Comorbidities of COPD

Abstract

By 2020, chronic obstructive pulmonary disease (COPD) will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation. All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately.

Figure 1.

3-year survival of lung cancer patients in the general population and in those with a prior diagnosis of chronic obstructive pulmonary disease (COPD). COPD is a negative predictor of survival in lung cancer patients. Reproduced from [43] with permission from the publisher.

Figure 2.

Evaluation of cognitive performance based on the ability to copy a simple drawing. Cognitive impairment is a negative predictor of survival in chronic obstructive pulmonary disease patients. Black line: normal copying drawings with landmarks and no hypoxaemia; blue line: normal copying drawings with landmarks and hypoxaemia; green line: impaired copying drawings with landmarks and no hypoxaemia; red line: impaired copying drawings with landmarks and hypoxaemia. Reproduced from [74] with permission from the publisher.

Figure 3.

Comparison of a) survival and b) exacerbation-free survival in three populations: chronic obstructive pulmonary disease (COPD) alone; COPD with obstructive sleep apnoea syndrome (OSAS) treated with continuous positive airway pressure (CPAP); and COPD with OSAS not treated with CPAP. Reproduced from [178] with permission from the publisher.