Expertentreffen obstruktive Atemwegserkrankungen: Kardiovaskuläre Aspekte der COPD^[*]

Zusammenfassung

Die hier vorgestellten, aktuellen Forschungsergebnisse zur COPD sind einer neuen Qualität in der klinischen Wissenschaft zu verdanken. Es sind vor allem zwei neue Datenquellen, die in den letzten Jahren erschlossen wurden: große populationsbasierte, retrospektive Beobachtungsstudien mit bis zu 5-stelligen Fallzahlen einerseits und sehr intensiv untersuchte, prospektive Kohorten andererseits. In einem der Beiträge dieses Artikels wird das neben der amerikanischen ECLIPSE-Kohorte in Deutschland entstehende COSYCONET vorgestellt. Hier kann sich der Leser einen Eindruck über den wissenschaftlichen Umgang mit einer prospektiven Kohorte verschaffen.

Die Flut neuer Daten hat auch dazu beigetragen, dass die Aussagen des internationalen GOLD-Komitees komplexer geworden sind. Klinisch wichtig sind der Verzicht auf das Ergebnis des Bronchospasmolysetests als Diagnosekriterium der COPD und die Verwendung von Symptomfragebögen – neuerdings auch des CCQ-Scores – als neue Dimension in der Beschreibung der Erkrankungsschwere. Außerdem wird die Bedeutung schwerer akuter Exazerbationen für das weitere Schicksal der Patienten hervorgehoben. Die im GOLD-Update von 2011 erstmals vorgestellten COPD-Typen I bis IV waren zunächst lediglich eine Expertenmeinung. Daher sind die jetzt vorliegenden Daten über die prognostische Relevanz der Klassifikation dringend notwendig.

Das Hauptthema der Tagung waren die kardiovaskulären Aspekte der COPD. Es wird deutlich, dass für Patienten mit COPD – über die Komorbidität zweier häufiger chronischer Erkrankungen hinaus – kardiovaskuläre Ereignisse von besonderer Bedeutung sind. Umgekehrt ist die fortgeschrittene COPD ein wichtiger Risikofaktor bei Erkrankungen des Herzens und der Gefäße. Diese gegenseitige Beeinflussung gilt sowohl für den Langzeitverlauf als auch für akute Komplikationen wie die COPD-Exazerbation und den Myokardinfarkt, und sie macht sich in harten Endpunkten wie der Letalität bemerkbar.

In den folgenden Beiträgen wird das Thema im Hinblick auf die Epidemiologie, die kardiovaskuläre Biologie und im Besonderen auf seine Bedeutung in der COPD-Exazerbation untersucht. Die kardiovaskuläre Toxizität der Pharmakotherapie der COPD wird ebenso neu bewertet wie mögliche protektive Effekte von Pharmaka mit kardiovaskulärer Indikation (Statine und Betarezeptorenblocker) bei Patienten mit COPD.

Abstract

This overview presents data that take advantage of a new step of insight into COPD. Large population-based retrospective studies and intensively investigated prospective cohorts are two important sources of knowledge that have been recently developed. One of the contributions introduces the German COSYCONET which is on its way shortly after the American ECLIPSE cohort.

The vast amount of new data has also contributed to some corrections of the recommendations of the international GOLD committee. Clinically important are the waiver of the reversibility test for the diagnosis of COPD, the inclusion of sympotom scores to evaluate quality of life and the estimation of exacerbations. The COPD types I through IV were originally the result of expert opinion, but their impact on prognosis has recently been evaluated empirically.

The top issues of the expert meeting were cardiovascular aspects of COPD. Besides the comorbidity of two significant chronic diseases, it became clear that cardiovascular events have an outstanding significance for COPD patients. Inversely, advanced COPD is an important risk factor in cardiac and vascular diseases. The mutual influence of both disease entities does not only affect the long term progression but also the outcome of acute events like myocardial infarction and COPD exacerbation.

The following contributions investigate the topic with regard to epidemiology, the biology of vessels, and especially with regard to acute COPD exacerbations and pharmakotherapy. Recent evidence enables a fresh view on the cardiovascular toxicity of COPD medication and on possible protective effects of cardiovascular drugs (i. e. statins and ß-receptor antagonists) for patients with COPD.

^* Sponsor: Boehringer Ingelheim Pharma GmbH & Co KG

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