Use of B-type Natriuretic Peptides in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Requiring Ventilatory Support

Abstract

Chronic obstructive pulmonary disease (COPD) is expected to become the third leading cause of death by 2020 [1]. Acute exacerbation of COPD is the most frequent reason for emergency room attendance and hospital admission. It accounts for most of the burden related to the disease, including healthcare costs, social impact, and mortality [2]. Biomarkers, such as natriuretic peptides, have the advantage of being easy to obtain at affordable cost. B-type natriuretic peptide (BNP) is a 32-amino acid peptide that is released following the cleavage of pro-BNP into the biologically active BNP, and the inactive amino terminal NTproBNP [3]. BNP and NT-proBNP are closely correlated to each other and change in parallel. NT-pro BNP has a longer half-life than BNP with plasma levels 2–10 times higher than those of BNP [4]. Both are detectable in plasma and, therefore, have the potential to serve as indicators of heart failure. BNP and NT-proBNP are released into the bloodstream in response to ventricular increase in volume or pressure. BNP is the sole biologically active peptide. It increases myocardial relaxation and opposes the activation of the renin-angiotensin-aldosterone system with effects against vasoconstriction, sodium retention, and diuretic effects [3]. The diagnostic usefulness of measuring plasma levels of BNP and NT-proBNP in patients presenting to the emergency department (ED) with dyspnea is now well established [5]. High levels of natriuretic peptides accurately reflect left ventricular (LV) dysfunction and help distinguish acute dyspnea due to acute cardiac dysfunction from that of pulmonary origin.