|Year : 2017 | Volume
| Issue : 2 | Page : 67-70
Erectile dysfunction in male patients with severe chronic obstructive pulmonary disease
Hamdy M Hasan1, Eisa I Afify1, Tareq M Tawfik2, Ismail M Al Wakeel1, Fawzy M Abd El Fattah1
1 Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
2 Department of Dermatology and Venereology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
|Date of Submission||15-Dec-2016|
|Date of Acceptance||30-Dec-2016|
|Date of Web Publication||21-Nov-2017|
Ismail M Al Wakeel
Source of Support: None, Conflict of Interest: None
Background Chronic obstructive pulmonary disease (COPD) is a common chronic disease, which diminishes the patient’s functional capacity and quality of life. Only few studies have been published on the occurrence of erectile dysfunction (ED) in COPD patients.
Objective The aim of this work was to study the prevalence of ED in COPD patients and its relation with other clinical and laboratory parameters.
Patients and methods The study included 30 patients with severe chronic stable COPD (diagnosed and staged according to the American Thoracic Society guidelines) and 30 healthy volunteers. Assessment of erectile function was carried out for all participants using the International Index of Erectile Function (IIEF-5) Questionnaire.
Results Both COPD patients and controls were age matched. On comparing the 6 min walk test results between the two groups, there was a highly significant decrease in the distance×weight parameter in COPD patients (19.687±3.104 kg/km) than in normal controls (35.24±4.35 kg/2 km). Evaluation of erectile function was carried out using the questionnaire of IIEF. The mean score of erectile function was significantly decreased in COPD patients than in the normal control group (P<0.05), and the results showed that 76% of all patients with COPD were found to have ED compared with 23% in healthy controls. ED in COPD patients was graded as mild [three cases (10%)], mild to moderate [4 (13%) cases], moderate [four (13%) cases], and severe ED [12 (40%) cases], whereas the ED in the control group was mild [four (13%) cases] and mild to moderate [three (10%) cases]. Correlation analyses showed a linear relationship (positive correlation) between IIEF-5 and forced expiratory volume in 1 s (%), forced vital capacity (%), peak expiratory flow (%), PaO2, SO2 (%), and distance×weight.
Conclusion ED is a frequent problem in patients with COPD. The limitations of physical activity in the pathophysiology of COPD seem to interfere with the sexual function of these patients.
Keywords: chronic obstructive pulmonary disease, erectile dysfunction, erectile function
|How to cite this article:|
Hasan HM, Afify EI, Tawfik TM, Al Wakeel IM, Abd El Fattah FM. Erectile dysfunction in male patients with severe chronic obstructive pulmonary disease. Al-Azhar Assiut Med J 2017;15:67-70
|How to cite this URL:|
Hasan HM, Afify EI, Tawfik TM, Al Wakeel IM, Abd El Fattah FM. Erectile dysfunction in male patients with severe chronic obstructive pulmonary disease. Al-Azhar Assiut Med J [serial online] 2017 [cited 2018 Sep 23];15:67-70. Available from: http://www.azmj.eg.net/text.asp?2017/15/2/67/218857
| Introduction|| |
Chronic obstructive pulmonary disease (COPD) is one of the most important causes of death in most countries. The Global Burden of Disease Study projected that COPD, which ranked sixth as a cause of death in 1990, will become the third leading cause of death worldwide by 2020 .
COPD is a common chronic disease, which diminishes the patient’s functional capacity and quality of life. Although erectile dysfunction (ED) is one of the most important reasons for decrease in the quality of life, to our knowledge there has been no prevalence study on ED in patients with COPD . ED is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance . ED is not perceived as a life-threatening condition; it is closely associated with many important physical conditions and may affect psychosocial health. As such, ED has a significant impact on the quality of life of patients and their partners .
The aim of this work was to study the prevalence of ED in COPD patients and its relation with disease severity.
| Patients and methods|| |
The study was carried out at the Chest Department, AL Hussein University Hospital over a period from February 2013 to October 2013. Informed consent was obtained from all patients and the study was approved ethically by Al-Azhar University. A total of 60 male participants (30 COPD patients and 30 healthy volunteers) were included in the study; all patients had stable COPD. COPD was diagnosed and staged according to the American Thoracic Society guidelines . Spirometry was performed for all participants, and COPD was diagnosed if the postbronchodilator forced expiratory volume in 1 s (FEV1)/ forced vital capacity (FVC) was less than 70% and the reversibility of FEV1 was less than 12%. Only severe COPD patients in whom postbronchodilator FEV1 is less than 50% but more than or equal to 30% of the predicted were included. Assessment of erectile dysfunction was carried out on all participants using the International Index of Erectile Function (IIEF-5) Questionnaire. The Questionnaire is formed of five questions and each question has several possible responses and scored from 1 to 5 points ([Table 1] and [Table 2]). Points of all questions are summed to reach the total score. The Sexual Health Inventory for Men classified ED severity with the following breakpoints: 1–7 (severe ED); 8–11 (moderate ED); 12–16 (mild-to-moderate ED); 17–21 (mild ED); and 22–25 (no ED) . Physical fitness in all participants was assessed using the 6-min walking test. The absolute distance (D) reached by each participant (km) was multiplied by his weight (W) (kg) and this is called the 6-min work. The product of distance×weight (DW) or the 6-min work was proved to be more reliable in estimation of the patient’s functional capacity than to measure the absolute distance irrespective of the weight . Penile Duplex was performed to exclude any peripheral vascular diseases that could be the cause of ED rather than COPD.
|Table 1 The international index of erectile function (IIEF-5) questionnaire |
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|Table 2 Pulmonary function tests and arterial blood gases in both chronic obstructive pulmonary disease patients and controls (N=30)|
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Statistical presentation and analysis of the present study was conducted, using the mean, SD, SE, t-test, analysis of variance test, and χ2 using SPSS, version 17. Significant statistical results were considered if P value was less than 0.05.
| Results|| |
Both COPD patients and healthy controls were age matched without significant difference (P>0.05). Spirometric measurements including FEV%, FVC%, FEV1/FVC, and PEF% were significantly lower in COPD patients than in healthy volunteers (P<0.05). Moreover, COPD patients had a decrease in PaO2 and SO2 and an increase in PaCO2 compared with the healthy control group (P<0.05) ([Table 3]). The 6-min walking test values were significantly decreased in COPD patients (P<0.05) ([Table 4]). On comparing the erectile function between the two groups, IIEF-5 was significantly decreased in COPD patients than in normal controls (11.78±8.18 vs. 21.6±4.37) (P<0.05). In addition, the percentage of patients with ED was 76% in COPD patients compared with 23% in normal healthy controls. Erectile function scores, in COPD patients, correlated positively with FEV1%, FVC%, FEV/EVC, PEF%, PaO2, SO2%, and DW and correlated negatively with the duration of COPD ([Table 3]).
|Table 3 Correlation between erectile function score and age, smoking index, pulmonary functions, arterial blood gas, distance×weight, and the duration of disease in chronic obstructive pulmonary disease patients|
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|Table 4 Six-minute walking test in both chronic obstructive pulmonary disease patients and controls (N=30)|
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| Discussion|| |
Chronic obstructive pulmonary disease is one of the common chronic diseases; the studies concerning erectile function and sexual status in patients with COPD are still fragmentary . In some prevalence studies of ED in the community, pulmonary disease was found to be a correlate of ED in multivariate analyses . Blanker et al.  suggested a relation between COPD and ED. Thus, with this study we assessed the erectile function in patients with COPD. In the present study the percentage of ED was 76% in COPD patients compared with 23% in normal healthy controls, and IIEF-5 score was significantly decreased in COPD patients than in normal controls. Correlation analyses showed a significant positive correlation between IIEF-5 and FEV1%, FVC%, PEF%, PaO2, SO2, and DW, which mean that the severity of sexual dysfunction is increased with the increased severity of COPD indicated by the decline in FEV1, PaO2, SO2, and the deterioration in the DW parameter of the 6-min walk test. Moreover, there was a negative correlation between IIEF-5 and the duration of COPD, whereas there was no correlation with the age and smoking index.
Koseoglu and colleagues previously studied erectile function in COPD patients including all COPD stages, from mild to moderate and severe COPD. IIEF-5 questionnaire was used to classify the severity of ED, whereas the physical fitness of patients was assessed using the 6-min walking test. They found that 75.5% of all patients with COPD had ED with varying degrees: 28.3% had severe ED, 11.3% had moderate ED, 15.1% had mild-to-moderate ED, and 20.8% had mild ED. Within the patients with severe COPD, the percentage of patients who had ED was 80% with varying degrees: 40% had severe ED, 15% had moderate ED, 10% had mild-to-moderate ED, and 15% had mild ED. These findings are in agreement with the results of the present study. They suggested that the main factor for erectile dysfunction in those patients was the decrease in physical fitness due to COPD even in the absence of hypoxemia, whereas age, other comorbid diseases (hypertension, hyperlipidemia, and coronary artery disease), and medications used for COPD were found not to affect erectile function scores when controlled for in partial correlation analyses .
The exact mechanism of the pathophysiology of ED in COPD remains unclear. Some studies suggested decreased functional capacity due to hypoxemia as the main cause of ED. Aasebo et al.  reported the reversal of erectile dysfunction in 42% of 12 patients with COPD with respiratory failure using long-term oxygen therapy, but impotence was assessed subjectively in that study. Bratel et al.  showed that hypoxemia had no effect on hormonal status and the hypothalamic–pituitary–testicular axis. Ibañez et al.  reported sexual function deterioration in the form of lack of desire or impotence in 67.3% of 49 patients with COPD and chronic respiratory failure.
| Conclusion|| |
ED is a frequent problem in patients with COPD. The limitations of physical activity due to mechanisms in the pathophysiology of COPD also seem to interfere with the sexual function of these patients. The severity of erectile dysfunction correlated with the severity of physical limitation denoted by the deterioration of the 6 min walk test and by the severity of decline in the FEV1.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Fletcher EC, Martin R. Sexual dysfunction and erectile impotence in chronic obstructive pulmonary disease. Chest 1982; 81:413.
No authors listed. NIH consensus conference. Impotence. NIH consensus development panel on impotence. JAMA 1993; 270:83–90.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151:54–61.
Rosen RC, Cappelleri JC, Gendrano N. The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res 2002; 14:226–244.
Shiri R, Koskimaki J, Hakama M, Hakkinen J, Tammela TL, Huhtala H, Auvinen A. Effect of chronic diseases on incidence of erectile dysfunction. Urology 2003; 62:1097.
Blanker MH, Bohnen AM, Groeneveld FP, Bernsen RM, Prins A, Thomas S, Bosch JL. Correlates for erectile andejaculatory dysfunction in older Dutch men: a community based study. J Am Geriatr Soc 2001; 9:436.
Koseoglu N, Koseoglu H, Ceylan E, Esen A. Erectile dysfunction prevalence and sexual function status in patients with chronic obstructive pulmonary disease. Am Urol Assoc 2005; 174:249–252.
Aasebo U, Gyltnes A, Bremnes RM, Aakvaag A, Slordal L. Reversal of sexual impotence in male patients with chronic obstructive pulmonary disease and hypoxemia with long-term oxygen therapy. J Steroid Biochem Mol Biol 1993; 46:799.
Bratel T, Wennlund A, Carlstrom K. Impact of hypoxaemia on neuroendocrine function and catecholamine secretion in chronic obstructive pulmonary disease (COPD). Effects of long-term oxygen treatment. Respir Med 2000; 94:1221.
Ibañez M, Aguilar JJ, Maderal MA, Prats E, Farrero E, Font A, Escarrabill J. Sexuality in chronic respiratory failure: coincidences and divergences between patient and primary caregiver. Respir Med 2001; 95:975.
[Table 1], [Table 2], [Table 3], [Table 4]