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Review
. 2015 Jan 7:10:95-109.
doi: 10.2147/COPD.S54473. eCollection 2015.

Managing comorbidities in COPD

Georgios Hillas  1 , Fotis Perlikos  1 , Ioanna Tsiligianni  2 , Nikolaos Tzanakis  3
Affiliations
Review

Managing comorbidities in COPD

Georgios Hillas et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Age and smoking are common risk factors for COPD and other illnesses, often leading COPD patients to demonstrate multiple coexisting comorbidities. COPD exacerbations and comorbidities contribute to the overall severity in individual patients. Clinical trials investigating the treatment of COPD routinely exclude patients with multiple comorbidities or advanced age. Clinical practice guidelines for a specific disease do not usually address comorbidities in their recommendations. However, the management and the medical intervention in COPD patients with comorbidities need a holistic approach that is not clearly established worldwide. This holistic approach should include the specific burden of each comorbidity in the COPD severity classification scale. Further, the pharmacological and nonpharmacological management should also include optimal interventions and risk factor modifications simultaneously for all diseases. All health care specialists in COPD management need to work together with professionals specialized in the management of the other major chronic diseases in order to provide a multidisciplinary approach to COPD patients with multiple diseases. In this review, we focus on the major comorbidities that affect COPD patients. We present an overview of the problems faced, the reasons and risk factors for the most commonly encountered comorbidities, and the burden on health care costs. We also provide a rationale for approaching the therapeutic options of the COPD patient afflicted by comorbidity.

Keywords: chronic obstructive pulmonary disease; comorbid major diseases; health care costs; management; treatment.

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Figures

Figure 1
Figure 1
The most common and clinically important comorbidities in patients with COPD. Abbreviations: PHRHF, pulmonary hypertension and right heart failure; HTN, hypertension; CHF, congestive heart failure; CHD, coronary heart disease; AF, atrial fibrillation; VTE, venous thromboembolism; MS, metabolic syndrome; OSAS, obstructive sleep apnea syndrome; GERD, gastroesophageal reflux disease; CRF, chronic renal failure; COPD, Chronic Obstructive Pulmonary Disease.
Figure 2
Figure 2
Cause-effect diagram shows the four different ways in which other abnormalities may be linked with COPD, presented in the same individual, the so-called multidiseased COPD patient, and leading in increase morbidity and mortality. Abbreviations: CVD, cardiovascular disease; CHF, congestive heart failure; MS, metabolic syndrome; OSAS, obstructive sleep apnea syndrome; DALY, disability-adjusted life years; MS, Metabolic Syndrome; COPD, Chronic Obstructive Pulmonary Disease.
Figure 3
Figure 3
A holistic approach to medical intervention. Abbreviation: COPD, chronic obstructive pulmonary disease.
See this image and copyright information in PMC

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MeSH terms