malattie respiratorie e fattori di rischio cardiovascolare malattie respiratorie e... · bpco e...
TRANSCRIPT
Malattie respiratorie e fattori di rischio cardiovascolare
Dr. Alessandro Grembiale
ULSS 10 Veneto Orientale P.O. San Donà di Piave
UOC Medicina Generale
BPCO e mortalità
COPD is a worldwide epidemic COPD is the fourth leading cause of death in the world Its prevalence ranges between 6% and 19,7%
Mortality rates for COPD have jumped by > 163%, and will increase by 50% in the next 15 years
World Health Report. Geneva: World Health Organization. Available from URL: http://www.who.int/whr/2000/en/ statistics.htm; 2000. Lopez AD, et al. “Chronic obstructive pulmonary disease: current burden and future projections.”, Eur Respir J. 2006 Feb;27(2):397-412.
Vestbo J, et al. “Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary”, Am J Respir Crit Care Med. 2013 Feb 15;187(4):347-65. doi: 10.1164/rccm.201204-0596PP. Epub 2012 Aug 9.Review. PubMed PMID: 22878278. – Update 2015
Multimorbidità
Multi
morbidità
Infiammazione sistemica Aging
Politerapia
Interazioni farmacologiche
Fattori di rischio
Tabagismo
Multimorbidità
• Condivisione di meccanismi fisiopatologici
• Fenotipizzazione
• Impatto sulle risorse sanitarie
• Mortalità
Classificazione Multimorbidità
Approccio clinico patologico Respiratorio Asma, polmonite, fibrosi polmonare, embolia polmonare, OSAS
Cardiovascolari Ipertensione arteriosa, cardiopatia ischemica, ictus, scompenso cardiaco
Metaboliche Sindrome metabolica, diabete, dislipidemia, obesità
Oncologiche K polmone, K esofago, K mammella
Condivisione del meccanismo patologico Infiammazione Asma, polmonite, cardiopatia ischemica, ipertensione , sindrome
metabolica
Necrosi/ degenerazione
Malattie cardiovascolari, osteoporosi, MRGE
Metaboliche Sindrome metabolica, diabete, dislipidemia
Riparazione/ proliferazione cellulare
K polmone, K esofago, K mammella, disfunzione muscolo scheletrica,
Trombosi/ emorragia
Embolia polmonare, malattie cerebrovascolari.
BPCO, Ipertensione arteriosa e Diabete
STUDIO ETA’ PAZIENTE DIABETE MELLITO TIPO 2 (%)
IPERTENSIONE ARTERIOSA (%)
MAPEL 67 12 45
VAN MANEN 66 5 23
WALSH 16 52
MANNINO 57 13 40
Prevalenza malattie cardiovascolari e Diabete (studio ARNO)
CVD
Diabete
BPCO, Ipertensione arteriosa e Diabete
Coorti ARIC (Atherosclerosis Risk in Communities Study) e
CHS (Cardiovascular Health Study)
Età Diabete Mellito (%) Ipertensione arteriosa (%)
45-49 8 24
50- 54 10,6 32
55-59 12,9 38,1
60-64 16,5 46,4
65-71 16,2 49,9
72-75 13,9 51,3
76-79 15,9 58
>80 15,4 62
D.M. Mannino Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD Eur Respir J 2008; 32: 962–969
Diabete Mellito (%) Ipertensione arteriosa (%)
Prevalenza media
12 40
BPCO, Ipertensione arteriosa e Diabete
Coorti ARIC (Atherosclerosis Risk in Communities Study) e
CHS (Cardiovascular Health Study)
D.M. Mannino Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD Eur Respir J 2008; 32: 962–969
BPCO e Sindrome Metabolica
Origine studio Prevalenza SM in BPCO (%)
Grecia 21
Corea 33 (M) – 49 (F)
Turchia 27
Canada 47
Germania GOLD I 50 GOLD II 53 GOLD III 37 GOLD IV 44
Francia 50
SM in BPCO (%)
Prevalenza media 20 - 50
INDACO project
Fumagalli et al. INDACO project: a pilot study on incidence of comorbidities in COPD patients referred to pneumology units Multidisciplinary Respiratory Medicine 2013, 8:28
Fumagalli et al. INDACO project: COPD and link between comorbidities, lung function and inhalation therapy Multidisciplinary Respiratory Medicine 2015, 10:4
INDACO project
Fumagalli et al. INDACO project: a pilot study on incidence of comorbidities in COPD patients referred to pneumology units Multidisciplinary Respiratory Medicine 2013, 8:28
Fumagalli et al. INDACO project: COPD and link between comorbidities, lung function and inhalation therapy Multidisciplinary Respiratory Medicine 2015, 10:4
Asma e BPCO: quadri patologici classici
Dirkje S. Postma, Klaus F. Rabe The Asthma–COPD Overlap Syndrome N Engl J Med 2015;373:1241-9.
Asma, ipertensione e Diabete
A. Wardzynska Comorbidities in elderly patients with asthma: Association with control of the disease and concomitant treatment Geriatr Gerontol Int 2015; 15: 902–909
Asma e sindrome metabolica
Walter RE, Beiser A, Givelber RJ, O'Connor GT, Gottlieb DJ. Association between glycemic state and lung function: the Framingham Heart Study. Am J Respir Crit Care Med 2003;167:911-6.
Davis WA, Knuiman M, Kendall P, Grange V, Davis TM; Fremantle Diabetes Study. Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care 2004;27:752-7.
• Several epidemiological studies have shown that elevated insulin level and insulin resistance were associated with decreased lung function.
• Obesity and asthma may be related through common inflammatory pathways associated with insulin resistance.
Asma e sindrome metabolica
• fasting insulin level and HOMA-IR had significant correlation with FEV1 (%) (r = –0.1440, p=0.011, and r = –0.1156, p = 0.042, respectively).
Definizioni attuali
Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment (GINA 2011).
COPD, a common preventable and treatable disease, is characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases Exacerbations and comorbidities contribute to the overall severity in individual patients (GOLD 2011)
Vanfleteren LEGW, Kocks JWH, Stone IS, et al. Moving from the Oslerian paradigm to the postgenomic era: are asthma and COPD outdated terms?
Thorax 2014;69:72–79.
Mast cell
CD4+ cell (Th2)
Eosinophil
Allergens
Ep cells
ASTHMA
Bronchoconstriction AHR
Alv macrophage Ep cells
CD8+ cell (Tc1)
Neutrophil
Cigarette smoke
Small airway narrowing Alveolar destruction
COPD
Reversible Irreversible Airflow Limitation
Fattori di rischio per lo sviluppo di malattie croniche
Principali Comportamentali Metabolici
Aging Fumo Ipertensione arteriosa
Infiammazione Sedentarità Sovrappeso ed obesità
Abuso di alcol Dislipidemia
Dieta non corretta
Liver IL-6, TNF-α, IL-1β IL-6
CRP
Cardiovascular disease Muscle wasting
Skeletal muscle
Other Inflammatory diseases
Circulation
Infiammazione sistemica
Senectus ipsa morbu
De Martinis M, Franceschi C, et al. Inflammation markers predicting frailty and mortality in the elderly.” Exp Mol Pathol. 2006 Jun;80(3):219-27.