Treumova S. I., Petrov Ye. Ye., Burmak Yu. G., Ivanyts’ka T. A.

LITERATURE REVIEWS

Scentific article

The epidemiological research conducted in different parts of the world for many years have showed that diseases of respiratory organs have a great percentage, the morbidity remains on the high level and has no tendency to the reduction.Chronic obstructive pulmonary disease (COPD) remains one of the main problems of the public health service in the world. Every year this pathology becomes the reason for 2,75 million deaths. COPD will have taken the 3rd place among the reasons for death by 2030. Only 25% cases of COPD is diagnosed in time even in European countries and it is the reason for early patients’ disability. Increase of spreading of the broncho-pulmonary and cardiovascular pathology, aging of population cause the prognosis for the increase of the patients with comorbidity in future. Many experts claim that COPD must be considered only as the polymorbid state and that it is often manifested on the background of the ischemic heart disease (IHD), arterial hypertension, metabolic disorders, diabetes mellitus, infiltrative diseases, tumors of the lungs, primary pulmonary hypertension etc. Comorbidity of COPD with the cardiovascular pathology remains the most important one. It reflects the unity of the cardiorespiratory system becoming a summary integral factor of a negative prognosis: COPD and cardiovascular diseases are considered as “criminal partners” nowadays. Anatomic-functional connections “lungs-heart” are so closely interwoven that changes in one organ cause changes in the other inevitably. Even the first exacerbation of COPD or patient’s hospitalization is accompanied by the reaction of the heart. It has been proved in a number of works that the presence of COPD can be considered as an independent riskfactor of IHD together with age, smoking, the cholesterol level, elevation of systolic blood pressure. According to multicenter research the frequency of IHD in patients with COPD is 7-13%, and COPD is diagnosed in 26-35% patients with IHD. Spreading of IHD grows with the increase of severity of the broncho-pulmonary pathology reaching 60% and rises significantly with age. It is IHD that is the cause of lethality of the patients with COPD of mild and moderate severity. IHD is revealed in the third part of cases among hospitalized patients with exacerbation of COPD, i.e. death occurs most often not as the result of a respiratory disease but for cardiovascular reasons; it is confirmed by literature information. The synchronous course of COPD and IHD is accompanied by the syndrome of “mutual burdening” which causes the earlier disability and the death of the patients. The changes of rheological properties of the blood, increase of hemostatic and decrease of fibrinolytic blood potential are its main mechanisms. It promotes the disorder of pulmonary and myocardial microcirculation, ventilating, hemodynamic (and later also tissue) hypoxia, forming of pulmonary hypertension which intensifies myocardial ischemia of the both ventricles and leads to the coronary and pulmonary insufficiency. It is necessary to mention that IHD in patients with COPD has the course without apparent clinical symptoms in most cases; it is characterized by modification of the typical anginous attack and severe arrhythmias. In turn, systolic blood pressure and the degree of dyspnea by MRC-test increase significantly in patients with COPD and the combined pathology, also a short distance covered by patients during 6 minutes (in comparison with the same indices of the patients without the accompanied IHD) is registered, pulmonary hemodynamics, alveolar gas exchange become worse. One should keep in mind the possibility of latent and small-symptom course of COPD; it must be taken into account during follow-up of the patients with IHD. The community of the pathogenesis of COPD and atherosclerosis which is a basis of IHD is determined by a problem of the oxidant stress, inflammation, development of the endothelial dysfunction. The signs of right ventricular hypertrophy, the increase of its sizes are marked mainly in the patients with COPD while also the sizes, thickness of the left ventricle increase and its pumping function decrease in the combined pathology (COPD+IHD). The issue of the follow-up of the patients with the mentioned comorbid pathology is complicated. An appropriate combined prescription of medicaments and an adequately planned rehabilitation program for these patients will help not only to prevent progression of each from the diseases but also to improve a long-term forecast and life quality.

chronic obstructive pulmonary disease, ischemic heart disease, comorbidity, combined pathology

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«Bulletin of problems biology and medicine» Issue 4 Part 3 (141), 2017 year, 66-72 pages, index UDK 616.23/24-06:616.127-005.4

10.29254/2077–4214–2017–4–3–141–66-72