Chronic obstructive pulmonary disease (COPD) is a growing global epidemic that is particularly important in developing countries.Morbidity and mortality from COPD will rise as populations age and mortality from cardiovascular and infectious diseases falls.Whereas cigarette smoking is the commonest cause of COPD in developed countries, COPD is also seen in nonsmokers, particularly in developing countries, yet very little is know about this form of COPD.COPD is primarily characterized by the presence of airflow limitation resulting from inflammation and remodelling of small airways and is often associated with lung parenchymal destruction or emphysema.It is increasingly recognised that COPD extends beyond the lung and that many patients have several systemic manifestations that can further impair functional capacity and health-related quality of life [1].In addition, COPD is associated with several other diseases, such as cardiovascular diseases, osteoporosis, diabetes, and metabolic syndrome, more commonly than expected by chance.These associations are greater than expected from common aetiological factors, such as smoking, suggesting that these comorbidities may be causally associated with the mechanisms of COPD.Systemic effects and comorbidities of COPD increase both the risks of hospitalisation and mortality and the costs, and are therefore a topic of increasing concern [2].Indeed, cardiovascular disease and lung cancer are the commonest causes of death in patients with COPD [2,3].Although comorbidities are more commonly seen in association with severe COPD, they may also be associated with milder or earlier disease.The Essay section contains opinion pieces on topics of broad interest to a general medical audience.
1. Direct radioligand—binding techniques have been used to characterize and quantify adrenoreceptors in human peripheral lung tissue removed at thoracotomy from ten patients, nine of whom had evidence of obstructive airways disease. 2. [3H]Dihydroalprenolol was used to characterize β–adrenoreceptor sites and [3H]prazosin to identify α–adrenoreceptor sites. Binding of both ligands showed saturability, high affinity, rapid kinetics, reversibility and stereospecificity. The rank order of agonists and antagonists inhibiting specific binding correlated well with known physiological potencies. Specificity of [3H]dihydroal-prenolol binding suggested that the population of lung β–adrenoreceptors is predominantly of the β2 subtype.
Coronary artery disease (CAD) manifesting as stable angina pectoris or acute coronary syndrome (ACS) is often treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in the contemporary practice.However, concomitant use of optimal medical therapy (OMT) remains essential for these patients.OMT would include aspirin, a P2Y 12 inhibitor (if indicated e.g., post PCI or post ACS), a lipid lowering agent (usually a statin), a β-blocker and possibly an ACE inhibitor.This editorial highlights the importance of initiation and continuation of these vital medications in cardiac patients in the context of recently published data (1,2).
