The impact of secondary pulmonary hypertension in elderly patients with chronic obstructive pulmonary disease

Abstract

Introduction. Chronic obstructive pulmonary disease (COPD) is considered an important disease in the structure of morbidity and mortality and a rising public health problem with increasing global age prevalence. Exacerbation of COPD in the elderly has a significant negative impact on the clinical and paraclinical picture, daily activity capacity, and quality of life. The need for correct diagnostic management is dictated by the severity of the pathology in the elderly and the high frequency of cardiac complications. Studying the clinical-paraclinical picture and the diagnostic capacity of natriuretic peptides in COPD patients with cardiovascular complications was the aim of the present research. Material and methods. We conducted an analytical, observational, case-control study with the use of modern research methods. The study included 194 elderly patients (≥ 65 years old) divided into two study groups: those with only COPD (COPD group) and those with associated pulmonary hypertension (PHCOPD group). Patients underwent clinical, paraclinical, and functional investigation methods with subsequent mathematical-statistical data processing. Results. The study groups were similar according to socio-demographic data. The clinical assessment revealed that PHCOPD patients had, in comparison with COPD patients, statistically significantly more frequent and severe complaints. The objective examination determined that in PHCOPD patients, the values of the objective examination indices were much more affected than in the COPD group. At the complex geriatric assessment, the COPD group of patients shows a lower degree of dependence and less cognitive impairment. The multidimensional assessment of COPD reflected more severe impairment according to the CAT, SGRQ, CCQ, mMRC, BODE questionnaires, and 6MWT test in the PHCOPD group compared to the COPD group. Spirographic, radiographic, ultrasonographic, and echocardiographic evaluations correlated with age, inflammatory syndrome, and natriuretic peptide level. Conclusions. The PHCOPD group patients present a clinical picture, exercise capacity, objective data, complex geriatric assessment scores, and a multidimensional assessment of COPD that is statistically more frequent and severely affected compared to the COPD group. The impact of hemodynamic disturbances in COPD could be confirmed by the correlation of paraclinical data, such as the inflammatory response syndrome, increased natriuretic peptides, echocardiography data, and indices of internal organ ultrasound examination.