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COPD: a systemic disease or a co-morbid condition?
P47 The impact of comorbid ischaemic heart disease on exercise capacity in COPD patients
  1. A R C Patel,
  2. A D Alahmari,
  3. G C Donaldson,
  4. B Kowlessar,
  5. A J Mackay,
  6. R Singh,
  7. J R Hurst,
  8. J A Wedzicha
  1. Academic Unit of Respiratory Medicine, UCL Medical School, London, UK

Abstract

Introduction Comorbid ischaemic heart disease (IHD) is associated with an adverse impact on health status, symptoms (ARJCCM 2011;183:A2614) and exacerbation recovery in COPD patients (ERJ 2010;954s:E5209). Any impact on exercise capacity is poorly understood. We aimed to assess and quantify differences in exercise capacity in stable COPD patients with and without IHD.

Methods We assessed 6-min walking distance (6MWD) in accordance with ATS guidance (AJRCCM 2002;166:111–117) in patients from the London COPD cohort. All assessments were performed in the stable state with no symptom-defined exacerbations recorded on daily diary cards for 6 weeks prior and 2 weeks following the visit. Dyspnoea and fatigue were measured before and after the test using the Borg scale, as were saturations from a pulse oximeter. Data were analysed using unpaired t-tests, Mann–Whitney U, χ2 tests and multiple regression techniques.

Results 115 patients had a 6MWD assessment, 19 (17%) had IHD (Abstract P47 table 1). COPD patients with IHD had a lower mean ± SD 6MWD than those without (310±138 vs 354±107 m) although this was not statistically significant (p=0.119). Following adjustment for age, gender, FEV1 % predicted, BMI and smoking pack year history, IHD was found to be independently related with a 66 m reduction in 6MWD (95% CI 5 to 127 m), p=0.035. Median (IQR) dyspnoea on the Borg scale before the test was not higher in those with IHD (1(1,2) vs 1(0,3), p=0.135), this increased more in those with IHD compared to those without during the test (2(1,3) vs 1(0,3), p=0.043). Fatigue measured on the Borg scale was higher at the start of the test in those with IHD (1.5(0,3) vs 0(0,2), p=0.038), however, the increase after the test was not different between the groups (0(0,2) vs 0(0,2), p=0.831). The mean ± SD pre-test oxygen saturations and post-test change were similar in those with and without IHD (93.8±2.6% vs 94.1±2.4%, p=0.684; −0.9±4.4% vs −1.4±3.2%, p=0.595).

Abstract P47 Table 1

Clinical characteristics of COPD patients with and without comorbid ischaemic heart disease (IHD)

Conclusions Comorbid IHD is independently associated with a clinically significant lower exercise capacity in COPD patients. Such patients may have a higher level of fatigue before exercise and develop more dyspnoea during exercise. Such patients may be an appropriate target for further intervention such as tailored pulmonary rehabilitation.

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