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      Comorbidities and COPD severity in a clinic-based cohort

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          Abstract

          Background

          Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality around the world. The aim of our study was to determine the association between specific comorbidities and COPD severity.

          Methods

          Pulmonologists included patients with COPD using a web-site questionnaire. Diagnosis of COPD was made using spirometry post-bronchodilator FEV1/FVC < 70%. The questionnaire included the following domains: demographic criteria, clinical symptoms, functional tests, comorbidities and therapeutic management. COPD severity was classified according to GOLD 2011. First we performed a principal component analysis and a non-hierarchical cluster analysis to describe the cluster of comorbidities.

          Results

          One thousand, five hundred and eighty-four patients were included in the cohort during the first 2 years. The distribution of COPD severity was: 27.4% in group A, 24.7% in group B, 11.2% in group C, and 36.6% in group D. The mean age was 66.5 (sd: 11), with 35% of women . Management of COPD differed according to the comorbidities, with the same level of severity. Only 28.4% of patients had no comorbidities associated with COPD. The proportion of patients with two comorbidities was significantly higher ( p < 0.001) in GOLD B (50.4%) and D patients (53.1%) than in GOLD A (35.4%) and GOLD C ones (34.3%). The cluster analysis showed five phenotypes of comorbidities: cluster 1 included cardiac profile; cluster 2 included less comorbidities; cluster 3 included metabolic syndrome, apnea and anxiety-depression; cluster 4 included denutrition and osteoporosis and cluster 5 included bronchiectasis. The clusters were mostly significantly associated with symptomatic patients i.e. GOLD B and GOLD D.

          Conclusions

          This study in a large real-life cohort shows that multimorbidity is common in patients with COPD.

          Electronic supplementary material

          The online version of this article (10.1186/s12890-018-0684-7) contains supplementary material, which is available to authorized users.

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          Most cited references10

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          Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper

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            50-year trends in smoking-related mortality in the United States.

            The disease risks from cigarette smoking increased in the United States over most of the 20th century, first among male smokers and later among female smokers. Whether these risks have continued to increase during the past 20 years is unclear. We measured temporal trends in mortality across three time periods (1959-1965, 1982-1988, and 2000-2010), comparing absolute and relative risks according to sex and self-reported smoking status in two historical cohort studies and in five pooled contemporary cohort studies, among participants who became 55 years of age or older during follow-up. For women who were current smokers, as compared with women who had never smoked, the relative risks of death from lung cancer were 2.73, 12.65, and 25.66 in the 1960s, 1980s, and contemporary cohorts, respectively; corresponding relative risks for male current smokers, as compared with men who had never smoked, were 12.22, 23.81, and 24.97. In the contemporary cohorts, male and female current smokers also had similar relative risks for death from chronic obstructive pulmonary disease (COPD) (25.61 for men and 22.35 for women), ischemic heart disease (2.50 for men and 2.86 for women), any type of stroke (1.92 for men and 2.10 for women), and all causes combined (2.80 for men and 2.76 for women). Mortality from COPD among male smokers continued to increase in the contemporary cohorts in nearly all the age groups represented in the study and within each stratum of duration and intensity of smoking. Among men 55 to 74 years of age and women 60 to 74 years of age, all-cause mortality was at least three times as high among current smokers as among those who had never smoked. Smoking cessation at any age dramatically reduced death rates. The risk of death from cigarette smoking continues to increase among women and the increased risks are now nearly identical for men and women, as compared with persons who have never smoked. Among men, the risks associated with smoking have plateaued at the high levels seen in the 1980s, except for a continuing, unexplained increase in mortality from COPD.
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              Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function.

              Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70 as assessed by spirometry after bronchodilator use. However, many smokers who do not meet this definition have respiratory symptoms.
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                Author and article information

                Contributors
                Chantal.raherison@chu-bordeaux.fr
                al.bernady@gmail.com
                casteigt.julien@orange.fr
                c.nocent@ch-cotebasque.fr
                Laurent.falque@orange.fr
                Frederic.le.guillou@pneumopole-aunis.fr
                Laurent.nguyen33000@gmail.com
                ozierannaig@free.fr
                Mathieu.molimard@u-bordeaux.fr
                Journal
                BMC Pulm Med
                BMC Pulm Med
                BMC Pulmonary Medicine
                BioMed Central (London )
                1471-2466
                16 July 2018
                16 July 2018
                2018
                : 18
                : 117
                Affiliations
                [1 ]ISNI 0000 0001 2106 639X, GRID grid.412041.2, Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, ; F-33000 Bordeaux, France
                [2 ]ISNI 0000 0004 0593 7118, GRID grid.42399.35, Pole cardiothoracique, Respiratory Diseases Department, , CHU de Bordeaux, ; F-33000 Bordeaux, France
                [3 ]Rehabiliation Center, Cambo-les-Bains, France
                [4 ]Pneumology Clinic, St Medard en Jalles, France
                [5 ]General Hospital, Bayonne, France
                [6 ]Pneumology Clinic, Bordeaux, France
                [7 ]Pneumology Clinic, La Rochelle, France
                [8 ]Pneumology Clinic, St Augustin, Bordeaux, France
                [9 ]ISNI 0000 0001 2106 639X, GRID grid.412041.2, U1219 Pharmaco-epidemiology, , Bordeaux University, ; Bordeaux, France
                [10 ]ISNI 0000 0001 2106 639X, GRID grid.412041.2, Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, ; 146 rue Leo Saignat, 33076 Cedex Bordeaux, France
                Author information
                http://orcid.org/0000-0003-0015-2883
                Article
                684
                10.1186/s12890-018-0684-7
                6048834
                30012144
                d78726ec-9425-403c-8537-37e1ee303e74
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 February 2018
                : 5 July 2018
                Funding
                Funded by: Fondation Bordeaux Université
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Respiratory medicine
                copd,comorbidities,cluster analysis,management
                Respiratory medicine
                copd, comorbidities, cluster analysis, management

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