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Chronic obstructive pulmonary disease (COPD) is a progressive pathological condition characterized by a huge epidemiological and socioeconomic impact worldwide. In Italy, the actual annual cost of COPD was assessed for the first time in 2002: the mean cost per patient per year was €1801 and ranged from €1500 to €3912, depending on COPD severity. In 2008, the mean annual cost per patient was €2723.7, ranging from €1830.6 in mild COPD up to €5451.7 in severe COPD. In 2015, it was €3291, which is 20.8% and 82.7% higher compared to the costs estimated in 2008 and 2002, respectively. In all these studies, the major cost component was direct costs, in particular hospitalization costs due to exacerbations, which corresponded to 59.9% of the total cost and 67.2% of direct costs, respectively. When the annual healthcare expenditure per patient is related to the length of survival by means of the PRO-BODE Index (PBI, which is the implementation of the well-known BODE Index with costs due to annual exacerbations and/or hospitalizations), the annual cost of care proved much more strictly and inversely proportional to patients’ survival at three years, with the highest regression coefficient (r = −0.58) of all the multidimensional indices presently available, including the BODE Index (r = −021). In Italy, even though tobacco smoking has progressively declined by up to 21% in the general population, the economic impact of COPD has shown relentless progression over the last two decades, confirming that the present national health system organization is still insufficient for facing the issue of chronic diseases, in particular COPD, effectively. The periodic assessment of costs is an effective instrument for care providers in predicting COPD mortality, and for decision makers for updating and planning their social, economic, and political strategies. Full article

Introduction: Cardiovascular diseases often coexist with chronic obstructive pulmonary disease (COPD), and in some cases it is difficult to differentiate between cardiac and pulmonary cause of dyspnoea. It is well known that the serum concentration of NT-proBNP in patients with cardiovascular diseases, especially with congestive heart failure, is elevated. The aim of this study was to estimate the usefulness of NT-proBNP serum level measurement in patients with COPD complaining of chronic dyspnoea. Material and methods: The study group consisted of 81 stable COPD patients in the mean age, 65 ± 7 years, (57 of them with concomitant cardiovascular disease). Serum concentration of NT-proBNP was measured using VITROS laboratory test. Results. There were no statistical differences in serum NT-proBNP between patients stratified according to the GOLD staging system for COPD severity or BODE index and mMRC breathlessness scale. The concentration of NT-proBNP was statistically significantly higher in the patients with coexisting cardiovascular diseases (220.8 ± 258.1 vs. 95.4 ± 56.1 pg/ml). The group of patients with NT-proBNP concentration > 125 pg/ml (n = 36) was statistically significantly older (67.5 ± 6 years old vs. 63.2 ± 7.1 years old; p = 0.009) and had statistically significantly lower PaO2 (67.4 ± 11.8 mm Hg vs. 73.0 ± 11.6 mm Hg; p = 0.04). Conclusions: 1. In the group of stable COPD patients there were no differences between NT-proBNP serum concentration according to GOLD staging, BODE index, and mMRC breathlessness scale. 2. The NT-proBNP serum concentration was statistically significantly higher in the group of COPD patients with the concomitant cardiovascular disease. 3. In patients with chronic dyspnoea testing of serum NT-proBNP may be useful in the detection of patients with cardiovascular problems, who require more intensive therapy. Full article