Aging and extrapulmonary effects of chronic obstructive pulmonary disease

Emanuela Tudorache,¹ Ariadna Petronela Fildan,² Mirela Frandes,³ Elena Dantes,⁴ Doina Ecaterina Tofolean<sup>2

1</sup>Department of Pulmonology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara, ²Faculty of Medicine, Internal Medicine Discipline, Medical Clinical Disciplines I, “Ovidius” University of Constanta, Constanţa, ³Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timişoara, ⁴Faculty of Medicine, Pneumophtisiology Department, Medical Clinical Disciplines II, “Ovidius” University Constanta, Constanţa, Romania

Introduction: People with COPD have a decline in functional status, but little is known about the rate of decline and factors that contribute. Of particular concern is the decline in cognitive and functional performance. Decrease in cognitive and functional performance will finally lead to decreased health status, sedentary life style and premature frailty.
Aim: The aim of this study is to compare functional performance and cognitive status in patients with COPD of different ages and to examine the changes in extrapulmonary effects.
Patients and methods: This study included 62 patients with COPD risk class D who were divided into two groups (<70 years, N=30 and >70 years, N=32). Patients first completed the Montreal Cognitive Assessment (MoCA), which is a 30-point test that assesses different cognitive domains, while isometric knee extension (IKE) was measured using a digital handheld dynamometer, and functional exercise level was assessed using the 6-minute walking distance (6MWD) test.
Results: The patients’ older age (age higher than 70 years) was associated with a significantly lower body mass index (BMI, 27.50 vs 24.24 kg/m²; P=0.020), higher vital capacity parameters, forced vital capacity (FVC, 2.74 vs 2.82 L; P=0.799), FVC (%) (73.00 vs 66.50, P=132), forced expiratory volume in the first second (FEV₁, 0.93 vs 1.13 L; P=0.001) and FEV₁ (%) (28.50 vs 30.50, P=0.605). In addition, patients at older age presented a significantly reduced physical activity capacity, 6MWD (385.93 vs 320.84 m, P<0.001) and IKE (24.75 vs 22.55 kgf, P=0.005), as well as higher values for inflammatory biomarkers, C-reactive protein (8.77 vs 3.34 mg/L, P=0.022). Moreover, patients at older age presented significantly lower score at the cognitive assessment, MoCA (23.50 vs 20.00, P<0.001).
Conclusion: Elderly COPD patients have reduced exercise capacity and muscle strength, deteriorated cognitive function and increased inflammatory markers. Furthermore, inflammation markers were significantly correlated with muscle strength, walking distance and cognitive impairment.

Keywords: aging, inflammation, strength, pulmonary function