• Exfoliation Syndrome and Chronic Obstructive Pulmonary Disease

    By Jean Shaw
    Selected By: Henry D. Jampel, MD

    Journal Highlights

    Ophthalmology Glaucoma, January/February 2019

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    Exfoliation syndrome (XFS) and chronic pulmonary obstructive disease (COPD) share some elements of pathophysi­ology, notably the process of elastin repair and extracellular matrix (ECM) modeling. Given this link, Taylor et al. set out to determine whether patients with XFS were at greater risk of having COPD and vice versa. They found that patients with XFS were more likely to be diagnosed with COPD, particularly if they were smokers, but that those with COPD were not at elevated risk of developing XFS. They also found that patients with both COPD and XFS had significantly better survival rates than did those with COPD alone.

    The researchers evaluated 2,943 patients with XFS, 20,589 patients with COPD, and 162 patients with both illnesses. All were older than age 50 and had been treated between 1996 and 2015. Medical records were drawn from the Utah Population Database. Controls were selected and matched by sex and birth year to patients in a 5:1 ratio. Conditional multivariable logistic re­gression was used to calculate the odds ratio (OR) to estimate risk of COPD in patients with XFS. Model covariates included race, obesity, and tobacco use.

    The results show that the risk of a COPD diagnosis was increased in XFS patients compared to that of non-XFS controls (OR = 1.41, 95% confidence intervals [CI] 1.17-1.70; p < .0004), with a subset of patients who used tobacco at a 2.2-fold increased risk (OR = 2.17, 95% CI 1.15-4.09; p = .02). Overall 10-year survival rates were better in COPD patients who had XFS than in those who did not (76% and 43%, respectively), perhaps because the diagnosis of XFS moved these patients into the health care system at an earlier point in their lives.

    The findings add to the understand­ing that XFS is more than an ophthal­mic disease, the researchers said. They also noted that the finding that COPD risk was particularly elevated in those XFS patients who used tobacco suggests that tobacco is the “insult” that leads to degradation of ECM metabolism, thus increasing COPD risk.

    The original article can be found here.