Chronic Obstructive Pulmonary Disease (COPD): Complications

The following are the major diseases or complications that may be contributed to by chronic obstructive pulmonary disease (COPD):

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Malnutrition (malnutrition)

Respiratory system (J00-J99)

  • Acute exacerbations of infection
  • Bronchiectasis (synonym: bronchiectasis) – persistent irreversible saccular or cylindrical dilatation of the bronchi (medium-sized airways) that may be congenital or acquired; symptoms: chronic cough with “mouthful expectoration” (large-volume triple-layered sputum: foam, mucus, and pus), fatigue, weight loss, and decreased exercise capacity
  • Pulmonary failure
  • Pneumonia (inflammation of the lungs)
  • Pneumothorax, secondary – collapse of the lung caused by an accumulation of air between the visceral pleura and the parietal pleura.
  • Respiratory insufficiency (failure of external (mechanical) respiration).
  • Recurrent infections – acute bronchitis.

Blood, blood-forming organs – immune system (D50-D90).

  • Secondary polyglobulia (isolated increased erythrocyte (red blood cell) count with normal plasma volume).

Cardiovascular system (I00-I99)

  • Apoplexy* (stroke)
  • Cor pulmonale – lung-related increase in pressure and enlargement of the right heart.
  • Heart failure (cardiac insufficiency)
  • Coronary artery disease (CAD; coronary artery disease).
  • Pulmonary embolism after acute exacerbation (acute worsening) of COPD (AECOPD) (about 16% of cases)Symptomatology: pleuritic pain; signs of heart failure (cardiac insufficiency) such as hypotension (low blood pressure), syncope (momentary loss of consciousness), and echocardiographic evidence of acute right heart failure (right ventricular insufficiency).
  • Myocardial infarction* (heart attack) (2.7-fold increase).
    • Note: The Global Registry of Acute Coronary Events (GRACE) score, which takes into account information on age, heart rate, systolic blood pressure, presence of heart failure, diuretic prescriptions, creatinine level, ST-segment deviation, any cardiac arrest suffered, and troponin elevation, systematically underestimates mortality (mortality) in patients with COPD after myocardial infarction:The calculation is Internet-based.
  • Peripheral arterial occlusive disease (pAVD) – progressive narrowing or occlusion of the arteries supplying the arms/ (more commonly) legs, usually due to atherosclerosis (arteriosclerosis, hardening of the arteries).
  • Sudden cardiac death (PHT; double the risk compared to people without COPD); possibly CHD-independent, also the risk of life-threatening cardiac arrhythmias should be increased
  • Pulmonary hypertension (pulmonary hypertension), mild form.
  • Right heart failure (right heart failure).
  • Atrial fibrillation (VHF)

Musculoskeletal system and connective tissue (M00-M99)

  • Osteoporosis – causative involvement:
    • Inhaled glucocorticosteroids (daily dose > 500 µg).
    • TNF-alpha (tumor necrosis factor) as well as other cytokines that accelerate bone resorption; prevalence (disease frequency) about 35%.
  • Sarcopenia (muscle weakness or muscle degradation) – with COPD is accompanied by chronic inflammation (inflammation), which causes catabolism (destruction of body substance), which leads to a reduction in muscle mass.

Neoplasms – tumor diseases (C00-D48).

Psyche – nervous system (F00-F99; G00-G99)

  • Anxiety disorders
  • Dementia (1.4-fold increased risk of dementia)
  • Depression
  • Insomnia (sleep disorders: Trouble sleeping through the night with reduction in sleep efficiency and increased daytime sleepiness).
  • Mild cognitive impairment (LKB; also mild cognitive impairment; English : Mild cognitive impairment, MCI).

Symptoms and abnormal clinical and laboratory parameters not elsewhere classified (R00-R99).

  • Chronic inflammation (inflammation) or systemic inflammation.
  • Cachexia (emaciation; very severe emaciation), pulmonary (lung-related).

Injuries, poisonings, and certain other sequelae of external causes (S00-T98).

  • Fractures (broken bones) caused by
    • Inhaled glucocorticoids (incidence of 15.2 fractures per 1,000 person-years).
    • Osteoporosis

* Most common cause of death in COPD patients (6-year follow-up).

Prognostic factors

  • COPD patients on antipsychotics have an increased risk of acute respiratory failure, increasing by half to four times depending on the dose. The authors’ findings make a life-threatening respiratory effect of antipsychotics likely.
  • Frequency and severity of exacerbations depend on GOLD stage.
  • The ECLIPSE study demonstrated that a phenotype with a primary propensity for frequent exacerbations exists that is independent of GOLD severity of COPD. Predictors were:
  • COPD and sleep apnea (overlap patients) – increased morbidity (disease incidence) and mortality (mortality).
  • Laboratory parameters/measurements associated with increased mortality risk (risk of death):
    • Troponin I ↑
    • “time-updated heart rate“: increase in heart rate over time.

Risk score for bronchial carcinoma.

Parameter Score
Age > 60 years 3
BMI (body mass index) < 25 kg/m2 1
Inhaled cigarette smoking > 60 pack-years 2
Radiologic evidence of pulmonary emphysema ( irreversible hyperinflation of the smallest air-filled structures (alveoli, alveoli) of the lungs) 4

Interpretation

  • 0-6 score points: low risk
  • 7-10 score points: high risk (3.5 times higher than in the first group)