Malattie respiratorie e fattori di rischio cardiovascolare

Transcript

1 Malattie respiratorie e fattori di rischio cardiovascolare Dr. Alessandro Grembiale ULSS 10 Veneto Orientale P.O. San Donà di Piave UOC Medicina Generale

2 Asma e BPCO Asma Prevalenza: 1 20 % BPCO:Prevalenza : 5-22%

3 BPCO e mortalità COPD is a worldwide epidemic COPD is the fourth leading cause of death in the world Its prevalence ranges between 6% and 19,7% Mortality rates for COPD have jumped by > 163%, and will increase by 50% in the next 15 years World Health Report. Geneva: World Health Organization. Available from URL: statistics.htm; Lopez AD, et al. Chronic obstructive pulmonary disease: current burden and future projections., Eur Respir J Feb;27(2): Vestbo J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary, Am J Respir Crit Care Med Feb 15;187(4): doi: /rccm PP. Epub 2012 Aug 9.Review. PubMed PMID: Update 2015

4 COPD Comorbidome

5 Multimorbidità Fattori di rischio Infiammazione sistemica Aging Tabagismo Politerapia Multi morbidità Interazioni farmacologiche

6 Multimorbidità Condivisione di meccanismi fisiopatologici Fenotipizzazione Impatto sulle risorse sanitarie Mortalità

7 Classificazione Multimorbidità Respiratorio Cardiovascolari Metaboliche Oncologiche Approccio clinico patologico Asma, polmonite, fibrosi polmonare, embolia polmonare, OSAS Ipertensione arteriosa, cardiopatia ischemica, ictus, scompenso cardiaco Sindrome metabolica, diabete, dislipidemia, obesità K polmone, K esofago, K mammella Condivisione del meccanismo patologico Infiammazione Asma, polmonite, cardiopatia ischemica, ipertensione, sindrome metabolica Necrosi/ degenerazione Metaboliche Riparazione/ proliferazione cellulare Trombosi/ emorragia Malattie cardiovascolari, osteoporosi, MRGE Sindrome metabolica, diabete, dislipidemia K polmone, K esofago, K mammella, disfunzione muscolo scheletrica, Embolia polmonare, malattie cerebrovascolari.

8 BPCO, Ipertensione arteriosa e Diabete STUDIO ETA PAZIENTE DIABETE MELLITO TIPO 2 (%) IPERTENSIONE ARTERIOSA (%) MAPEL VAN MANEN WALSH MANNINO Prevalenza malattie cardiovascolari e Diabete (studio ARNO) CVD Diabete

9 BPCO, Ipertensione arteriosa e Diabete Coorti ARIC (Atherosclerosis Risk in Communities Study) e CHS (Cardiovascular Health Study) Prevalenza media Diabete Mellito (%) Ipertensione arteriosa (%) Età Diabete Mellito (%) Ipertensione arteriosa (%) , ,9 38, ,5 46, ,2 49, ,9 51, ,9 58 >80 15,4 62 D.M. Mannino Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD Eur Respir J 2008; 32:

10 BPCO, Ipertensione arteriosa e Diabete Coorti ARIC (Atherosclerosis Risk in Communities Study) e CHS (Cardiovascular Health Study) D.M. Mannino Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD Eur Respir J 2008; 32:

11 Sindrome Metabolica Rischio Cardiovascolare Diabete Mellito tipo 2

12 Sindrome Metabolica: definizioni

13 BPCO e Sindrome Metabolica SM in BPCO (%) Prevalenza media Origine studio Prevalenza SM in BPCO (%) Grecia 21 Corea 33 (M) 49 (F) Turchia 27 Canada 47 Germania GOLD I 50 GOLD II 53 GOLD III 37 GOLD IV 44 Francia 50

14 INDACO project Fumagalli et al. INDACO project: a pilot study on incidence of comorbidities in COPD patients referred to pneumology units Multidisciplinary Respiratory Medicine 2013, 8:28 Fumagalli et al. INDACO project: COPD and link between comorbidities, lung function and inhalation therapy Multidisciplinary Respiratory Medicine 2015, 10:4

15 INDACO project Fumagalli et al. INDACO project: a pilot study on incidence of comorbidities in COPD patients referred to pneumology units Multidisciplinary Respiratory Medicine 2013, 8:28 Fumagalli et al. INDACO project: COPD and link between comorbidities, lung function and inhalation therapy Multidisciplinary Respiratory Medicine 2015, 10:4

16 Asma e BPCO: quadri patologici classici Dirkje S. Postma, Klaus F. Rabe The Asthma COPD Overlap Syndrome N Engl J Med 2015;373:

17 Transizione demografica

18 Asma, ipertensione e Diabete A. Wardzynska Comorbidities in elderly patients with asthma: Association with control of the disease and concomitant treatment Geriatr Gerontol Int 2015; 15:

19 Asma, ipertensione e Diabete

20 Asma e sindrome metabolica Several epidemiological studies have shown that elevated insulin level and insulin resistance were associated with decreased lung function. Obesity and asthma may be related through common inflammatory pathways associated with insulin resistance. Walter RE, Beiser A, Givelber RJ, O'Connor GT, Gottlieb DJ. Association between glycemic state and lung function: the Framingham Heart Study. Am J Respir Crit Care Med 2003;167: Davis WA, Knuiman M, Kendall P, Grange V, Davis TM; Fremantle Diabetes Study. Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care 2004;27:752-7.

21 Asma e sindrome metabolica

22 Asma e sindrome metabolica

23 Asma e sindrome metabolica

24 Asma e sindrome metabolica fasting insulin level and HOMA-IR had significant correlation with FEV1 (%) (r = , p=0.011, and r = , p = 0.042, respectively).

25 Asma e sindrome metabolica

26 Definizioni attuali Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment (GINA 2011). COPD, a common preventable and treatable disease, is characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases Exacerbations and comorbidities contribute to the overall severity in individual patients (GOLD 2011) Vanfleteren LEGW, Kocks JWH, Stone IS, et al. Moving from the Oslerian paradigm to the postgenomic era: are asthma and COPD outdated terms? Thorax 2014;69:72 79.

27 ASTHMA Allergens COPD Cigarette smoke Ep cells Mast cell Alv macrophage Ep cells CD4+ cell (Th2) Eosinophil Bronchoconstriction AHR CD8+ cell (Tc1) Neutrophil Small airway narrowing Alveolar destruction Reversible Airflow Limitation Irreversible

28 Fattori di rischio per lo sviluppo di malattie croniche Principali Comportamentali Metabolici Aging Fumo Ipertensione arteriosa Infiammazione Sedentarità Sovrappeso ed obesità Abuso di alcol Dieta non corretta Dislipidemia

29 Infiammazione sistemica Liver CRP IL-6 Circulation IL-6, TNF-α, IL-1β Cardiovascular disease Skeletal muscle Muscle wasting Other Inflammatory diseases

30 Senectus ipsa morbu De Martinis M, Franceschi C, et al. Inflammation markers predicting frailty and mortality in the elderly. Exp Mol Pathol Jun;80(3):

31 Il giovane medico comincia la sua professione prescrivendo venti medicine per ogni malanno, quello vecchio finisce per prescriverne una sola per venti malanni. Sir William Osler Grazie per l attenzione