CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis

W Q Gan³, S F P Man^1,2, A Senthilselvan⁴, D D Sin^1,2

¹ The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, Vancouver, British Columbia, Canada
² Department of Medicine (Pulmonary Division), University of British Columbia, Vancouver, British Columbia, Canada
³ Department of Medicine, Pulmonary Division, University of Alberta, Edmonton, Alberta, Canada
⁴ Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada

Correspondence to:
Correspondence to:
Dr D D Sin
James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St Paul’s Hospital, Room 368A, 1081 Burrard Street, Vancouver, BC, Canada V6A 1Y6; dsin{at}mrl.ubc.ca

Background: Individuals with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular diseases, osteoporosis, and muscle wasting. Systemic inflammation may be involved in the pathogenesis of these disorders. A study was undertaken to determine whether systemic inflammation is present in stable COPD.

Methods: A systematic review was conducted of studies which reported on the relationship between COPD, forced expiratory volume in 1 second (FEV₁) or forced vital capacity (FVC), and levels of various systemic inflammatory markers: C-reactive protein (CRP), fibrinogen, leucocytes, tumour necrosis factor- (TNF-), and interleukins 6 and 8. Where possible the results were pooled together to produce a summary estimate using a random or fixed effects model.

Results: Fourteen original studies were identified. Overall, the standardised mean difference in the CRP level between COPD and control subjects was 0.53 units (95% confidence interval (CI) 0.34 to 0.72). The standardised mean difference in the fibrinogen level was 0.47 units (95% CI 0.29 to 0.65). Circulating leucocytes were also higher in COPD than in control subjects (standardised mean difference 0.44 units (95% CI 0.20 to 0.67)), as were serum TNF- levels (standardised mean difference 0.59 units (95% CI 0.29 to 0.89)).

Conclusions: Reduced lung function is associated with increased levels of systemic inflammatory markers which may have important pathophysiological and therapeutic implications for subjects with stable COPD.

Abbreviations: COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; FEV₁, forced expiratory volume in 1 second; IL, interleukin; TNF-, tumour necrosis factor-

Keywords: chronic obstructive pulmonary disease; inflammation; C-reactive protein; meta-analysis

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• Yende, S, Waterer, G W, Tolley, E A, Newman, A B, Bauer, D C, Taaffe, D R, Jensen, R, Crapo, R, Rubin, S, Nevitt, M, Simonsick, E M, Satterfield, S, Harris, T, Kritchevsky, S B (2006). Inflammatory markers are associated with ventilatory limitation and muscle dysfunction in obstructive lung disease in well functioning elderly subjects. Thorax 61: 10-16 [Abstract] [Full Text]  
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COPD, restrictive syndrome and inflammation

Filippo Fimognari, et al.

Thorax Online, 19 Nov 2004 [Full text]

Authors' Response

Don D. Sin, et al.

Thorax Online, 14 Feb 2005 [Full text]