ReviewComorbidity in chronic obstructive pulmonary disease
Introduction
Chronic obstructive pulmonary disease (COPD) is a progressive disabling illness associated with an abnormal inflammatory response of the airways and the lung to noxious stimuli [1]. It is characterized by persistent airflow limitation that is not fully reversible and airway inflammation [1]. According to the estimates of the Burden of Lung Disease Initiative (BOLD) study [2], the overall global prevalence of COPD in adults over the age of 40 is 10.1%, with the prevalence being slightly higher in men (11.8%) than women (8.5%). In 2010, nearly 2.9 million people were reported to have died of COPD globally [3]. The illness burden associated with COPD is projected to rise with continued exposure to COPD risk factors [4].
Cigarette smoking is the single most important cause of COPD, with emerging data suggesting the presence of airflow limitation in nearly 50% of smokers [5]. Nevertheless, a significant proportion of patients with COPD are also non-smokers [6]. This is particularly true in developing countries where indoor air pollution such as biomass fuel exposure is most common [7], [8]. Nevertheless, even in developed countries between 10% and 30% of COPD patients are believed to be never-smokers [2], [9]. Other etiological factors for developing COPD include genetic susceptibility (α1-antitrypsin deficiency) [10], occupational exposure to dust and chemicals such as vapors, irritants, and fumes, severe respiratory infections during childhood [11], and childhood severe asthma [12].
The major pathological changes that cause the inexorable airflow limitation in COPD include remodeling and narrowing of the small airways and destruction of the lung parenchyma [13]. Many converging lines of argument suggest that these pathological changes are secondary to chronic inflammation in the periphery of the lung, which increases as the disease progresses [13], [14]. It is now recognized that this inflammation in patients with COPD is not just confined within the lungs and may contribute to the extra pulmonary effects of the disease [15], [16], [17]. So whilst COPD primarily affects the lungs, it is a complex, heterogeneous, and multicomponent disease characterized by chronic systemic inflammation and often coexists with other disorders known as comorbidities [15], [16], [17]. Comorbidities in COPD are known to pose a challenge in the clinical care of COPD patients, are likely to add to the complexity and cost of care, and are now recognized as key components of the disease [18], [19]. Comorbidities that have been associated with COPD include cardiovascular diseases, lung cancer, metabolic disorder, osteoporosis, anxiety and depression, skeletal muscle dysfunction, cachexia, gastrointestinal diseases, and other respiratory conditions [19], [20], [21], [22], [23]. In this review, we have tried to comprehensively describe the comorbid conditions that are often coexistent with COPD, along with their reported prevalence and their significant impact in the management of patients with COPD. A perspective on integrated disease management approaches is also provided.
Section snippets
Comorbidities in COPD
The majority of COPD patients suffer from at least one comorbid condition [19], [24]. Schnell and co-workers found that over 96% of 995 physician-diagnosed patients with COPD aged 45 and over had at least one comorbidity [19]. Moreover, nearly 52% of the patients with COPD were reported to take more than four medications compared to those without COPD (32%). A subsequent study by Vanfleteren et al. [24] showed similar results with nearly 98% of a cohort of 213 well-characterized COPD patients
Implications of comorbidities for clinical practice
As may be evident from the foregoing discussion, comorbidities in COPD have a considerable impact on the overall clinical care of patients with COPD. The coexistence of multiple chronic conditions in COPD patients has also been associated with multiple parallel treatments or polypharmacy [102], which may result in increased incidences of inappropriate prescriptions and drug interactions culminating in adverse events [32], [103], [104]. Clinical decision making is further complicated by the lack
Summary
In this review, we have described the most common comorbid conditions that co-occur with COPD with particular emphasis on their reported prevalence and detrimental impacts on clinical outcome such as severity of symptoms, quality of life, hospitalization, health care utilization, and mortality. Although the impacts of comorbid conditions in the management of COPD has now been acknowledged, little has been done so far on how to provide improved care for comorbid COPD patients. What is now
Conflict of interest
Netsanet A. Negewo has no competing interests to declare. A/Prof. Vanessa M. McDonald is supported by Lung Foundation of Australia and Boehringer Ingelhiem COPD Research fellowship. Professor Peter G. Gibson has no competing interest to declare.
Acknowledgment
Netsanet A. Negewo is supported by the Priority Research Centre for Asthma and Respiratory Diseases Ph.D. Scholarship and Emlyn and Jennie Thomas Postgraduate Medical Research Scholarship through the Hunter Medical Research Institute (Grant number is G1401393).
Vanessa M. McDonald is supported by Boehringer Ingelheim Chronic Obstructive Pulmonary Disease Research Fellowship through the Lung Foundation Australia (Grant number G1300813).
Peter G. Gibson is supported by a NHMRC practitioner
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2019, European Journal of PharmacologyCitation Excerpt :The patients of COPD associated with smoke are more susceptible to depression (Zhang et al., 2014). Other studies have reported that the amount of exposure to cigarette smoke was also closely correlated with declines in psycho-emotional state and in cognitive function (Iyer et al., 2016; Negewo et al., 2015) However, the interrelationship among smoking, COPD, and depression has not been fully characterized until now. The COPD model established by cigarette smoke was used in our study.
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