‘’DETERMINE THE RELATIONSHIP BETWEEN ARRYTHMIA OCCURRENCE AND THE SEVERITY OF COPD’’
Main Article Content
Keywords
Chronic obstructive pulmonary disease, arrhythmias, Holter monitoring, COPD severity, right heart dysfunction.
Abstract
Introduction- Chronic obstructive pulmona1y disease (COPD) is a prevalent respiratory condition characterized by airflow limitation that is not completely reversible, with a forced expiratory volume in one second to forced vital capacity (FEVl/FVC) ratio of less than 70%. It ranks as the fom1h leading cause of mortality worldwide, following myocardial infarction, cancer, and stroke. COPD is associated with significant morbidity and mortality, and cardiovascular events have been identified as the leading cause of death in COPD patients
Aims Objective: This prospective cohort study aimed to investigate ‘’determine the relationship between arrythmia occurrence and the severity of COPD’’.
Methods: The study included 100 diagnosed cases of COPD, divided into stable COPD and acute exacerbations. Routine blood investigations, electrocardiogram (ECG), 2D echocardiography, and 24-hour Holter monitoring were conducted to assess cardiac rhythm disturbances. The type of arrhythmia was noted for each patient. Statistical analysis was performed using SPSS 26 software.
Results: Among the COPD patients, 53% had supraventricular ectopic, 20% had atrial tachycardia, 16% had conduction abnormalities, and 10% had ventricular ectopics. Males had a higher prevalence of COPD and arrhythmias compared to females. ECG abnormalities associated with right heart dysfunction, such as P-pulmonale, right ventricular hypertrophy (RVH), and right bundle branch block (RBBB), were more prevalent in patients with severe COPD. Sinus tachycardia was more common in severe COPD patients.
Conclusion: The study findings highlight the relationship between COPD severity and the presence of arrhythmias. Patients with severe COPD had a higher incidence of ECG abnormalities associated with right hea11 dysfunction. The prevalence of arrhythmias in COPD patients was estimated at 12-14%, with supraventricular ectopics and atrial tachycardia being the most common types observed. Understanding the prevalence and types of arrhythmias in COPD patients can guide appropriate monitoring and interventions to reduce arrhythmia-related complications.
References
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6. Shih HT, Webb CR, Conway WA, Peterson E, Tilley B, Goldstein S: Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease. Chest 1988;94:44-48.External Resources Pubmed/Medline (NLM) Crossref (DOI)
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9. Mapel DW, Dedrick D, Davis K: Trends and cardiovascular co- morbidities of COPD patients in the Veterans Administration Medical System, 1991-1999. COPD 2005;2:35-41.External Resources Pubmed/Medline (NLM)Crossref (DOI)
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11. van Dijk WD, Lenders JWM, Holtman J, Grootens J, Akkermans R, Heijdra Y, van Weel C, Schermer TRJ: Bronchodilation and smoking interaction in COPD: a cohort pilot study to assess cardiovascular risk. Respiration 2012;83:125-132.External Resources Pubmed/Medline (NLM) Crossref (DOI)
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30. Barnes PJ. Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol 2016; 138(1): 16-27.
31. Sze MA, Dimitriu PA, Suzuki M, et al. Host Response to the Lung Microbiome in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2015; 192(4): 438-45.
32. Lee SH, Goswami S, Grudo A, et al. Antielastin autoimmunity in tobacco smoking-induced emphysema. Nature medicine 2007; 13(5): 567-9.
33. Domej W, Oettl K, Renner W. Oxidative stress and free radicals in COPD--implications and relevance for treatment. Int J Chron Obstruct Pulmon Dis 2014; 9: 1207-24.
34. Malhotra D, Thimmulappa R, Vij N, et al. Heightened endoplasmic reticulum stress in the lungs of patients with chronic obstructive pulmonary disease: the role of Nrf2-regulated proteasomal activity. Am J Respir Crit Care Med 2009; 180(12): 1196-207.
35. Stockley RA. Neutrophils and protease/antiprotease imbalance. Am J Respir Crit Care Med 1999; 160(5 Pt 2): S49-52.
36. Johnson SR. Untangling the protease web in COPD: metalloproteinases in the silent zone. Thorax 2016; 71(2): 105-6.
37. Polosukhin VV, Richmond BW, Du RH, et al. Secretory IgA Deficiency in Individual Small Airways Is Associated with Persistent Inflammation and Remodeling. Am J Respir Crit Care Med 2017; 195(8): 1010-21.
38. Barnes PJ. Cellular and molecular mechanisms of chronic obstructive pulmonary disease. Clin Chest Med 2014; 35(1): 71-86.
39. Katzenstein AL, Mukhopadhyay S, Myers JL. Diagnosis of usual interstitial pneumonia and distinction from other fibrosing interstitial lung diseases. Human pathology 2008; 39(9): 1275-94.
40. Washko GR, Hunninghake GM, Fernandez IE, et al. Lung volumes and emphysema in smokers with interstitial lung abnormalities. N Engl J Med 2011; 364(10): 897-906.
41. Putman RK, Hatabu H, Araki T, et al. Association Between Interstitial Lung Abnormalities and All-Cause Mortality. Jama 2016; 315(7): 672- 81.
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48. Ofir D, Laveneziana P, Webb KA, Lam YM, O'Donnell DE. Mechanisms of dyspnea during cycle exercise in symptomatic patients with GOLD stage I chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008; 177(6): 622-9.
49. Elbehairy AF, Ciavaglia CE, Webb KA, et al. Pulmonary Gas Exchange Abnormalities in Mild Chronic Obstructive Pulmonary Disease. Implications for Dyspnea and Exercise Intolerance. Am J Respir Crit Care Med 2015; 191(12): 1384-94.
50. Casaburi R, Maltais F, Porszasz J, et al. Effects of tiotropium on hyperinflation and treadmill exercis e tolerance in mild to moderate chronic obstructive pulmonary disease. Annals of the American Thoracic Society 2014; 11(9): 1351-61.
51. Rodriguez-Roisin R, Drakulovic M, Rodriguez DA, Roca J, Barbera JA, Wagner PD. Ventilation -perfusion imbalance and chronic obstructive pulmonary disease staging severity. J Appl Physiol 2009; 106(6): 1902-8.
52. Burgel PR, Nadel JA. Epidermal growth factor receptor-mediated innate immune responses and their roles in airway diseases. Eur Respir J 2008; 32(4): 1068-81.
53. S.P. Bhatt, M.T. Dransfield, Chronic obstructive pulmonary disease and cardiovascular disease, Transl. Res. 162 (2013) 237–251.
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57. S.K. Agarwal, G. Heiss, R.G. Barr, et al., Airflow obstruction, lung function, and risk of incident heart failure: the Atherosclerosis Risk in Communities (ARIC) study, Eur. J. Heart Fail. 14 (2012) 414–422.
58. L.M. Fabbri, F. Luppi, B. Beghe, et al., Complex chronic comorbidities of COPD, Eur. Respir. J. 31 (2008) 204–212.
59. H.T. Shih, C.R.Webb, W.A. Conway, et al., Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease, Chest 94 (1988) 44–48.
60. J. Li, S.K. Agarwal, A. Alonso, et al., Airflow obstruction, lung function, and incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study, Circulation 129 (2014) 971–980.
61. Obstructive Lung Disease. Chest 94(1): 44-48
2. Sidney S, Sorel M, Quesenberry CP Jr, DeLuise C, Lanes S, Eisner MD: COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest 2005;128:2068-2075.External Resources Pubmed/Medline (NLM) Crossref (DOI)
3. Maclay JD, MacNee W: Cardiovascular disease in COPD: mechanisms. Chest 2013;143:798-807.External Resources Pubmed/Medline (NLM) Crossref (DOI)
4. Schneider C, Bothner U, Jick SS, Meier CR: Chronic obstructive pulmonary disease and the risk of cardiovascular diseases. Eur J Epidemiology 2010;25:253-260.External Resources Pubmed/Medline (NLM) Crossref (DOI)
5. Konecny T, Park JY, Somers KR, Konecny D, Orban M, Soucek F, Parker KO, Scanlon PD, Asirvatham SJ, Brady PA, Rihal CS: Relation of chronic obstructive pulmonary disease to atrial and ventricular arrhythmias. Am J Cardiol 2014;114:272-277.External Resources Pubmed/Medline (NLM) Crossref (DOI)
6. Shih HT, Webb CR, Conway WA, Peterson E, Tilley B, Goldstein S: Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease. Chest 1988;94:44-48.External Resources Pubmed/Medline (NLM) Crossref (DOI)
7. Steer J, Gibson GJ, Bourke SC: Predicting outcomes following hospitalization for acute exacerbations of COPD. QJM 2010;103:817- 829.External Resources Pubmed/Medline (NLM) Crossref (DOI)
8. Soriano JB, Visick GT, Muellerova H, Payvandi N, Hansell AL: Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. Chest 2005;128:2099-2107.External Resources Pubmed/Medline (NLM)Crossref (DOI)
9. Mapel DW, Dedrick D, Davis K: Trends and cardiovascular co- morbidities of COPD patients in the Veterans Administration Medical System, 1991-1999. COPD 2005;2:35-41.External Resources Pubmed/Medline (NLM)Crossref (DOI)
10. Albert RK, Schuller JL; COPD Clinical Research Network: Macrolide antibiotics and the risk of cardiac arrhythmias. Am J Respir Crit Care Med 2014;189:1173-1180.External Resources Pubmed/Medline (NLM) Crossref (DOI)
11. van Dijk WD, Lenders JWM, Holtman J, Grootens J, Akkermans R, Heijdra Y, van Weel C, Schermer TRJ: Bronchodilation and smoking interaction in COPD: a cohort pilot study to assess cardiovascular risk. Respiration 2012;83:125-132.External Resources Pubmed/Medline (NLM) Crossref (DOI)
12. Chowdhury BA, Seymour SM, Levenson MS: Assessing the safety of adding LABAs to inhaled corticosteroids for treating asthma. N Engl J Med2011;364:2473-2475.External ResourcesPubmed/Medline (NLM) Crossref (DOI)
13. Bhatt SP, Dransfield MT: Chronic obstructive pulmonary disease and cardiovascular disease. Transl Res 2013;162:237-251.External Resources Pubmed/Medline (NLM) Crossref (DOI)
14. Gershon A, Croxford R, Calzavara A, To T, Stanbrook MB, Upshur R, Stukel TA: Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease. JAMA Intern Med 2013;173:1175-1185.External Resources Pubmed/Medline (NLM)Crossref (DOI)
15. Thomas L Petty. The history of COPD. International Journal of COPD 2006; 1(1):3-14.
16. Swash M, Glynn M. Hutchinson's Clinical methods. 22nd ed. Chapter 6. In: Respiratory System. London: Elsevier Company. p. 58.
17. Maria L Padilla. Pulmonary Circulation. Chest 2003;124:1183.
18. William F Ganong. Pulmonary function. 22nd ed. Chapter 34. In: Review of Medical Physiology. New York: The McGraw-Hill Companies pp. 628-9.
19. Victor I Peinado, Sandra Pizarro, Joan Albert Barbera. Pulmonary Vascular Involvement in COPD; CHEST 2008;134:808-14.
20. Celli BR, Macnee W, Agusti A. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. EurRespir J 2004;23:932-46.
22. William Macnee. Chronic bronchitis and emphysema. 5th ed. Chapter
23. In: Crofton and Douglas's respiratory disease, AnthonySeaton, Douglas, eds. Oxford: Blackwell Science Publishers; 2000. pp. 616-79.
23. Viegi G, Pistelli F, Sherrill DL. Definition, epidemiology and natural history of COPD. EurRespir J 2007;30:993-1013.
24. David M Mannino. COPD. Chest 2002;121:121S-126S.
25. Fletcher CM, Pride NB. Definitions of emphysema, chronic bronchitis, asthma, and airflow obstruction: 25 years on from the Ciba symposium. Thorax 1984;39:81-5.
26. Koul PA, Hakin NA, Malik SA, Khan UH, Patel J, Gnatiuc L, Burney PJ. Prevalence of chronic airflow limitation in Kashmir, North India: results from the BOLD study. Int J Tuberc LUng Dis 2016;20:1399- 1404.
27. Burney P, Jithoo A, kato B, janson C, Mannino D, Nizankowska- Mogilnicka E, Studnicka M, Tan W, Bateman E, Kocabas A, vollmer WM, Gislason T, Marks G, Koul PA, Harrabi I, Gnautic L, Buist S. Burden of Obstructive Lung Disease (BOLD) Study. Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty- a BOLD analysis. Thorax 2014;69:465-73.
28. GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet Respiratory Medicine August 17, 2017.
29. Hogg JC, Timens W. The pathology of chronic obstructive pulmonary disease. Annual review of pathology 2009; 4: 435-59.
30. Barnes PJ. Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol 2016; 138(1): 16-27.
31. Sze MA, Dimitriu PA, Suzuki M, et al. Host Response to the Lung Microbiome in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2015; 192(4): 438-45.
32. Lee SH, Goswami S, Grudo A, et al. Antielastin autoimmunity in tobacco smoking-induced emphysema. Nature medicine 2007; 13(5): 567-9.
33. Domej W, Oettl K, Renner W. Oxidative stress and free radicals in COPD--implications and relevance for treatment. Int J Chron Obstruct Pulmon Dis 2014; 9: 1207-24.
34. Malhotra D, Thimmulappa R, Vij N, et al. Heightened endoplasmic reticulum stress in the lungs of patients with chronic obstructive pulmonary disease: the role of Nrf2-regulated proteasomal activity. Am J Respir Crit Care Med 2009; 180(12): 1196-207.
35. Stockley RA. Neutrophils and protease/antiprotease imbalance. Am J Respir Crit Care Med 1999; 160(5 Pt 2): S49-52.
36. Johnson SR. Untangling the protease web in COPD: metalloproteinases in the silent zone. Thorax 2016; 71(2): 105-6.
37. Polosukhin VV, Richmond BW, Du RH, et al. Secretory IgA Deficiency in Individual Small Airways Is Associated with Persistent Inflammation and Remodeling. Am J Respir Crit Care Med 2017; 195(8): 1010-21.
38. Barnes PJ. Cellular and molecular mechanisms of chronic obstructive pulmonary disease. Clin Chest Med 2014; 35(1): 71-86.
39. Katzenstein AL, Mukhopadhyay S, Myers JL. Diagnosis of usual interstitial pneumonia and distinction from other fibrosing interstitial lung diseases. Human pathology 2008; 39(9): 1275-94.
40. Washko GR, Hunninghake GM, Fernandez IE, et al. Lung volumes and emphysema in smokers with interstitial lung abnormalities. N Engl J Med 2011; 364(10): 897-906.
41. Putman RK, Hatabu H, Araki T, et al. Association Between Interstitial Lung Abnormalities and All-Cause Mortality. Jama 2016; 315(7): 672- 81.
42. Churg A, Tai H, Coulthard T, Wang R, Wright JL. Cigarette smoke drives small airway remodeling by induction of growth factors in the airway wall. Am J Respir Crit Care Med 2006; 174(12): 1327-34.
43. Rennard SI, Wachenfeldt K. Rationale and emerging approaches for targeting lung repair and regeneration in the treatment of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2011; 8(4): 368- 75. 43. Hogg JC, McDonough JE, Gosselink JV, Hayashi S. What drives the peripheral lung-remodeling process in chronic obstructive pulmonary disease? Proc Am Thorac Soc 2009; 6(8): 668-72.
44. Barnes PJ. Immunology of asthma and chronic obstructive pulmonary disease. Nature reviews Immunology 2008; 8(3): 183-92.
45. Global Initiative for Asthma. 2015 Asthma, COPD and Asthma-COPD Overlap Syndrome (ACOS). 2015 (accessed 14 October 2018).
46. Hogg JC, Chu F, Utokaparch S, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med 2004; 350(26): 2645-53.
47. McDonough JE, Yuan R, Suzuki M, et al. Small-airway obstruction and emphysema in chronic obstructive pulmonary disease. N Engl J Med 2011; 365(17): 1567-75.
48. Ofir D, Laveneziana P, Webb KA, Lam YM, O'Donnell DE. Mechanisms of dyspnea during cycle exercise in symptomatic patients with GOLD stage I chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008; 177(6): 622-9.
49. Elbehairy AF, Ciavaglia CE, Webb KA, et al. Pulmonary Gas Exchange Abnormalities in Mild Chronic Obstructive Pulmonary Disease. Implications for Dyspnea and Exercise Intolerance. Am J Respir Crit Care Med 2015; 191(12): 1384-94.
50. Casaburi R, Maltais F, Porszasz J, et al. Effects of tiotropium on hyperinflation and treadmill exercis e tolerance in mild to moderate chronic obstructive pulmonary disease. Annals of the American Thoracic Society 2014; 11(9): 1351-61.
51. Rodriguez-Roisin R, Drakulovic M, Rodriguez DA, Roca J, Barbera JA, Wagner PD. Ventilation -perfusion imbalance and chronic obstructive pulmonary disease staging severity. J Appl Physiol 2009; 106(6): 1902-8.
52. Burgel PR, Nadel JA. Epidermal growth factor receptor-mediated innate immune responses and their roles in airway diseases. Eur Respir J 2008; 32(4): 1068-81.
53. S.P. Bhatt, M.T. Dransfield, Chronic obstructive pulmonary disease and cardiovascular disease, Transl. Res. 162 (2013) 237–251.
54. M. Decramer, W. Janssens, M. Miravitlles, Chronic obstructive pulmonary disease, Lancet 379 (2012) 1341–1351.
55. S.M. Curkendall, C. DeLuise, J.K. Jones, et al., Cardiovascular disease in patients with chronic obstructive pulmonary disease: Saskatchewan Canada cardiovascular disease in COPD patients, Ann. Epidemiol. 16 (2006) 63–70. [56] F.H. Rutten, M.J. Cramer, D.E. Grobbee, et al., Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease, Eur. Heart J. 26 (2005) 1887–1894.
57. S.K. Agarwal, G. Heiss, R.G. Barr, et al., Airflow obstruction, lung function, and risk of incident heart failure: the Atherosclerosis Risk in Communities (ARIC) study, Eur. J. Heart Fail. 14 (2012) 414–422.
58. L.M. Fabbri, F. Luppi, B. Beghe, et al., Complex chronic comorbidities of COPD, Eur. Respir. J. 31 (2008) 204–212.
59. H.T. Shih, C.R.Webb, W.A. Conway, et al., Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease, Chest 94 (1988) 44–48.
60. J. Li, S.K. Agarwal, A. Alonso, et al., Airflow obstruction, lung function, and incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study, Circulation 129 (2014) 971–980.
61. Obstructive Lung Disease. Chest 94(1): 44-48
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Jul 23, 2023
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Dr. Seema, Dr. Bharat Batham, Dr. Ajay Pal Singh, & Dr. Jadi Suresh. (2023). ‘’DETERMINE THE RELATIONSHIP BETWEEN ARRYTHMIA OCCURRENCE AND THE SEVERITY OF COPD’’. Journal of Population Therapeutics and Clinical Pharmacology, 30(7), 497-507. https://doi.org/10.53555/jptcp.v30i7.2613
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Author Biographies
Dr. Seema
Senior Resident, Department Of General Medicine, Ssmc Rewa
Dr. Bharat Batham
Senior Resident, Department Of General Medicine, Grmc Gwalior, M.P
Dr. Ajay Pal Singh
Professor, Department Of General Medicine, Grmc Gwalior, M.P
Dr. Jadi Suresh
Senior Resident, Department Of General Medicine, Grmc Gwalior, M.P
How to Cite
Dr. Seema, Dr. Bharat Batham, Dr. Ajay Pal Singh, & Dr. Jadi Suresh. (2023). ‘’DETERMINE THE RELATIONSHIP BETWEEN ARRYTHMIA OCCURRENCE AND THE SEVERITY OF COPD’’. Journal of Population Therapeutics and Clinical Pharmacology, 30(7), 497-507. https://doi.org/10.53555/jptcp.v30i7.2613