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Why You Should Think of COPD as a Systemic Disease and Not a Localized Issue

May 12, 2021 1:33:27 PM / by Daniel Seter

Why You Should Think of COPD as a Systemic Disease and Not a Localized Issue

The medical term “localized disease” refers to a condition that is confined to one organ or system of the body. For example, an ear infection is a localized disease because it typically only affects the “middle ear” just behind the eardrum. While ear infections can spread to other parts of the body, this is very uncommon. A “systemic disease”, on the other hand, is one that has systemic manifestations. For example, diabetes is a disease that affects the level of glucose in your blood. Since every organ in the body is reliant on this blood, diabetes can have many systemic effects ranging from cardiovascular disease to nerve damage.

 

Traditionally, chronic obstructive pulmonary disease (COPD) has been considered a localized disease. Cigarette smoking either results in chronic inflammation in the bronchioles (chronic bronchitis), the lungs (emphysema), or both. But an increasing amount of evidence suggests that COPD should be re-labeled as a systemic condition rather than a localized one. Or at the very least, patients and medical specialists should treat COPD as if it were a systemic issue.

 

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In this post, we’re going to help you understand the big picture of COPD. Instead of looking at respiratory symptoms associated with COPD like chronic cough, breathlessness, and chest pain, we’re going to focus on the systemic issues that can manifest as a result of this disease and why other respiratory diseases like asthma don’t put you at the same risk. If you have any questions, please address them in the comment section and we’ll get back to you soon.

 

Why COPD is a Systemic Disease

In the world of medical treatment, not everything is set in stone. Sometimes, medical specialists disagree on how to diagnose conditions and how to treat them both in the short- and long term. While it’s generally accepted that supplemental oxygen therapy, a revised dietary regime, and a pulmonary rehabilitation plan are the best ways to treat COPD, other aspects of the disease are not as clear-cut and straightforward. For example, some medical specialists may focus on treating the respiratory symptoms associated with COPD while others will focus on a more holistic approach that encompasses your systemic well-being.

 

Systemic health

 

While there’s nothing wrong with focusing on the respiratory symptoms associated with COPD, there’s an increasing amount of evidence to suggest that it can have equally adverse effects elsewhere in the body. The benefit of viewing COPD as a systemic disease is that it may help pulmonologists detect these symptoms early on and better understand how they are linked to COPD. Early disease detection is almost always associated with better outcomes for their patients. In the following sections, we’ll take a look at just a few of the systemic manifestations of COPD.

 

Systemic Inflammation

Inflammation is a natural part of your body’s immune response. It’s the way your body reacts to infection or physical injury. Essentially, the body sends white blood cells to the affected area which protect it from foreign invaders. When inflammation occurs it can cause the affected area to become red, itchy, and swollen. Acute inflammation plays an important role in healing the affected area, but if the inflammation persists longer than usual it can become chronic and can begin to cause serious damage to your tissues and organs.

 

Systemic inflammation

 

Airborne irritants are one common cause of inflammation in the body. When pathogens are inhaled into the lungs, they become inflamed leading to coughing, chest stiffness, and chest pain. In the case of cigarette smokers who often inhale smoke once or more each day, this inflammation can become chronic and irreversible — this is known as chronic obstructive pulmonary disease. In the past, researchers believed this inflammation was localized, however, now there’s reason to believe that it can spread to other areas of the body.  

 

Cigarette smoking

The systemic inflammatory response associated with COPD is not fully understood, but there are a number of theories about how it starts. The first theory is that inflammatory mediators are transferred to the bloodstream from the lungs and are sent to other areas of the body. The idea behind this is that smoking increases the permeability of the pulmonary vessels, thus allowing inflammatory cells that would normally not cross over into the blood. This study found that people with poor pulmonary function experience higher levels of permeability than people with healthy pulmonary function. 

 

Cachexia and Muscle Wasting

According to Medical News Today, about 25 to 40% of people with COPD experience weight loss. While many people are delighted to find out that they’re losing weight, the type of weight loss caused by COPD and other respiratory conditions isn’t usually healthy. The most common cause of this weight loss is a lack of appetite. COPD patients experience higher levels of fatigue and breathlessness than people with healthy lungs both of which can make eating a normal-sized meal exhausting and overwhelming. Oftentimes, respiratory patients reach for foods that provide them with a quick energy boost but likely don’t provide the body with the nutrients it needs.

 

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 Another reason for weight loss in COPD is that many people believe that they should be eating less food if they are less active than they used to be before contracting COPD. However, due to impaired lung function, COPD patients are actually expending a lot more energy than they realize because they have to work harder to get oxygen into their lungs and release carbon dioxide. Typically, doctors and dieticians will advise COPD patients to increase their calorie intake by about 430 to 720 each day depending on their weight and size. 

 

One of the biggest problems with weight loss in COPD patients is muscle wasting, also known as muscle atrophy. This is when your muscles begin to deteriorate either due to a poor diet, lack of exercise, or both. This is a particularly dangerous side-effect of COPD because some people are under the impression that they’re losing fat when they’re actually losing muscle. This puts the patient at risk for falls, exacerbations, and other serious accidents.

 

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Cachexia is a more generalized term to describe a state of “ill health” that results from having a chronic condition. If muscle wasting and weight loss occur quickly in a patient, it may cause them to feel sick to their stomach, dizzy, or confused. Your body might also have a difficult time adapting to your new lifestyle whether that involves a new diet, exercise routine, sleep schedule, etc.  

 

Cardiovascular Disease

Cardiovascular disease is the most common cause of death in the United States and globally. This is an umbrella term that describes disorders of the blood vessels and heart. Some common disorders include rheumatic heart disease, cerebrovascular disease, and coronary heart disease. COPD and cardiovascular diseases are often associated because they share similar risk factors and they act synergistically as negative prognostic factors. Pulmonary hypertension and ischemic coronary disease are two common progressions of COPD.

 

Heart health

The lungs, heart, and circulatory system all work together to bring oxygen into the body and send it to each organ, so it makes sense that if the lungs aren’t functioning as they should, it’s going to cause problems with your cardiovascular system. One of the ways this can manifest is through hypertension, also known as high blood pressure. Hypertension is common in COPD patients and can worsen during exercise, sleep, or respiratory exacerbation. Combatting this underlying issue may put you at a much lower risk of cardiovascular disease. 

 

Osteoporosis

Your bones play a vital role in the overall construction of your body. In order to keep bone tissue strong, it’s constantly removed and replaced. In an osteoporosis patient, the new tissue doesn’t generate as fast as it’s removed making the bones brittle and weak. This is referred to as low bone mineral density (BMD). Osteoporosis can lead to a number of symptoms such as joint pain and broken bones, but many patients will experience no symptoms at all. Osteoporosis is common in old age, but it’s even more common in people with COPD and other respiratory diseases.

 

Osteoporosis

 

One cause of osteoporosis in COPD patients is the use of corticosteroids. This is a type of drug that’s used to reduce inflammation in the body, which in turn alleviates some of the symptoms associated with COPD. Corticosteroids have been found to affect the way body uses calcium and vitamin D to build bones. To counter this, your doctor may prescribe you a very low dose of corticosteroids. Ideally, it would be enough to treat your symptoms, but not enough to result in serious side effects like osteoporosis.

 

Anemia

Anemia is a condition in which your body doesn’t have enough healthy red blood cells. The primary function of red blood cells is to transport hemoglobin throughout the body. Hemoglobin is a chemical that carries oxygen molecules. Similar to not receiving enough oxygen in your lungs, anemia leads to feelings of dizziness, fatigue, and confusion. The reason anemia occurs more frequently in COPD patients is likely due to the abnormal immune response. Like we discussed earlier, COPD can lead to the release of inflammatory mediators in the blood. A specific type of inflammation-causing protein called cytokines reduces the lifespan of red blood cells and makes it more difficult for the bone marrow to produce more, thus resulting in fewer red blood cells.

 

Anemia

Another way that COPD can cause anemia is through iron deficiency. Iron is an essential mineral that your body needs to create hemoglobin, the chemical that carries oxygen and myoglobin, the protein that provides oxygen to the muscles. COPD patients may become iron deficient if their diets change enough that they exclude foods that are high in iron. This includes things like red meat, seafood, dark green vegetables, and beans. While anyone can develop anemia for a variety of reasons, it is more common in COPD patients. COPD patients with anemia are found to have worse outcomes due to respiratory exacerbations than those who are not anemic.

 

Anxiety and Depression

According to a study published in Health Psychology Research, not only do people with chronic illness have higher rates of anxiety, but anxiety rates are highest among people with obstructive lung disease as well as cardiovascular diseases. While there are many reasons why this could be the case, it’s likely mainly due to the way COPD affects your breathing. Studies have shown a strong correlation between anxiety and shortness of breath. There’s a negative feedback cycle where breathlessness can increase anxiety and anxiety, which in turn, creates tightness in the chest, causing more breathlessness. COPD patients can break this cycle by practicing breathing exercises. For more information on breathing exercises to reduce anxiety, read through this article.

 

Anxiety

Depression is another issue associated with COPD. About 40% of COPD patients have depression compared to about 6% of the general population. Depression can result from prolonged anxiety or it can be a completely separate issue. One of the most effective treatment options for depression is cognitive behavioral therapy (CBT). This is a type of psychological intervention that aims to pinpoint and reverse negative or inaccurate thoughts that can lead to anxiety and depression. CBT is being increasingly used by people with chronic conditions as a way to cope with the challenges of their disease. For more information on cognitive behavioral therapy, please read this article.

 

Conclusion

While on the surface it may seem like COPD is a disease that only affects your breathing, it’s actually far more complex than that. Your respiratory system plays a vital role in your holistic well-being and when you experience chronic inflammation in the lungs and low blood oxygen levels, this can affect your health in more ways than you think. Muscle wasting, cardiovascular disease, osteoporosis, anemia, and anxiety are just a few of the systemic manifestations of COPD.

 

If you’re concerned about how your COPD is affecting your heart, bones, or mental health, it’s important to address them with your pulmonologist. He/she may be able to perform tests or provide you with additional treatments that can put your mind at ease and ensure that you prevent any systemic conditions from occurring as a result of your COPD. What’s more, you should take care to follow your current treatment plan because this will help you manage your symptoms effectively.

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Topics: COPD, Medication and Treatment, Respiratory Resource Center, wellness goals, COPD education, COPD management, wellness for seniors, Mental heath

Daniel Seter

Written by Daniel Seter