Prevalence of comorbidities in chronic obstructive pulmonary disease patients

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Abstract

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Abstract

Background:

This study compares the prevalence rates of comorbidities between chronic obstructive pulmonary disease (COPD) and non-COPD control patients reported in literature.

Method:

Literature was searched in several electronic databases. After the selection of studies by following précised eligibility criteria, meta-analyses of odds ratios (ORs) were carried out with subgroup and sensitivity analyses under random effects model.

Results:

Eleven studies (47,695,183 COPD and 47,924,876 non-COPD control patients’ data) were used for meta-analysis. Average age of COPD patients was 66.66 ± 8.72 years of whom 55.4 ± 11.9% were males. The prevalence of cardiovascular comorbidities [OR 1.90, 95% confidence interval (95% CI) 1.59–2.28; P < .00001], cerebrovascular comorbidities (OR 1.84, 95% CI 1.47–2.31; P < .00001), hypertension (OR 1.45, 95% CI 1.31–1.61; P < .00001), diabetes mellitus (OR 1.22, 95% CI 1.07–1.38; P = .003), neurological and psychiatric disorders (OR 1.78, 95% CI 1.48–2.14; P < .00001), gut and renal disorders (OR 1.96, 95% CI 1.43–2.68; P < .00001), musculoskeletal disorders (OR 1.51, 95% CI 1.27–1.78; P < .00001), non-COPD respiratory comorbidities (OR 2.81, 95% CI 2.52–3.14; P < .00001), and cancer (OR 1.67, 95% CI 1.25–2.23; P = .0005) were significantly higher in COPD patients than in non-COPD controls.

Conclusion:

COPD is associated with significantly higher comorbidities than in other diseases that should be taken into consideration in COPD control strategies.

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Most cited references 24

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Not 15 but 50% of smokers develop COPD?--Report from the Obstructive Lung Disease in Northern Sweden Studies.

Kara M. Lindstrom, L Larsson, E Rönmark … (2003)

The prevalence of chronic obstructive pulmonary disease (COPD) according to guidelines of today seems considerably higher than has been reported also in recent literature. To estimate the prevalence of COPD as defined by British Thoracic Society (BTS) criteria and the recent global initiative for chronic obstructive lung disease (GOLD) criteria. Further aims were to assess the proportion of underdiagnosis and of symptoms in subjects with COPD, and to study risk factors for COPD. In 1996, 5892 of the Obstructive Lung Disease in Northern Sweden (OLIN) Study's first cohort could be traced to a third follow-up survey, and 5189 completed responses (88%) were received corresponding to 79% of the original cohort from December 1985. Of the responders, a random sample of 1500 subjects were invited to a structured interview and a lung function test, and 1237 of the invited completed a lung function test with acceptable quality. In ages >45 years, the prevalence of COPD according to the BTS guidelines was 8%, while it was 14% according to the GOLD criteria. The absolutely dominating risk factors were increasing age and smoking, and approximately a half of elderly smokers fulfilled the criteria for COPD according to both the BTS and the GOLD criteria. Family history of obstructive airway disease was also a risk factor, while gender was not. Of those fulfilling the BTS criteria for COPD, 94% were symptomatics, 69% had chronic productive cough, but only 31% had prior to the study been diagnosed as having either chronic bronchitis, emphysema, or COPD. The corresponding figures for COPD according GOLD were 88, 51, and 18%. In ages >45 years, the prevalence of COPD according to the BTS guidelines was 8%, and it was 14% according to the GOLD criteria. Fifty percent of elderly smokers had developed COPD. The large majority of subjects having COPD were symptomatic, while the proportion of those diagnosed as having COPD or similar diagnoses was small.

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Alpha1-antitrypsin deficiency.

James K. Stoller, Loutfi Aboussouan (2015)

Alpha1-antitrypsin deficiency is a genetic disorder that affects about one in 2000-5000 individuals. It is clinically characterised by liver disease and early-onset emphysema. Although alpha1 antitrypsin is mainly produced in the liver, its main function is to protect the lung against proteolytic damage from neutrophil elastase. The most frequent mutation that causes severe alpha1-antitrypsin deficiency arises in the SERPINA 1 gene and gives rise to the Z allele. This mutation reduces concentrations in serum of alpha1 antitrypsin by retaining polymerised molecules within hepatocytes: an amount below the serum protective threshold of 11 micromol/L increases risk for emphysema. In addition to the usual treatments for emphysema, infusion of purified alpha1 antitrypsin from pooled human plasma represents a specific treatment and raises the concentrations in serum and epithelial-lining fluid above the protective threshold. Evidence suggests that this approach is safe, slows the decline of lung function, could reduce infection rates, and might enhance survival. However, uncertainty about the cost-effectiveness of this expensive treatment remains.

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Managing comorbidities in COPD

Georgios Hillas, Fotis Perlikos, Ioanna Tsiligianni … (2015)

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.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: May 2017

Publication date (Electronic): 12 May 2017

Volume: 96

Issue: 19

Electronic Location Identifier: e6836

Affiliations

[a ]Department of Respiratory Medicine, Heilongjiang Provincial Hospital

[b ]Department of Respiratory Medicine, Heilongjiang Electric Power Hospital, Harbin, Heilongjiang, China.

Author notes

[∗ ]Correspondence: Tao Liu MD, Department of Respiratory Medicine, Heilongjiang Provincial Hospital, No. 405, Guogeli Street, Nangang District, Harbin 150001, China (e-mail: taoliu_med@ 123456126.com ).

Article

Publisher ID: MD-D-15-05306 Accession ID: 06836

DOI: 10.1097/MD.0000000000006836

PMC ID: 5428602

PubMed ID: 28489768

SO-VID: 7f8394ca-6bda-44d4-abf2-7b50f9f6f94c

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

History

Date received : 29 November 2015

Date revision received : 10 April 2017

Date accepted : 14 April 2017

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Keywords: chronic obstructive pulmonary disease,comorbidities,copd,prevalence

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Keywords: chronic obstructive pulmonary disease, comorbidities, copd, prevalence

Prevalence of comorbidities in chronic obstructive pulmonary disease patients : A meta-analysis

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Biomarkers for Inflammatory Lung Disease

Most cited references 24

Not 15 but 50% of smokers develop COPD?--Report from the Obstructive Lung Disease in Northern Sweden Studies.

Alpha1-antitrypsin deficiency.

Managing comorbidities in COPD

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