Within 90 days of hospital admission, 11 out of 100 patients die from an exacerbation of chronic obstructive disease (COPD) , compared to 4 out of 100 from heart attack or acute ischemic heart disease. Which means that the mortality of COPD is three times that of a heart attack. This has been highlighted on the eve of World COPD Day, which is celebrated this November 17, the Spanish Society of Pulmonology and Thoracic Surgery (Separ).
COPD is a chronic respiratory disease in which the bronchial tubes become obstructed, making it difficult to breathe. In Spain almost 3 million people suffer from it. Only in the group over 40 years of age, 10% of the population has COPD, with 75-80% of patients being undiagnosed. It is the third leading cause of death worldwide, even above lung cancer.
In its acute phase, COPD has a mortality rate 90 days after hospital admission of 11.3%. These COPD data are based, on the one hand, on a clinical audit carried out in Spain in 2016 and later extended to Europe (AudiEPOC and European COPD Audit).
That is why the expert Dr. Juan José Soler, a pulmonologist who is a member of Separ, has presented at the 54th National Congress of the Society a new plan to improve the approach to exacerbations of COPD with the idea of improving results. For this they have been based on the action of heart disease, whose service allows 4.2% of the posting mortality to be recorded due to ischemic heart disease.
As the expert recalls, 25% of COPD patients have ischemic heart disease, something that could be explained by smoking . However, “COPD also increases the risk of ischemic heart disease , regardless of smoking. COPD causes systemic inflammation, produces oxidative stress and endothelial damage, increasing the risk of coronary events ”, added Soler
Hospital cardiology is «more proactive in carrying out diagnostic and therapeutic procedures to address acute coronary syndrome», explains Dr. Soler. «Thanks to this, a progressive reduction in mortality rates in this disease has been observed . We believe that this way of proceeding constitutes a reference model to improve the care of patients with an exacerbation of COPD», he continues.
Currently , the COPD approach is carried out through symptom management , which hinders the impact on the clinical results of the pathology. However, in the case of ischemic heart disease, the approach is made taking into account that it is a syndrome, in which the guiding symptom is chest pain and that there are biomarkers that determine the disease. In this way, different mechanisms are identified that allow a more precise and specific approach.
Inspired by this definition, Separ, as stated in a press release, has created the GesEPOC 2021 clinical guide, with an approach to the exacerbation of COPD «more syndromic, rather than symptomatic, more inclusive and supported by biomarkers». “We are going to consider the exacerbation due to COPD as a syndrome, with a main guiding symptom, dyspnea, some underlying pathophysiological changes, especially the increase in inflammation and the worsening of bronchial obstruction and the identification of different biomarkers that help us to improve the specificity of the picture ”, clarifies Dr. Soler. In the case of biomarkers, they would be guided by C-reactive protein (CRP), the fall in airflow or various imaging biomarkers that may be of interest.
With this, the disease can be prevented, diagnosed and treated, in turn following the patient to seek the most precise treatments that prevent the appearance of these exacerbations. The mechanisms involved in the acute phase of COPD could even be identified.
“We think that this change in definition opens the door to the application of a more personalized medicine to treat exacerbations of COPD. By considering them as a syndrome and relying on specific biomarkers, we will be able to identify treatable traits, specific to each patient, and address these exacerbations in a more individualized way ”, says Dr. Soler.