Thorax 59:574-580 doi:10.1136/thx.2003.019588
  • Chronic obstructive pulmonary disease

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

  1. W Q Gan3,
  2. S F P Man1,2,
  3. A Senthilselvan4,
  4. D D Sin1,2
  1. 1The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, Vancouver, British Columbia, Canada
  2. 2Department of Medicine (Pulmonary Division), University of British Columbia, Vancouver, British Columbia, Canada
  3. 3Department of Medicine, Pulmonary Division, University of Alberta, Edmonton, Alberta, Canada
  4. 4Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
  1. 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;
  • Received 28 November 2003
  • Accepted 29 March 2004


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-α (TNF-α), 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-α 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.


  • DDS is supported by a New Investigator Award from the Canadian Institutes of Health Research and by the Glaxo-Smith-Kline/St Paul’s Hospital Foundation COPD Professorship

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