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. 2024 Nov 18;10(6):00268-2024.
doi: 10.1183/23120541.00268-2024. eCollection 2024 Nov.

Comorbidities reduce survival and quality of life in COPD with severe lung hyperinflation

Else A M D Ter Haar  1   2 , Dirk-Jan Slebos  1   2 , Karin Klooster  1   2 , Simon D Pouwels  1   2   3 , Jorine E Hartman  1   2
Affiliations

Comorbidities reduce survival and quality of life in COPD with severe lung hyperinflation

Else A M D Ter Haar et al. ERJ Open Res. .

Abstract

Rationale and aim: Patients with COPD often present with a significant number of comorbidities, which are thought to be related to a higher mortality risk. Our aim was to investigate the prevalence and impact of comorbidities on survival and quality of life (QoL), specifically in patients with emphysema characterised by severe lung hyperinflation.

Patients and methods: Data were prospectively collected from patients who visited our hospital for evaluating their eligibility for a bronchoscopic lung volume reduction treatment and were included in the Groningen Severe COPD cohort (NCT04023409). Comorbidities were patient-reported by a questionnaire and were validated with patients' medical records. QoL was assessed with the St Georges Respiratory Questionnaire.

Results: We included 830 COPD patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage III and IV. The total number of comorbidities was an independent predictor of survival when adjusting for other factors influencing survival (HR 1.12, 95% CI 1.05-1.20, p<0.001). Of the individual comorbidities, pulmonary arterial hypertension (HR 1.53, 95% CI 1.01-2.32, p=0.045), low body mass index (HR 1.63, 95% CI 1.16-2.27, p=0.004) and anxiety (HR 1.46, 95% CI 1.11-1.92, p=0.007) were independently associated with worse survival. Moreover, patients having 3, 4 or >5 comorbidities had a significantly (all p<0.05) worse QoL, in comparison to patients without comorbidities.

Conclusion: Our results show that comorbidities were associated with lower survival and poor QoL in emphysema patients characterised by severe hyperinflation. Appropriate treatment of treatable traits, including anxiety, low body mass index and pulmonary arterial hypertension, could lead to a survival benefit and improvement in QoL in this specific patient population.

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Conflict of interest statement

Conflict of interest: D-J. Slebos reports grants or contracts from PulmonX Corp, USA; Nuvaira, USA; PulmAir, USA; and Apreo, USA (clinical trial expenses); consulting fees from Nuvaira, USA; MoreAir, USA; and Apreo, USA; payment or honoraria for lectures from PulmonX, USA; and support for attending meetings and/or travel from PulmonX, USA. Conflict of interest: K. Klooster reports support for attending meetings and/or travel from PulmonX; participation on a data safety monitoring or advisory board from Apreo. Conflict of interest: S.D. Pouwels reports support for the present manuscript from a Dutch Research Council (NOW) VENI grant (number 09150162010003). Conflict of interest: E.A.M.D. ter Haar and J.E. Hartman have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Patient inclusion flowchart. FEV1: forced expiratory volume in 1 s.
FIGURE 2
FIGURE 2
Kaplan–Meier curve of survival of patients with less than three comorbidities versus patients with at least three comorbidities. Significance was tested using a log-rank test.
FIGURE 3
FIGURE 3
Box and whisker plot of St George's Respiratory Questionnaire (SGRQ) total scores according to the total number of comorbidities. SGRQ total scores range from 0 to 100, with higher scores indicating a worse quality of life. n: number of patients per group. *p<0.05 compared with no comorbidities; **p<0.01 compared with no comorbidities; ***p=0.001 compared with no comorbidities.
See this image and copyright information in PMC

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