Prevalence of comorbidities according to predominant phenotype and severity of chronic obstructive pulmonary disease

Abstract

Background: In addition to lung involvement, several other diseases and syndromes coexist in patients with chronic obstructive pulmonary disease (COPD). Our purpose was to investigate the prevalence of idiopathic arterial hypertension (IAH), ischemic heart disease, heart failure, peripheral vascular disease (PVD), diabetes, osteoporosis, and anxious depressive syndrome in a clinical setting of COPD outpatients whose phenotypes (predominant airway disease and predominant emphysema) and severity (mild and severe diseases) were determined by clinical and functional parameters.

Methods: A total of 412 outpatients with COPD were assigned either a predominant airway disease or a predominant emphysema phenotype of mild or severe degree according to predictive models based on pulmonary functions (forced expiratory volume in 1 second/vital capacity; total lung capacity %; functional residual capacity %; and diffusing capacity of lung for carbon monoxide %) and sputum characteristics. Comorbidities were assessed by objective medical records.

Results: Eighty-four percent of patients suffered from at least one comorbidity and 75% from at least one cardiovascular comorbidity, with IAH and PVD being the most prevalent ones (62% and 28%, respectively). IAH prevailed significantly in predominant airway disease, osteoporosis prevailed significantly in predominant emphysema, and ischemic heart disease and PVD prevailed in mild COPD. All cardiovascular comorbidities prevailed significantly in predominant airway phenotype of COPD and mild COPD severity.

Conclusion: Specific comorbidities prevail in different phenotypes of COPD; this fact may be relevant to identify patients at risk for specific, phenotype-related comorbidities. The highest prevalence of comorbidities in patients with mild disease indicates that these patients should be investigated for coexisting diseases or syndromes even in the less severe, pauci-symptomatic stages of COPD. The simple method employed to phenotype and score COPD allows these results to be translated easily into daily clinical practice.

Keywords: COPD phenotypes; COPD severity; comorbidities.

Figure 1

Prevalence of comorbidities in 412 outpatients with COPD. Abbreviations: ADS, anxious depressive syndrome; com, comorbidities; COPD, chronic obstructive pulmonary disease; D, diabetes; HF, heart failure; IAH, idiopathic arterial hypertension; IHD, ischemic heart disease; O, osteoporosis; PVD, peripheral vascular disease.

Figure 2

Prevalence of comorbidities in 222 patients with the predominant airway disease (A) phenotype and in 190 patients with the predominant emphysema phenotype (B). Abbreviations: ADS, anxious depressive syndrome; com, comorbidities; D, diabetes; HF, heart failure; IAH, idiopathic arterial hypertension; IHD, ischemic heart disease; O, osteoporosis; PVD, peripheral vascular disease.

Figure 3

Comparisons of the prevalence of each examined comorbidity in 222 patients with a predominant airway disease phenotype and in 190 patients with a predominant emphysema phenotype. Note: ^*P<0.05. Abbreviations: ADS, anxious depressive syndrome; com, comorbidities; D, diabetes; HF, heart failure; IAH, idiopathic arterial hypertension; IHD, ischemic heart disease; O, osteoporosis; PVD, peripheral vascular disease.

Figure 4

Prevalence of comorbidities in 412 outpatients according to mild or severe grade of COPD. Notes: ^*P<0.05; ^***P<0.0001. Abbreviations: ADS, anxious depressive syndrome; com, comorbidities; COPD, chronic obstructive pulmonary disease; D, diabetes; HF, heart failure; IAH, idiopathic arterial hypertension; IHD, ischemic heart disease; O, osteoporosis; PVD, peripheral vascular disease.

Figure 5

Prevalence of cardiovascular comorbidities in 412 outpatients according to mild or severe grade of COPD and according to the predominant phenotype. Notes: ^*P<0.05; ^***P<0.0001. Abbreviation: COPD, chronic obstructive pulmonary disease.