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COPD and Its Comorbidities: New Evidence Gained from the COSYCONET Cohort Study

News 1-2019 EN

The cohort study COSYCONET (“German COPD and SYstemic consequences-COmorbidities NETwork”) investigates how lung health, comorbidities, and systemic inflammation are related in patients with Chronic Obstructive Pulmonary Disease (COPD). Between 2010 and 2013, around 3,000 patients suffering from different stages of COPD participated in the study.

They underwent thorough examinations in one of the 31 participating study sites. These examinations included questionnaires on their medical history, on demographic factors, and on quality of life as well as a number of pulmonary function tests. Both physical fitness and functioning of the cardiovascular system were also examined. The subjects donated blood and urine for subsequent investigations. This, however, was not the end of COSYCONET for the patients: To study the long-term course of COPD, they periodically visit their study sites for follow-up examinations.

COSYCONET is based on a logistic masterpiece, which starts with the planning of the visits. Once the patient has arrived at the study site, the study nurses collect data, carry out examinations, and process the biological samples, which are then stored in a central biobank. Now that the data validation for the first investigation dates has been completed, the analysis has begun. This has already resulted in a double figure of publications in scientific journals.
In the beginning, COSYCONET received direct funding from the German Ministry of Education and Research (BMBF), and it has been an associate member of the DZL since 2016.

The results published so far over the course of 2018 are outlined below.

  • Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently occur together. For this reason, Dr. Peter Alter from the University of Marburg and his peers investigated how airway obstruction, pulmonary hyperinflation, and various cardiovascular measurements are related. They found that cardiovascular problems often do not occur independently of COPD; on the contrary, they could probably be mitigated by reducing airway obstruction and pulmonary hyperinflation.[1]
  • Another aspect of this correlation was also investigated in a study headed by Peter Alter. The result of the study was that there is a connection between impaired pulmonary function and excessive stress of the left ventricular wall in patients without manifest heart conditions. This might be a result of excessive mechanical stress due to their COPD. The authors therefore recommend having the cardiovascular system of COPD patients examined preventively on a regular basis.[2]
  • COPD patients often take several types of medication concomitantly, particularly because of their comorbidities. The aim of the COSYCONET cohort was to study this correlation statistically in older people. The result of the study was that COPD patients aged over 65 indeed take five different drugs on average, three of which do not counter lung disease. In a further analysis, the scientists found that there might be unfavorable drug-drug interactions in 10% of the patients. However, they consider the percentage to be low given the number of different drugs taken by the patients.[3]
  • In another study, scientists from all five DZL sites investigated whether the new GOLD A–D grouping for COPD patients can also be associated with comorbidities. This is indeed the case: There is a dependence toward the risk of developing certain comorbidities. For this reason, the authors consider the GOLD grouping to be clinically useful not only in terms of exacerbations (acute worsening of the disease) but also regarding comorbidities.[4]
  • COPD can take on two different forms: In the first case, the condition is dominated by emphysema, while in the latter case–the airway-dominated form–the patient suffers from an inflammation. Mixed forms also occur. Both forms can be well determined by computed tomography (CT). It is important to differentiate between them, as this has an impact on therapy. Since CT is associated with a certain degree of exposure to radiation, the aim of the recent study of Dr. Kathrin Kahnert and her peers was to explain to what extent lung function measurements can be used to determine the COPD type. The conclusion is that a combination of spirometry and measurement of CO diffusing capacity allows us to reliably distinguish between the two types.[5]
  • Patients participating in the COSYCONET registry are donating blood. Such samples have now been analyzed in a cross-sectional study carried out by Kathrin Kahnert and her peers. The study revealed that uric acid levels in the blood are associated with certain clinical symptoms. Therefore, patients with high uric acid levels have poorer lung function, are less physically fit, and tend to develop cardiovascular comorbidities. The scientists conclude that uric acid levels are a useful laboratory value that allows us to draw conclusions on the state of the disease.[6]
  • The authors of a study published in the German-language medical magazine Deutsches Ärzteblatt wondered with what types of medication COPD patients are treated and if treatment is carried out in accordance with the guidelines. Surprisingly, they found considerable deviations, especially regarding the treatment of exacerbations. Non-guideline-adherent treatment may result in suboptimal therapeutic outcomes or avoidable side effects.[7]
  • Peter Alter and his co-authors studied pulmonary hyperinflation. This is a common symptom of COPD, which results in poor gas exchange and a whole range of consequential symptoms, such as reduced physical performance. In obese people, functional residual capacity may also be reduced, since the diaphragm essential for breathing can be pushed upwards. The scientists discovered that certain models used for the prediction of functional residual capacity are vague, as they overestimate the impact of the body weight. Physicians carrying out lung function tests should keep this in mind.[8]

Further Information

[1] Alter P, Watz H, Kahnert K, Pfeifer M, Randerath W, Andreas S, Waschki B, Kleibrink BE, Welte T, Bals R, Schulz H, Biertz F, Young D, Vogelmeier CF, Jörres RA (2018) Airway obstruction and lung hyperinflation in COPD are linked to an impaired left ventricular diastolic filling. Resp Med  137: 14–22 (Kooperation der DZL-Standorte ARCN, BREATH, CPC-M, UGMLC)
[2] Alter P, Jörres RA, Watz H, Welte T, Gläser S, Schulz H, Bals R, Karch A, Wouters EF, Vestbo J, Young D, Vogelmeier CF (2018) Left ventricular volume and wall stress are linked to lung function impairment in COPD.  Int J of Cardiol  261: 172–178 (Kooperation der DZL-Standorte ARCN, BREATH, CPC-M, UGMLC)
[3] Graf J, Lucke T, Herrera R, Watz H, Holle R, Vogelmeier C, Ficker JH, Jörres RA. (2018) Compatibility of medication with PRISCUS criteria and identification of drug interactions in a large cohort of patients with COPD. Pulm Pharmacol Ther 49: 123-129 (Kooperation der DZL-Standorte ARCN, CPC-M, UGMLC)
[4] Kahnert K, Alter P, Young D, Lucke T, Heinrich J, Huber RM, Behr J, Wacker M, Biertz F, Watz H, Bals R, Welte T, Wirtz H, Herth F,Vestbo J, Wouters EF, Vogelmeier CF, Jörres RA (2018) The revised GOLD 2017 COPD categorization in relation to comorbidities. Resp Med 134: 79–85 (Kooperation der DZL-Standorte ARCN, BREATH, CPC-M, TLRC, UGMLC)
[5] Kahnert K, Jobst B, Biertz F, Biederer J, Watz H, Huber RM, Behr J, Grenier PA, Alter P, Vogelmeier CF, Kauczor HU, Jörres RA (2018) Relationship of spirometric, body plethysmographic, and diffusing capacity parameters to emphysema scores derived from CT scans. Chron Respir Dis 18: 1479972318775423 (Kooperation der DZL-Standorte ARCN, CPC-M, TLRC, UGMLC)
[6] Kahnert K, Alter P, Welte T, Huber RM, Behr J, Biertz F, Watz H, Bals R, Vogelmeier CF,  Jörres RA (2018) Uric acid, lung function, physical capacity and exacerbation frequency in patients with COPD: a multi-dimensional approach. Respir Res 19(1): 110. (Kooperation der DZL-Standorte ARCN, BREATH, CPC-M, UGMLC)
[7] Graf J, Jörres RA, Lucke T, Nowak D, Vogelmeier CF, Ficker JH, Medikamentöse Therapie der COPD. Deutsches Ärzteblatt  115(37): 599-605 (Kooperation der DZL-Standorte CPC-M und UGMLC)
[8] Alter P, Rabe KF, Schulz H, Vogelmeier CF, Jörres RA (2018) Influence of body mass on predicted values of static hyperinflation in COPD. Int J Chron Obstruct Pulmon Dis 13: 2551-2555 (Kooperation der DZL-Standorte ARCN, CPC-M, UGMLC)

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