Multisystemic manifestations of chronic obstructive pulmonary disease

Kronična opstruktivna plućna bolest (KOPB) heterogena je bolest karakterizirana kroničnim respiratornim simptomima, abnormalnošću dišnih putova i/ili alveola te trajnom, često progresivnom opstrukcijom protoku zraka s periodičkim akutnim epizodama pogoršanja. Zbog visoke prevalencije i rastuće incidencije, ona danas predstavlja jedan od glavnih javnozdravstvenih problema. Patofiziološki se radi o kroničnoj upali dišnih puteva i plućnog parenhima uz nisku razinu kronične sustavne upale. KOPB nije bolest koja zahvaća isključivo pluća, već je često udružena s drugim bolestima i stanjima koja imaju utjecaj na kvalitetu života bolesnika, tijek osnovne bolesti, kliničku sliku, prognozu i preživljenje. Prisutnost komorbiditeta povečava učestalost hospitalizacija, produžuje oporavak, a time i duljinu hospitalizacije. Najčešći komorbiditeti koji se povezuju s KOPB-om su kardiovaskularne bolesti, bronhiektazije, karcinom pluća, anemija, metabolički sindrom, dijabetes tip 2, osteoporoza, atrofija skeletnog mišićnog sustava, pothranjenost, pretilost, opstruktivna apneja u spavanju, gastroezofagealni refluks, depresija i anksiozni poremećaji. Povezanost ovih bolesti s KOPB-om objašnjava se postojanjem istih ili sličnih zajedničkih čimbenika rizika, kroničnom sustavnom upalom, oksidativnim stresom, kroničnom hipoksijom. Uz to, neki komorbiditeti mogu biti uzrokovani ili pogoršani terapijskim intervencijama, posebno uporabom kortikosteroida. Ukupni dijagnostički i terapijski pristup bolesniku s KOPB-om treba uključivati identifikaciju, dijagnostiku i liječenje svih sustavnih manifestacija bolesti. Procjenjuje se da su komorbiditeti odgovorni za približno 60% smrtnosti u KOPB-u, što dodatno naglašava važnost njihove adekvatne dijagnoze i zbrinjavanja. U većini slučajeva, komorbiditeti ne utječu na metode liječenja te se terapija provodi po standardnim smjernicama i protokolima. U nekim je slučajevima, ipak potrebno prilagoditi pojedine komponente i poduzeti određene mjere opreza da ne bi došlo do dodatnih komplikacija.Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterized by chronic respiratory symptoms, abnormalities in the airways and/or alveoli, and persistent, often progressive airflow obstruction with periodic acute exacerbations. Due to its high prevalence and increasing incidence, it is now one of the major public health problems. Pathophysiologically, it involves chronic inflammation of the airways and lung parenchyma with a low level of chronic systemic inflammation. COPD is not solely a lung disease; it is often associated with other diseases and conditions that impact the quality of life of patients, the course of the underlying disease, clinical presentation, prognosis, and survival. The presence of comorbidities increases the frequency of hospitalizations, prolongs recovery, and therefore, the length of hospital stay. The most common comorbidities associated with COPD are cardiovascular diseases, bronchiectasis, lung cancer, anemia, metabolic syndrome, type 2 diabetes, osteoporosis, skeletal muscle atrophy, malnutrition, obesity, obstructive sleep apnea, gastroesophageal reflux, depression, and anxiety disorders. The association of these diseases with COPD can be explained by the presence of shared or similar risk factors, chronic systemic inflammation, oxidative stress, and chronic hypoxia. In addition, some comorbidities may be caused or worsened by therapeutic interventions, especially the use of corticosteroids. The overall diagnostic and therapeutic approach to patients with COPD should include the identification, diagnosis, and treatment of all systemic manifestations of the disease. Comorbidities are estimated to be responsible for approximately 60% of mortality in COPD, further emphasizing the importance of their adequate diagnosis and management. In most cases, comorbidities do not affect the treatment methods, and therapy is carried out according to standard guidelines and protocols. However, in some cases, it may be necessary to adjust certain components and take precautions to avoid additional complications