Научная статья на тему 'COPD: the impact of comorbid cardiovascular disease on the level of fractional exhaled nitric oxide'

COPD: the impact of comorbid cardiovascular disease on the level of fractional exhaled nitric oxide Текст научной статьи по специальности «Клиническая медицина»

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Ключевые слова
chronic obstructive pulmonary disease / coronary heart disease / fractional exhaled nitric oxide

Аннотация научной статьи по клинической медицине, автор научной работы — T. A. Pertseva, Ye. Yu. Gashinova, Ye. Ye. Bogatskaya, M. A. Krykhtina

At present, comorbid cardiovascular disease, especially coronary heart disease (CHD), becomes increasingly common in patients with chronic obstructive pulmonary disease (COPD). These nosologies are characterized by some similar symptoms, therefore, if patient has both diseases it is not always possible to determine the cause of health deterioration. Thus, it is relevant for physicians to search for a specific marker that would allow the differentiation of the condition’s data. In this context, determining the level of fractional exhaled nitric oxide (FeNO) is quite promising. The aim of our study was to investigate the effect of CVD on FeNO levels and the possibility of using this indicator as a specific marker of COPD exacerbation. During the study, patients were divided into groups depending on the phase of COPD, as well as the presence of cardiovascular disease (CVD). Spirometry was performed in all patients, as well as the determination of FeNO level in exhaled air. It has been found that the presence of cardiovascular diseases does not affect FeNO level in exhaled air in patients without bronchial obstruction, as well as in patients with COPD, regardless of phase. FeNO level in exhaled air was significantly higher in patients with COPD in exacerbation phase, regardless of the presence or absence of concomitant CVD as compared to COPD in remission, patients with cardiac disorders, and healthy people.

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Текст научной работы на тему «COPD: the impact of comorbid cardiovascular disease on the level of fractional exhaled nitric oxide»

На следующем этапе всем пациентам проводилось измерение ФИО в выдыхаемом воздухе. Анализируя полученные данные, мы выявили, что у пациентов с ХОЗЛ вне обострения, не зависимо от наличия ССЗ (Группа 1А и 1Б) результаты достоверно не отличались как от пациентов без легочной патологии, но с ССЗ (Группа 3) так и от здоровых добровольцев

(Группа 4). В то время, как у пациентов с ХОЗЛ в период обострения (Группа 2А и 2Б) показатели N0 в выдыхаемом воздухе были достоверно выше, в сравнении со здоровыми, с пациентами, страдающими ССЗ, а так же с больными ХОЗЛ в период ремиссии (рис.1, табл.2).

100

80

60

40

20

□ Median 25%-75%

Группа 1А Группа 2 А Группа 3 I Min-Max

Группас 2Б Группа 1Б Группа 4

Рис. 1. Уровень NO в выдыхаемом воздухе в группах

Таблица 2

Уровень достоверности различия р между группами и подгруппами при измерении ФNO

Pia-ib=0,114 P ia-4=0,400 P 1 b-4 =0,070 Р2б-3=0,006

Pia-2a=0,001 Pi б-2а =0,000 P 2а-2б=0,090 Р2б-4=0,028

P 1а-2б =0,001 P 1б-2б =0,000 P 2a-3=0,002 P 3-4=0,750

P ia-3=0,460 P 1б-3 =0,050 P 2a-4=0,01 0

Выводы

1. Кардиоваскулярная патология не влияет на уровень ФИО в выдыхаемом воздухе как у пациентов без бронхообструкции, так и при ХОЗЛ независимо от фазы заболевания.

2. При обострении ХОЗЛ, независимо от наличия или отсутствия сопутствующих заболеваний сердечно-сосудистой системы, уровень N0 в выдыхаемом воздухе достоверно выше по сравнению со здоровыми людьми и пациентами с ХОЗЛ в фазе ремиссии а также пациентами с кардиальной патологией.

Литература

1. Авдеев С.Н. ХОБЛ и сердечно-сосудистые заболевания: механизмы ассоциации [Текст] / С.Н. Авдеев, Г.Е. Байманакова // Пульмонология. - 2008. - № 1. - С. 5-13.

2. Авдеев С.Н. Стратегия ведения кардиологического пациента, страдающего ХОБЛ. Кардио-пульмональные взаимоотношения [Текст] / С.Н. Авдеев// Сердце 2008.-Т.6, №6. С.305-308.

3. Агеев Ф.Т. Эндотелиальная дисфункция как причина атеросклеротического поражения артерий при артериальной гипертензии. Методы коррекции [Текст] / Ю.Б. Белоусов Намсараев Ж.Н. // Кардиология. - 2001. - Т. 41, № 5. - С. 100-104.

4. Билецкий С. В. Эндотелиальная дисфункция и патология сердечно-сосудистой системы [Текст]. / С.В. Би-

10.

лецкий, С.С. Билецкий // Внутренняя медицина. - 2008. - № 2 (8). - С. 36-41.

Винниченко Л. Б. Особливост переб^ хрожчно!' серцево''' недостатност на mi iшемiчноï хвороби серця у хворих на хроычне обструктивне захворювання ле-гень [Текст]. / Л. Б. Винниченко, Т. М. Головко, Р. В Безсмертна // Журнал шычних та експериментальних медичних дослщжень - 2013 - 1 (2). - С.8. Перцева Т. А. Эпидемиология и диагностика хронического обструктивного заболевания легких [Текст]. / Т. А. Перцева// Укра'нський пульмонолопчний журнал. -2011. - № 2. - С. 20.

. Hawkins N.M. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology / N .M. Hawkins, M. C. Petrie, P. S. Jhund et al. // Europ. J. Heart Failure. - 2009. - Vol. 11. - P. 130-139. Mannino D. M. Prevalence and outcomes of diabetes, hypertension, and cardiovascular disease in COPD / D. M. Mannino, D. Thorn, A. Swensen, F. Holguin // The European respiratory journal. - 2008. - Vol. 32, № 4. - P. 962969.

Malerba M. Exhaled Nitric Oxide as a Biomarker in COPD and Related Comorbidities / A.Radaeli, A.Olivini, G. Damiani, B. Ragnoli, P. Montuschi // BioMed Research International - 2014 - P.7.

Sin D.D. Mortality in COPD: role of comorbidities / D.D. Sin, N. R Anthonisen, J. B. Soriano, A. G. Agusti// Eur Respir J. - 2006. - 28: 1245-1257.

0

ENGLISH VERSION: COPD: THE IMPACT OF COMORBID CARDIOVASCULAR DISEASE ON THE LEVEL OF FRACTIONAL EXHALED NITRIC OXIDE*

T.A. Pertseva, Ye.Yu. Gashinova, Ye. Ye. Bogatskaya, M.A. Krykhtina SE "Dnepropetrovsk Medical Academy of Ministry of Public Health of Ukraine"

At present, comorbid cardiovascular disease, especially coronary heart disease (CHD), becomes increasingly common in patients with chronic obstructive pulmonary disease (COPD). These nosologies are characterized by some similar symptoms, therefore, if patient has both diseases it is not always possible to determine the cause of health deterioration. Thus, it is relevant for physicians to search for a specific marker that would allow the differentiation of the condition's data. In this context, determining the level of fractional exhaled nitric oxide (FeNO) is quite promising. The aim of our study was to investigate the effect of CVD on FeNO levels and the possibiity of using this indicator as a specific marker of COPD exacerbation. During the study, patients were divided into groups depending on the phase of COPD, as well as the presence of cardiovascular disease (CVD). Sprrometry was performed in all patients, as well as the determination of FeNO level in exhaled air. It has been found that the presence of cardiovascular diseases does not affect FeNO level in exhaled arr in patients without bronchial obstruction, as well as in patients with COPD, regardless of phase. FeNO level in exhaled arr was significantly higher in patients with COPD in exacerbation phase, regardless of the presence or absence of concomitant CVD as compared to COPD in remission, patients with cardiac disorders, and healthy people.

Key words: chronic obstructive pulmonary disease, coronary heart disease, fractional exhaled nitric oxide.

Relevance of the research.

Chronic obstructive pulmonary disease (COPD), as well as coronary heart disease (CHD), constitutes a relevant medical and social problem due to the high levels of morbidity, disability and mortality worldwide [1,2]. Epidemiological studies, conducted in 2006-2007 by D. M. Mannino and co-authors have shown that most patients with COPD die due to cardiovascular causes (25% of cases) [8].

Epidemiological and clinical studies of the last decade have observed an increase in the number of COPD combined with coronary artery disease [6,7]. The combination of cardiac and pulmonary disease is considered to be prognostically unfavorable due to mutually exacerbating course of the disease [1,10].

Moreover, analysis of the causes of hospital admissions of patients with COPD, conducted on the basis of the results from major research Lung Health Study has shown that in 42% of cases the basic admission causes in COPD are cardiovascular events while the respiratory complications account for only 14% [7].

Taking into account the presence of some common risk factors in patients with CHD and COPD (smoking, atherosclerosis of the arteries due to immune inflammation, possibly induced by bacteria, viruses and pollutants) [1,9], one can assume that these diseases have mutually potentiating impact on microvascular endothelium, causing changes in its reactivity. Nitrogen oxide (NO) is one of the indicators in favour of endothelial dysfunction.

On the one hand, NO in exhaled air (FeNO) serves as a marker of local inflammation of airway and can be used for early detection of COPD exacerbation. On the other hand, it is an accepted fact that NO increases in plasma due to endothelial dysfunction intrinsic to cardiac disease [3,4].

COPD and CHD are characterized by some similar symptoms (shortness of breath, decreased exercise tol-

erance), so if a patient has both diseases it is not always possible to determine the cause of health deterioration. Therefore, it is relevant for physicians to search for a specific marker that would allow the differentiation of the condition's data. In this context, determining the level of nitric oxide in exhaled air (FeNO - fractional exhaled nitric oxide) is quite promising. However, the question of whether this is merely a marker indicative of the presence of pulmonary disease, or whether it changes under the influence of concomitant cardiovascular disease (CVD) remains debated.

Materials and methods of the research:

The study involved 60 patients with verified diagnosis of COPD. Group 1 consisted of 37 patients in remission, group 2 included 23 people in exacerbation stage. The presence, severity of obstruction and group of COPD, as well as the phase of the pathological process, was established in accordance with the criteria of the order of the Ministry of Public Health of Ukraine No 555 as of 27.06.2013 [2]. All patients received standard treatment depending on the stage of the disease and the group.

11 healthy volunteers, never-smokers, with normal respiratory function (NRF) were included in the control group 3. Comparison group 4 consisted of 7 patients with confirmed cardiovascular disease, not suffering from COPD.

In the course of research, the patients were divided into subgroups based on the presence of cardiovascular disease: subgroup 1A consisted of COPD patients in remission without CVD; subgroup 1B included patients with COPD who suffer from cardiac pathology; subgroup 2A -patients with COPD in exacerbation who do not have the history of cardiovascular disease; subgroup 2B - patients with COPD in exacerbation, with cardiovascular diseases.

In order to verify the diagnosis of COPD, in all patients the respiratory function (RF) was determined using

* To cite this English version: T.A. Pertseva, Ye.Yu. Gashinova, Ye. Ye. Bogatskaya, M.A. Krykhtina. COPD: The impact of comorbid cardiovascular disease on the level of fractional exhaled nitric oxide // Problemy ekologii ta medytsyny. - 2015. - Vol 19, № 3-4. - P. 52-54.

npoSAeMH eKOAorii Ta MeanuHHH

spirograph "Masterlab" (Jaeger, Germany): the levels of forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), ratio of FEV1 / FVC were analyzed; test for reversibility of airflow obstruction with short-acting p2-agonist (salbutamol) was conducted. Assessment of the degree of obstruction was performed by post-bronchodilatatory test (as recommended by GOLD, 2013).

With regard to CVD, the study included patients with previously verified chronic ischemic heart disease and / or hypertensive disease.

FeNO concentration was determined using "Niox Mino" device (Aerocrine, Sweden).

All patients were surveyed by mMRC scale for dyspnea assessment.

"Statistics 6.1" was used for statistical processing of the results. For adequately distributed variables, methods of parametric statistics with calculation of the mean values, standard deviation (M ± m) and Student's t test were

At the next stage, all patients underwent measurement of FeNO in exhaled air. Analyzing the data, we found that in patients with non-acute chronic obstructive pulmonary disease, regardless of the presence of cardiovascular disease (1A and 1B group) results were not significantly different from patients without lung disease, but with cardiovascular disease (Group 3) and from healthy

used. For inadequately distributed variables, methods of nonparametric statistics with the definition of the median and quartiles Med [25%-75%], Mann-Whitney or Kruskal-Wallis test for the significance of differences were used. Reliably significant results were considered at p<0.05. The significance of differences in quality and binary parameters was assessed using the chi-square (x2) for n<5 - using the Fisher's exact test for frequencies. Besides, the correlation analysis of FeNO levels and indicators of FVD using Spearman's test (R) was conducted.

Results and their discussion

Patients of the control group, as well as the comparison group were matched for age, sex, weight, BMI (p>0.05). Groups of patients with COPD also did not differ significantly in the number of smokers, the index of pack / years duration of the disease (p> 0.05) (Table 1).

Table 1

Characteristics of the comparison groups

volunteers (group 4). Meanwhile, in patients with COPD in exacerbation (2A and 2B group) NO indicators in exhaled air were significantly higher as compared to healthy patients suffering from cardiovascular disease, as well as with patients with chronic obstructive pulmonary disease in remission (Fig. 1, Table 2).

Index, units Group 1 Group 2 Group 3, n=7 Group 4, n=11

1 A, n=16 1B, n=21 2A,n=13 2B, n=10

Sex, n (%) m=13; (81.3) f =3; (18.7) m=18; (85.7) f =3; (14.3) m =11; (84.6) f =2; (15.4) m =10; (100) f =0; m =6; (85.7) f =1; (14.3) m =10; (90.9) f=1; (9.1)

Age Med [25%-75%], years 62.0 [54.5-70.0] 65.0 [55.0-78.0] 62.0 [56.0-66.0] 73.0 [66.0-74.0] 64.0-[62.0-70.0] 59.0 [57.0-64.0]

Weight Med [25%-75%], kg 74.0 [68.5-85.5] 82.0 [74.0-90.0] 72.0 [60.0-80.0] 88.0 [72.0-95.0] 86.0 [79.0-92.0] 79.0 [75.0-84.0]

BMI Med [25%-75%], kg/m2 27.0 [22.0-30,0] 28,0 [24,0-31,0] 24,0[21,0-26,0] 28,0 [23,0-33,0] 28,5 [25,0-33,5] 26,5[22,5-28,0]

Number of smokers, n (%) n=7 (43) n=8 (38) n=5 (38) n=3 (30) n=5 (45) n=0

Pack / years index 29.5 [23.0-35.0] 40.5 [15.0-70.0] 38.0 [30.0-41.0] 26.0 [15.0-45.0] 23.5 [12.5-38.0] 25.0 [15.0-45.5]

Duration of the disease Med [25%-75%], years 5.0 [3.5-9.0] 5.0 [3.0-10.0] 6.0 [3.0-10.0] 3.5 [3.0-10.0]

Forced expiratory volume Med [2575%] % 59.7 [43.4-74.2] 48.9 [36.3-53.7] 43.0 [32.0-47.0] 40.0 [33.0-58.0] 89.9 [88.7-102.5] 97.0 [90.0-100.0]

Fig. 1. NO level in the exhaled air in groups

Table 2

The confidence level of p differences between groups and subgroups in the measurement of FeNO

P1a-1b=0.114 P 1A-4=0.400 P 1b-4 =0.070 P2B-3=0.006

P1a-2b =0.001 P1b-2A =0.000 P 2a-2b=0.090 P2B-4=0.028

P 1a-2b =0.001 P 1b-2b =0.000 P 2a-3=0.002 P 3-4=0.750

P 1a-3=0.460 P 1b-3 =0.050 P 2A-4=0.010

Conclusions:

1. Cardiovascular pathology does not affect FeNO level in exhaled air in patients without bronchial obstruction, as well as in patients with COPD, regardless of phase.

2. During exacerbation of COPD, regardless of the presence or absence of concomitant diseases of the cardiovascular system, NO level in exhaled air was significantly higher as compared to healthy people and patients with chronic obstructive pulmonary disease in remission, as well as patients with cardiac disease.

References

1. Avdeyev S.N. KHOBL i serdechno-sosudistyye zabole-vaniya: mekhanizmy assotsiatsii [Tekst] / S.N. Avdeyev, G.Ye. Baymanakova // Pul'monologiya. - 2008. - № 1. - S. 5-13.

2. Avdeyev S.N. Strategiya vedeniya kardiologicheskogo patsiyenta, stradayushchego KHOBL. Kardio-pul'monal'nyye vzaimootnosheniya [Tekst] / S.N. Avd-eyev// Serdtse 2008.- T.6, №6. S.305-308.

3. Ageyev F.T. Endotelial'naya disfunktsiya kak prichina ateroskleroticheskogo porazheniya arteriy pri arterial'noy gipertenzii. Metody korrektsii [Tekst] / YU.B. Belousov Namsarayev ZH.N. // Kardiologiya. - 2001. - T. 41, № 5. -S. 100-104.

4. Biletskiy S.V. Endotelial'naya disfunktsiya i patologiya ser-dechno-sosudistoy sistemy [Tekst]. / S.V. Biletskiy, S.S.

1 0.

Biletskiy // Vnutrennyaya meditsina. - 2008. - № 2 (8). -S. 36-41.

Vynnychenko L. B. Osoblyvosti perebihu khronichnoyi sertsevoyi nedostatnosti na tli ishemichnoyi khvoroby sert-sya u khvorykh na khronichne obstruktyvne zakhvoryu-vannya lehenD [Tekst]. / L. B. Vynnychenko, T. M. Holovko, R. V Bezsmertna // Zhurnal klinichnykh ta eksperymentalDnykh medychnykh doslidzhenD - 2013 -1 (2). - S.8.

Pertseva T. A. Epidemiologiya i diagnostika khronicheskogo obstruktivnogo zabolevaniya legkikh [Tekst]. / T. A. Pertseva// Ukrains'kiy pul'monologichniy zhurnal. - 2011. - № 2. - S. 20.

Hawkins N.M. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology / N .M. Hawkins, M. C. Petrie, P. S. Jhund et al. // Europ. J. Heart Failure. - 2009. - Vol. 11. - P. 130-139. Mannino D. M. Prevalence and outcomes of diabetes, hypertension, and cardiovascular disease in COPD / D. M. Mannino, D. Thorn, A. Swensen, F. Holguin // The European respiratory journal. - 2008. - Vol. 32, № 4. - P. 962969.

Malerba M. Exhaled Nitric Oxide as a Biomarker in COPD and Related Comorbidities / A.Radaeli, A.Olivini, G. Damiani, B. Ragnoli, P. Montuschi // BioMed Research International - 2014 - P.7.

Sin D.D. Mortality in COPD: role of comorbidities / D.D. Sin, N. R Anthonisen, J. B. Soriano, A. G. Agusti// Eur Respir J. - 2006. - 28: 1245-1257.

MaTepian HagiMnoB go pegamii29.01.2016

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