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Title: The relationship between exacerbations of chronic obstructive pulmonary disease and the systemic vasculature
Author: Burrage, Daniel Richard
ISNI:       0000 0004 7962 5213
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2019
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Background: Vascular comorbidity is common in patients with severe exacerbations of chronic obstructive pulmonary disease (COPD). This relationship appears bi-directional. For example, cardiac dysfunction can cause exacerbations, and exacerbations can trigger myocardial infarction. The relationship between vascular disease and non-severe exacerbations is less clear. In addition, data are lacking on the relationship between exacerbations and systemic microvascular and cerebral small vessel disease. Aim: To compare systemic inflammation, cardiovascular disease, microvascular disease and cerebral small vessel disease in COPD patients with infrequent and frequent exacerbations, and over the time course of an acute exacerbation. Methods: This thesis is based on a prospective cohort study of 56 non-hospitalised COPD patients. Analysis was performed cross-sectionally, comparing infrequent and frequent exacerbators, and prospectively comparing baseline, acute exacerbation and 3-month recovery visit data. Cardiovascular measures included traditional risk factors (blood pressure, blood lipids, blood glucose) and serum troponin T; microvascular measures included retinal vascular imaging, skin capillary density and albuminuria; and cerebral small vessel disease measures included magnetic resonance imaging of the brain. Results: There was no difference in systemic inflammation between infrequent and frequent exacerbators, but systemic inflammatory markers increased at acute exacerbation. Cardiovascular risk factors were common but under-diagnosed and under­treated. At acute exacerbation a relationship between elevated C-reactive protein, heart rate and serum troponin T was identified that was not present at baseline or recovery. Microvascular disease was predicted by vascular risk factors, airflow obstruction and hypoxaemia, but not exacerbations. At acute exacerbation, brain tissue volume and cerebral blood flow were reduced, and ventricular volume was increased. White matter hyperintensities were predominantly age-related, although an association with hypoxaemia was also identified.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available