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Review
. 2020 Sep 24;9(10):3078.
doi: 10.3390/jcm9103078.

Comorbid Conditions in Chronic Obstructive Pulmonary Disease: Potential Therapeutic Targets for Unmet Needs

Kazuto Matsunaga  1 , Misa Harada  1 , Junki Suizu  1 , Keiji Oishi  2 , Maki Asami-Noyama  1 , Tsunahiko Hirano  1
Affiliations
Review

Comorbid Conditions in Chronic Obstructive Pulmonary Disease: Potential Therapeutic Targets for Unmet Needs

Kazuto Matsunaga et al. J Clin Med. .

Abstract

The management of chronic obstructive pulmonary disease (COPD) has improved significantly due to advances in therapeutic agents, but it has also become apparent that there are issues that remain difficult to solve with the current treatment algorithm. COPD patients face a number of unmet needs concerning symptoms, exacerbations, and physical inactivity. There are various risk factors and triggers for these unmet needs, which can be roughly divided into two categories. One is the usual clinical characteristics for COPD patients, and the other is specific clinical characteristics in patients with comorbid conditions, such as asthma, cardiovascular disease, and bronchiectasis. These comorbidities, which are also associated with the diversity of COPD, can cause unmet needs resistance to usual care. However, treatable conditions that are not recognized as therapeutic targets may be latent in patients with COPD. We again realized that treatable traits should be assessed and treated as early as possible. In this article, we categorize potential therapeutic targets from the viewpoint of pulmonary and systemic comorbid conditions, and address recent data concerning the pathophysiological link with COPD and the impact of intervention on comorbid conditions in order to obtain evidence that could enable us to provide personalized COPD management.

Keywords: COPD; asthma; bronchiectasis; cardiovascular disease; frailty.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The risk factors and triggers for COPD patients’ unmet needs can be divided into two categories; one is the usual clinical characteristics of COPD patients and the other is the specific clinical characteristics of patients with comorbid conditions. Treatable conditions that are not recognized as therapeutic targets may be latent in patients with COPD. Abbreviations: COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
Changes in the mean values (95% CI) of FEV1 (A) and CAT (B) by 12 weeks of add-on therapy with inhaled corticosteroids, stratified based on the criteria for type 2 inflammations in Japanese guidelines for ACO. Abbreviations: FeNO, exhaled nitric oxide fraction; FEV1, forced expiratory volume in 1s; CAT, chronic obstructive lung disease assessment test; CI, confidence interval; ACO, asthma–COPD overlap.
Figure 3
Figure 3
The schematic view of the vicious cycle of frailty/sedentary lifestyle in patients with COPD and potential approaches to attenuate the negative impact of this cycle.
See this image and copyright information in PMC

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