the last year.
According to clinical examination, 6% of COPD patients in our study had irregular pulse, 46.5% with central cyanosis,38% with raised jugular venous pressure and 38% with lower limb oedema ,10% with pallor,21.5% with hepatomegaly and 10% with ascites, whereas fever, jaundice and clubbing were less common.
According to laboratory investigations, we found high ESR in 46% of patients, positive CRP in 72%, leukocytosis in 31%, leucopenia in 0.5%, anemia in 10%, polycythemia in 10%, thrombocytopenia in 9.5%, chronic renal failure in 10%, chronic kidney disease in 9%, high blood sugar in 34.5%, dyslipidemia in 23%, prolonged PT and PC in 13%, hypokalemia in 21.5%, hypocalcemia in 15% and hyponatremia in 14.5%.
In our study we found that the pattern of comorbidities in patients with COPD was: hypertension 91 cases(45.5%), diabetes mellitus 69 cases(34.5%), ischemic heart disease 49cases(24.5%), osteopenia 22 cases (11%), anemia 20 cases(10%), weight loss 18 cases (9%), congestive heart failure 17 cases (8.5%), arrhythmias 12 cases(6%), pneumonia 13 cases (6.5%), osteoporosis 11 cases (5.5%), depression 6 cases(3%), lung cancer 3 cases (1.5%), anxiety 3 cases (1.5%) and gastroesophageal reflux 3 cases (1.5%).
52% of the patients presented with 2 or more comorbidites. Also we found that the major symptoms leading patients to seek medical advice were cough with expectoration, exertional dyspnea, wheezes, orthopnea and lower limb swelling.
It was shown that frequent exacerbators presented an increased risk of having at least two comorbidities (51.5%).
In our sudy we found that 48% of COPD patients were stage II, 40.5% were stage III and 11.5% were stage IV according to GOLD criteria.
The majority of comorbidities were more prevalent with the age group 61-70 years. The majority of comorbidities were more prevalent in men.
Conclusion
Nowadays COPD is defined as a preventable and treatable disease with significant extra-pulmonary effects, which contribute to the disease severity in individual patients. Some of these extra-pulmonary effects are at present considered as comorbid conditions.
There is growing attention for causal relationships between one disorder and another or for an underlying vulnerability to different disorders. Better understanding of the role and consequences of systemic inflammation in certain phenotypes of COPD as well as understanding of the chronicity of underlying inflammatory processes will broaden our current approach to COPD as a single disease.
A patient-oriented approach towards the management of COPD needs to take into account that several co-existing components of the chronic disease can contribute to the experienced symptomatology of the patient. Respiratory specialists need to extend their expertise to broader diagnostic and treatment approaches to optimally manage the patient suffering from COPD. This approach certainly will result in a better treatable disease condition and better health for the patient.
COPD is an independent risk factor for cardiovascular disease (CVD).
Knowing that COPD is an independent risk factor for CVD has many repercussions.
A concerted effort to evaluate a patient with symptomatic yet undiagnosed COPD may be essential to determine a patient’s cardiovascular status. Another indication would be to use a preventive medicine approach with a COPD patient making lifestyle choices clearly protective of CVD in their future. Lastly, further investigation of systemic inflammation as a culprit in the cascade of ensuing pathology as an underlying primary factor in both COPD and CVD is warranted.
The search for the most frequent comorbidities of COPD may be instrumental and of great help to improve our understanding of the complexities of the interplay between COPD, and comorbidities, like diabetes, osteoporosis, lung cancer and depression. This will ultimately improve our combat against COPD and its spectrum of major risk factors
from our study we concluded that
• COPD is more common in old aged males, smokers than non smokers.
• The most common clinical presentations are cough with expectoration and exertional dyspnea.
• The most common comorbid conditions associated with COPD are hypertension, diabetes mellitus and ischemic heart disease.
• Pulmonary function tests are the most important diagnostic tool in detecting different stages and severity of COPD.