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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
TARGETING PULMONARY (PART I)
Evans R. A
Centre of Exercise and Rehabilitation Science (CERS), NIHR Leicester Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, UK
This review aims to describe the systemic effects and comorbidities associated with chronic obstructive pulmonary disease (COPD) and the role of both pharmacological and non-pharmacological management. Symptoms in COPD do not solely arise from the degree of airflow obstruction, particularly in more advanced disease, as exercise limitation is compounded by the specific secondary manifestations of the disease. These include skeletal muscle dysfunction, osteoporosis, mood disturbance, anemia and hormonal imbalance caused by a combination of physical inactivity leading to deconditioning, systemic inflammation, nutritional abnormalities, hypoxia, and medication. To date the systemic effects are not routinely, objectively assessed in clinical practice and there are few specific pharmacological therapies available. Pulmonary rehabilitation is effective because it improves these secondary manifestations. Comorbidities are common in COPD including cardiac disease, obesity, diabetes and metabolic syndrome. Evaluation is needed to understand how to assess and manage comorbidities, systematically and objectively, in clinical practice. Most pharmacological studies for COPD have excluded patients with significant co-morbidities so further studies are needed to understand the effectiveness and safety of currently available therapies in patients with significant co-morbidities. Care should be taken to manage co-morbid conditions according to current disease-specific guidelines. Many of the co-morbid conditions may also benefit from similar approaches to pulmonary rehabilitation, but whether training strategies need to be adapted is still to be elucidated. How to deliver pulmonary rehabilitation for the patient with multi-morbidity also needs further evaluation. Personalising management by stratifying according to the systemic effects and co-morbidities of COPD may lead to improved clinical outcomes.