Comorbidity in patients with chronic obstructive pulmonary disease in family practice: a cross sectional study

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Abstract

Background

Chronic obstructive pulmonary disease (COPD) is frequent and often coexists with other diseases. The aim of this study was to quantify the prevalence of COPD and related chronic comorbidity among patients aged over 40 years visiting family practices in an area of Madrid.

Methods

An observational, descriptive, cross-sectional study was conducted in a health area of the Madrid Autonomous Region ( Comunidad Autónoma de Madrid). The practice population totalled 198,670 persons attended by 129 Family Physicians (FPs), and the study population was made up of persons over the age of 40 years drawn from this practice population. Patients were deemed to have COPD if this diagnosis appeared on their clinical histories. Prevalence of COPD; prevalence of a further 25 chronic diseases in patients with COPD; and standardised prevalence ratios, were calculated.

Results

Prevalence of COPD in family medicine was 3.2% (95% CI 3.0–3.3) overall, 5.3% among men and 1.4% among women; 90% of patients presented with comorbidity, with a mean of 4 ± 2.04 chronic diseases per patient, with the most prevalent related diseases being arterial hypertension (52%), disorders of lipid metabolism (34%), obesity (25%), diabetes (20%) and arrhythmia (15%). After controlling for age and sex, the observed prevalence of the following ten chronic diseases was higher than expected: heart failure; chronic liver disease; asthma; generalised artherosclerosis; osteoporosis; ischaemic heart disease; thyroid disease; anxiety/depression; arrhythmia; and obesity.

Conclusions

Patients with COPD, who are frequent in family practice, have a complex profile and pose a clinical and organisational challenge to FPs.

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Most cited references 33

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Mortality in COPD: Role of comorbidities.

D Sin, N R Anthonisen, J. Soriano … (2006)

Chronic obstructive pulmonary disease (COPD) represents an increasing burden throughout the world. COPD-related mortality is probably underestimated because of the difficulties associated with identifying the precise cause of death. Respiratory failure is considered the major cause of death in advanced COPD. Comorbidities such as cardiovascular disease and lung cancer are also major causes and, in mild-to-moderate COPD, are the leading causes of mortality. The links between COPD and these conditions are not fully understood. However, a link through the inflammation pathway has been suggested, as persistent low-grade pulmonary and systemic inflammation, both known risk factors for cardiovascular disease and cancer, are present in COPD independent of cigarette smoking. Lung-specific measurements, such as forced expiratory volume in one second (FEV(1)), predict mortality in COPD and in the general population. However, composite tools, such as health-status measurements (e.g. St George's Respiratory Questionnaire) and the BODE index, which incorporates Body mass index, lung function (airflow Obstruction), Dyspnoea and Exercise capacity, predict mortality better than FEV(1) alone. These multidimensional tools may be more valuable because, unlike predictive approaches based on single parameters, they can reflect the range of comorbidities and the complexity of underlying mechanisms associated with COPD. The current paper reviews the role of comorbidities in chronic obstructive pulmonary disease mortality, the putative underlying pathogenic link between chronic obstructive pulmonary disease and comorbid conditions (i.e. inflammation), and the tools used to predict chronic obstructive pulmonary disease mortality.

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Anxiety and depression in COPD: current understanding, unanswered questions, and research needs.

Janet Maurer, Venkata Rebbapragada, Soo Borson … (2008)

Approximately 60 million people in the United States live with one of four chronic conditions: heart disease, diabetes, chronic respiratory disease, and major depression. Anxiety and depression are very common comorbidities in COPD and have significant impact on patients, their families, society, and the course of the disease. We report the proceedings of a multidisciplinary workshop on anxiety and depression in COPD that aimed to shed light on the current understanding of these comorbidities, and outline unanswered questions and areas of future research needs. Estimates of prevalence of anxiety and depression in COPD vary widely but are generally higher than those reported in some other advanced chronic diseases. Untreated and undetected anxiety and depressive symptoms may increase physical disability, morbidity, and health-care utilization. Several patient, physician, and system barriers contribute to the underdiagnosis of these disorders in patients with COPD. While few published studies demonstrate that these disorders associated with COPD respond well to appropriate pharmacologic and nonpharmacologic therapy, only a small proportion of COPD patients with these disorders receive effective treatment. Future research is needed to address the impact, early detection, and management of anxiety and depression in COPD.

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Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities.

M Miravitlles, J. Soriano, F. García-Río … (2009)

This study aimed to determine the prevalence of chronic obstructive pulmonary disease (COPD) in Spain and identify the level of undiagnosed disease and its impact on health-related quality of life (HRQL) and activities of daily living (ADL). A population-based sample of 4274 adults aged 40-80 years was surveyed. They were invited to answer a questionnaire and undergo prebrochodilator and postbronchodilator spirometry. COPD was defined as a postbronchodilator FEV(1)/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio of <0.70. For 3802 participants with good-quality postbronchodilator spirometry, the overall prevalence of COPD was 10.2% (95% CI 9.2% to 11.1%) and was higher in men (15.1%) than in women (5.6%). The prevalence of COPD stage II or higher was 4.4% (95%CI; 3.8%-5.1%). The prevalence of COPD increased with age and with cigarette smoking and was higher in those with a low educational level. A previous diagnosis of COPD was reported by only 27% of those with COPD. Diagnosed patients had more severe disease, higher cumulative tobacco consumption and more severely impaired HRQL compared with undiagnosed subjects. However, even patients with undiagnosed COPD stage I+ already showed impairment in HRQL and in some aspects of ADL compared with participants without COPD. The prevalence of COPD in individuals between 40 and 80 years of age in Spain is 10.2% and increases with age, tobacco consumption and lower educational levels. The rate of diagnosised COPD is very high and undiagnosed individuals with COPD already have a significant impairment in HRQL and ADL.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Fam Pract

Journal ID (iso-abbrev): BMC Fam Pract

Title: BMC Family Practice

Publisher: BioMed Central

ISSN (Electronic): 1471-2296

Publication date Collection: 2013

Publication date (Electronic): 16 January 2013

Volume: 14

Page: 11

Affiliations

[1 ]Multiprofessional Education Unit for Family and Community Care (South-east), Hacienda de Pavones, 271, Madrid, 28030, Spain

[2 ]Multiprofessional Education Unit for Family and Community Care (Centre), Alberto Palacios, 22, Madrid, 28021, Spain

[3 ]Medical Department, Praxair España, Orense, 11, Madrid, 28020, Spain

[4 ]Telemedicine and e-Health Unit, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, Madrid, 28029, Spain

[5 ]Bioengineering and Telemedicine Unit, Puerta de Hierro University Teaching Hospital, Majadahonda, Madrid, Spain

Article

Publisher ID: 1471-2296-14-11

DOI: 10.1186/1471-2296-14-11

PMC ID: 3556139

PubMed ID: 23324308

SO-VID: 15e6548d-1032-41e8-bebf-1e178c8566bf

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comorbidity in patients with chronic obstructive pulmonary disease in family practice: a cross sectional study

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Abstract

Background

Methods

Results

Conclusions

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Biomarkers for Inflammatory Lung Disease

Most cited references 33

Mortality in COPD: Role of comorbidities.

Anxiety and depression in COPD: current understanding, unanswered questions, and research needs.

Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities.

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