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1 The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St. Paul's Hospital, 2 Dept of Medicine (Division of Respirology), The University of British Columbia, Vancouver, and, 3 University of Manitoba, Winnipeg, Canada., 4 Fundacio Caubet-Cimera Illes Balears, Bunyola, and 7 Hospital Universitario Son Dureta, Palma de Mallorca, Balearic Islands, Spain., 6 Dept of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. 5 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
CORRESPONDENCE: D. D. Sin, The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada. Fax: 1 6048069274. E-mail: dsin{at}mrl.ubc.ca
Keywords: Chronic obstructive pulmonary disease, comorbidities, inflammation, mortality
Received: November 14, 2005
Accepted June 8, 2006
Chronic obstructive pulmonary disease (COPD) represents an increasing burden throughout the world. COPD-related mortality is probably underestimated because of the difficulties associated with identifying the precise cause of death. Respiratory failure is considered the major cause of death in advanced COPD. Comorbidities such as cardiovascular disease and lung cancer are also major causes and, in mild-to-moderate COPD, are the leading causes of mortality.
The links between COPD and these conditions are not fully understood. However, a link through the inflammation pathway has been suggested, as persistent low-grade pulmonary and systemic inflammation, both known risk factors for cardiovascular disease and cancer, are present in COPD independent of cigarette smoking.
Lung-specific measurements, such as forced expiratory volume in one second (FEV1), predict mortality in COPD and in the general population. However, composite tools, such as health-status measurements (e.g. St George's Respiratory Questionnaire) and the BODE index, which incorporates Body mass index, lung function (airflow Obstruction), Dyspnoea and Exercise capacity, predict mortality better than FEV1 alone. These multidimensional tools may be more valuable because, unlike predictive approaches based on single parameters, they can reflect the range of comorbidities and the complexity of underlying mechanisms associated with COPD.
The current paper reviews the role of comorbidities in chronic obstructive pulmonary disease mortality, the putative underlying pathogenic link between chronic obstructive pulmonary disease and comorbid conditions (i.e. inflammation), and the tools used to predict chronic obstructive pulmonary disease mortality.
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