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Abstract
Introduction Cigarette smoking is a known contributing factor to the development of chronic obstructive pulmonary disease (COPD), and to the formation of an aneurysm. In addition COPD is the most important risk factor associated with abdominal aortic aneurysms (AAA). Studies1 have observed the relationship of COPD and AAA, demonstrating a prevalence in COPD patients of 3.7% and a 1.22–1.78 fold increased risk of AAA when compared to those without COPD.2
Aims Our aim was to identify the prevalence of undiagnosed airflow obstruction in patients attending for CPET for preoperative assessment for AAA.
Methods Data from 122 patients (108 male), median age 75 years (range 65–90) with an AAA of 5 cm or more, attending between September 2014 and May 2016 were included. Spirometry, CPET, smoking history, BMI and current medication were all analysed. The patient’s clinical records were reviewed to establish any previous respiratory diagnosis.
Results 17/122 (14%) patients had a known diagnosis of COPD however 32/122 (26%) had airflow obstruction on spirometry, with only 12 of these having a diagnosis of COPD. 5 patients with a diagnosis of COPD did not demonstrate airflow obstruction. There were significant differences between those with airflow obstruction and those without for breathing reserve 20.8 versus 37.95% (p=0.0002), anaerobic threshold 11.0 versus 12.30 ml/min/kg (p=0.0073), Peak VO2 15.1 versus 16.8 ml/min/kg (p=0.0018), smoking history 49 versus 30 pack years (p=0.0069) and BMI 26.0 versus 28.1 kg/m2 (p=0.0024); respectively.
Conclusion The Results confirmed that a significant proportion of our patients had previously undiagnosed/unrecognised airflow obstruction. As would be expected, patients with airflow obstruction had an increased pack year smoking history and a decreased BMI when compared to those without. Airflow obstruction also resulted in a decreased peak VO2 and a worsening of ventilatory limitation which has the potential to influence surgical decision making.
References
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Flessenkaemper IH, Loddenkemper R, Roll S, Enke-Melzer K, Wurps H, Bauer TT. Screening of COPD patients for abdominal aortic aneurysm. Int J Chron Obstruct Pulmon Dis2015, Jun 10;10:1085–91.