About COPD and associated comorbidities

Comorbidity

People with chronic obstructive pulmonary disease (COPD) often have other chronic diseases and long-term conditions. These are referred to as comorbidities—two or more health problems present at the same time. Comorbidities often share common risk factors, and are increasingly seen as acting together to determine the health outcome.

As people age, they are more likely to have more than one chronic condition. Because COPD is more likely to occur in older people, people with COPD also commonly report a range of other chronic conditions [1, 2, 3]. These comorbidities contribute to ill health and risk of death in all stages of COPD, and the incidence of hospitalisation for non-respiratory causes is increased in patients with COPD [3, 4]. As well, when people are admitted for non-respiratory causes, they have a longer length of hospital stay and are more likely to die if they also have COPD [5].

The chronic conditions that have been selected for this analysis are: asthma, cardiovascular disease, back problems, mental health problems, arthritis, diabetes and cancer. They have been selected because they are common in the general community and cause significant burden. Other chronic conditions that are found commonly in people with COPD, and that can impact on COPD, include chest infections, bronchiectasis, diabetes, obstructive sleep apnoea and osteoporosis [6].

Having a history of asthma is a major risk factor for being given a diagnosis of COPD, particularly for smokers [7, 8]. Around 15–20% of people with COPD also have a diagnosis of asthma; this is often called asthma–COPD overlap or asthma–COPD overlap syndrome (ACOS) [9, 10]. Due to the overlap in the definitions for asthma and COPD, it can be difficult to make an accurate diagnosis of these conditions [11].

Treatment and management

Comorbidities can complicate management options and multiply the effects of chronic conditions [7, 12]. Physicians may need to prescribe medications for one condition that may exacerbate another existing comorbid condition. For example, some bronchodilator medications prescribed for COPD may worsen glaucoma (increased pressure in the eyes), or can cause urinary problems in men with an enlarged prostate. Use of steroid tablets for COPD exacerbations (or flare-ups) may contribute to weakening of the bones (osteoporosis).

COPD has a high rate of comorbidity with cardiovascular disease (CVD) [13]. Beta-blocker medications are recommended for management of acute coronary syndromes, cardiac failure and sometimes for irregular heartbeat and hypertension. However, these medications can cause severe flare-ups in people with asthma and so have frequently been withheld from people with COPD. Despite this, recent evidence suggests that beta-blockers may be safe and helpful for managing COPD [14]. This highlights the importance of taking a person-centred, integrated, multidisciplinary approach to management and treatment of comorbid chronic conditions.

Establishing a better understanding of the common comorbidities of COPD may help with the diagnosis of comorbid conditions. For example, coronary artery disease is common in patients with COPD and is underdiagnosed [15]. As there are limited therapeutic options for COPD, the diagnosis and treatment of comorbidities is particularly important [6].

Prevention and diagnosis can be improved by a better understanding of risk factors for the development of COPD. Tobacco smoking, poor nutrition, air pollution, and serious childhood lung infections are all known risk factors for developing COPD [6].

Treatment strategies that target modifiable behaviours can be used to manage various chronic diseases, for example, diet, exercise, weight control, and smoking cessation or reduction [16]. For COPD, only smoking cessation has been shown to change prognosis.

References

  1. Chatlia WM, Thomashow BM, Minai OA, Criner GJ, Make BJ, et al. 2008. Comorbidities in chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society, 5(4):549–555.
  2. Divo M, Cote C, de Torres JP, Casanova C, Marin JM, Pinto-Plata V, et al. 2012. Comorbidity and risk of mortality in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 186(2):155–161.
  3. Vanfleteren LE, Spruit MA, Groenen M, Gaffron S, van Empel VP, Bruijnzeel PL. et al. 2013. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 187(7):728–735.
  4. Franssen F & Rochester C. 2014. Comorbidities in patients with COPD and pulmonary rehabilitation: do they matter? European Respiratory Review, 22:577–586.
  5. Holguin F, Folch E, Redd SC & Mannino DM 2005. Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001, Chest 128(4):2005–11.
  6. Lung Foundation Australia. 2015. COPD-X Guidelines - Version 2.44. Viewed 16 February 2016.
  7. Van der Molen T. 2010. Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences. Primary Care Respiratory Journal, 19(4):326–334.
  8. de Marco R, Pesce G, Marcon A, Accordini S, Antonicelli L, Bugiani M, et al. 2013. The coexistence of asthma and chronic obstructive pulmonary disease (COPD): Prevalence and risk factors in young, middle-aged and elderly people from the general population. PloS One 8(5):e62985.
  9. Gibson PG & McDonald VM. 2015. Asthma-COPD overlap 2015: now we are six. Thorax; 70:683–91.
  10. GINA 2015. Diagnosis of Diseases of Chronic Airflow Limitation: Asthma, COPD and Asthma–COPD Overlap Syndrome. Viewed 27 May 2016.
  11. Reddel H. 2015. Treatment of overlapping asthma-chronic obstructive pulmonary disease: Can guidelines contribute in an evidence-free zone? Journal of Allergy and Clinical Immunology, 136(3):546–552.
  12. Leeder S & Wells B 2012. Findings: Optimising prevention and the management of care for Australians with serious and continuing chronic illness. Menzies Centre for Health Policy, The University of Sydney.
  13. Bhatt SP, Wells JM & Dransfield MT 2014. Cardiovascular disease in COPD: a call for action. Lancet Respir Med; 2:783–785.
  14. Bhatt SP, Wells JM, Kinney GL, Washko Jr GR, Budoff M, Kim Y, et al. 2016. β-Blockers are associated with a reduction in COPD exacerbations. Thorax; 71:8–14.
  15. Reed RM, Eberlein M, Girgis MB, Hashmi S, Iacono A, Jones S, et al. 2012. Coronary artery disease is under-diagnosed and under-treated in advanced lung disease. American Journal of Medicine 125(12):1228.e13–1228e.22.
  16. Bauer UE, Briss PA, Goodman RA, et al. 2014. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 384:45–52.