Current opinion in pulmonary medicine
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Chronic obstructive pulmonary disease (COPD) is characterized by an abnormal persistent inflammatory response to noxious environmental stimuli, particularly cigarette smoke. The determinants of the dysregulated immune responses, which play a role both in the onset and continuation of COPD, are largely unknown. We examined several molecular mechanisms regulating the inflammatory pathway, such as cytokine polymorphisms, miRNA expression, and DNA methylation in COPD and aging, with the aim to provide evidence supporting the view that aging of the immune system may predispose to COPD. ⋯ COPD and aging are associated with significant dysregulation of the immune system that leads to a chronic inflammatory response. The similar molecular mechanisms and the common genetic signature shared by COPD and aging suggest that immunosenescence may contribute to the development of COPD.
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Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronic diseases among older persons worldwide and the rapid increase in commonly associated COPD-disabilities requires urgent awareness among healthcare professionals. The presence of pulmonary and extrapulmonary comorbidities is highly prevalent among COPD patients and complicates treatment management, especially in advanced age. Some of the most common geriatric conditions in COPD patients lead to respiratory function decline, physical function impairment with limited physical performance, cognitive decline, and depression. Unfortunately, the activation of each component may lead to the progression of the other, which, if not corrected, will lead to critical clinical outcomes such as disability (as seen by the worsening of each condition) and death. ⋯ As disability is a growing phenomenon in COPD and substantially impacts patient perception of the disease, we will highlight the recent literature regarding the importance of common geriatric conditions leading to disability in older COPD patients. In particular, we will discuss the impact of the following conditions in older patients with COPD: respiratory function decline, physical function impairment, and mood disorders. Clinical use for measuring such parameters in COPD elderly will aid in identifying those at risk for severe clinical decline.
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Defining the nature of the association between chronic obstructive pulmonary disease (COPD) and other chronic conditions is of primary importance to improve the health status of COPD patients through the optimal care of comorbidities. We aimed at providing a reasoned guide to understand, recognize and treat comorbidity of COPD with the perspective of shifting from comorbidity to multimorbidity. ⋯ Evidence suggests that systemic inflammation may be the link between COPD and comorbidities, but this issue is still debated. Whatever the mechanism underlying comorbidities in COPD may be, it has an important clinical, prognostic and therapeutic impact. Nevertheless, clinical practice guidelines do not take into account comorbidities in their recommendations. Additionally, clinical trials investigating COPD treatment in the context of multimorbidity and considering geriatric outcomes are also distinctly lacking.