Endothelial dysfunction in patients with chronic obstructive pulmonary disease: some aspects of medicamental treatment (a literature review)

Abstract

The aim of the study was to analyze the professional literature concerning general principles of medicamental correction for endothelial dysfunction and their peculiarities in patients with chronic obstructive pulmonary disease.  The development of chronic obstructive pulmonary disease (COPD) is based on certain trigger factors and pathogenetic processes (chronic inflammation of low intensity, oxidative stress, endothelial dysfunction). These factors are common for a number of other pathological processes, promoting the development of systemic extrapulmonary effects and comorbid conditions. Endothelial dysfunction is of particular interest because it causes, first of all, cardiovascular system pathology. Therefore, modern treatment of COPD, in addition to the drugs approved by clinical protocols, must be supplemented by methods of endothelial dysfunction correction in the long-term management for patients beyond the exacerbation period, which at the same time have no negative effect on the disease course.   At present, medicines of various pharmacological groups with a positive effect on the endothelial function are known. Among them are those ones that replenish the deficiency of endothelial relaxing factors or have a direct effect on endothelial receptors; stimulate endothelial nitric oxide synthase activation; prevent endothelial dysfunction caused by mediator influences; regulate the blood coagulation system; provide protection from endothelial cell membrane damage or affect various pathogenetic links of the disease (inflammatory process, immune disorders, dysbiosis, etc.), that indirectly reduces endothelial dysfunction.   Conclusions. The key role of endothelial dysfunction in the formation of comorbid pathology in COPD, first of all lesions of cardiovascular system, determines the necessity for complex treatment of these patient groups with additional correction of endothelial dysfunction, especially in long-term management programs beyond the exacerbation period. Given the multifactorial mechanisms of endothelial dysfunction development, the treatment choice for its correction should be personalized taking into account all the disease peculiarities and the comorbid pathology spectrum.