Influence of the tobacco smoking factor in the comorbid course of chronic obstructive pulmonary disease and ischemic heart disease
Journal Title: Український терапевтичний журнал - Year 2018, Vol 0, Issue 2
Abstract
Objective — to assess the clinical state, external respiration, structural and functional state of the heart and blood vessels, blood levels of NT-proBNP and factors of the systemic inflammatory response in patients with chronic obstructive pulmonary disease (COPD) with coronary heart disease (CHD), depending on the tobacco smoking factor. Materials and methods. The examinations involved 104 male patients aged 45 to 59 years with a diagnosis of COPD with phenotypes A and B in combination with CHD, postinfarction cardiosclerosis and signs of chronic heart failure (CHF) of the 2nd functional class. Patients were divided into two groups: the first included 29 non-smoking patients, the second sonsisted of 75 smoking patients. All patients were assessed by the tobacco smoking history, a 6-minute walk test, CAT and mMRC questionnaires, spirography, ultrasound investigation of the heart and blood vessels. Blood levels of the C-reactive protein (С-RP), fibrinogen, N-terminal fragment of the medullary natriuretic peptide (NT-proBNP) precursor were determined. Results and discussion. In patients with COPD with concomitant CHD, tobacco smoking was associated with more severe symptoms and severity of dyspnoea (CAT and mMRC questionnaires), worse tolerability of physical activity according to the 6-minute walking test. In the group of smokers, the median vital capacity was 1.26 times lower than in non-smoking patients. The forced vital capacity median in the group of patients with COPD with CHD (II group) was 59.49 % and was 1.18 times statistically significantly lower than in the group of non-smokers (I group) (t = 5.04, p < 0.05). The FEV1 index of smokers was 1.15 times statistically significantly lower than that of non-smokers with COPD with CHD (t = 4.13, p < 0.05). In patients of I group, the PEF index was 1.29 times (t = 6.38, p < 0.05), FEF25 — 1,39 times (t = 8.04, p < 0,01), FEF50 — in 1.45 times (t = 7.84, p < 0.01), FEF75 — 1.45 times (t = 5.73, p < 0.05) were statistically significantly higher than those in smokers (II group). MEF25—75 in II group was statistically significantly lower than in the group of non-smokers (I group) (1.25 times) (t = 5.60, p < 0.05). In the group of non-smokers (I group), the median diastolic sizes of the right (DSRA) and left (DSLA) atriums were 1.19 times and 1.04 times lower respectively than those of smokers (II group), respectively. The median thickness of the right ventricular wall (TW RV) was 1.17 times less in patients of Group I than in patients of II group. The values of median basal (B RV) and longitudinal (L RV) right ventricular size in non-smokers COPD and CHD n = 29) were less than those of smokers, at 1.16 and 1.07 times, respectively. The indicator of right ventricular ejection fraction in non-smokers was 1.11 times higher than that of smokers. In the group of smoking patients, pulmonary hypertension (26.9 % of the total observation group and 37.3 % of the smokers group) was detected in 28 patients. The values of the factors of the systemic inflammatory response in the group of smoking patients were higher than in non-smoking patients, namely: the median C-RP was 1.25 times, the median IL-6 1.6 times, the median FG 1.18 times. The concentration of NT-proBNP in smoking COPD patients with CHD was 1.23 times higher than for non-smokers. Conclusions. In patients with COPD with concomitant CHD, tobacco smoking was associated with worse tolerance to exercise, higher blood concentrations of systemic inflammatory response factors and NT-proBNP (p < 0.05); decrease in volumetric and velocity indices of HPV, more pronounced processes of remodelling of blood vessels and right heart.
Authors and Affiliations
О. M. Kolesnikova, O. O. Krakhmalova
Keywords
Related Articles
- EP ID EP420742
- DOI 10.30978/UTJ2018-2-27
- Views 73
- Downloads 0
Idiopathic inflammatory myopathies: difficulties of diagnosis
The rapid development of basic researches in medicine in the last decade allowed a new approach to the etiopathogenesis of a number of diseases, which, in particular, include inflammatory myopathies. Idiopathic inflammat...
Metabolic disorders in patients with arterial hypertension with concomitant obesity
Objective — further investigation of the pathogenetic triggers of arterial hypertension with concomitant obesity. Materials and methods. Examinations involved 111 patients with arterial hypertension (AH) with concomitant...
Macrophage migration inhibitory factor and acute myocardial infarction
Macrophage migration inhibitory factor (MIF) is a pleiotropic proinflammatory cytokine involved in the development of many acute and chronic inflammatory diseases, including cardiovascular diseases. A link between MIF a...
Acetylsalicylic acid in the cardiological practice: the focus on enterotoxicity
Acetylsalicylic acid (ASA) is one of the most commonly prescribed drugs all over the world. The constant ASA administration results in the considerable side effects, especially associated with the gastrointestinal tract....
Effects of actovegin on the treatment efficacy of patients with gastroesophageal reflux disease with concomitant bronchial asthma
Objective — to study the actovegin effects on the clinical course of comorbid pathology, the quality of life of patients and the state of oxidative stress, that is, the level of aggression and protection factors, against...