COPD Comorbidities and Prognosis
Strict control of comorbidities in patients with chronic obstructive pulmonary disease it decreases exacerbations, morbidity and mortality and prevents readmissions. More and more women are suffering from the disease, which progresses differently in women than in men and even has different comorbidities.
“Comorbidities in patients with chronic obstructive pulmonary disease are more common in older adults, in those with more advanced lung disease, and in those who are hospitalized for an acute exacerbation,” said Belén Alonso, MD, PhD, coordinator of the Task Force on COPD. of the Spanish Society of Internal Medicine. Up to 73 comorbidities associated with chronic obstructive pulmonary disease have been described. Alonso made these statements during her presentation at the Panel on Comorbidities in Chronic Obstructive Pulmonary Disease, which took place during the 43rd Conference of the Spanish Society of Internal Medicine (SEMI), in Gijón, Spain.
According to the press release of the scientific society, the moderator María Gómez Antúnez, Dr. chronic obstructive pulmonary disease.”
The different published works, two of them from the SEMI COPD Working Group (ECCO and ESMI studies), indicate that the main comorbidities of patients with this lung disease are arterial hypertension, dyslipidemia, diabetes, heart failure, atrial fibrillation, ischemic heart disease, chronic kidney disease, Peripheral arterial diseaseand osteoporosis. Chronic liver disease, lung cancer, depression, and cerebrovascular disease are less common.
73 Comorbidities described
Alonso said Medscape Spanish Edition“Of those 73 comorbidities, some of the least well known or least attention-grabbing, according to a paper we presented to the panel, include sleep disorders that include insomnia, nightmares, night terrors, sleep apneas, or hypopneas. Other lesser-known related comorbidities with cognitive impairment, with patterns reflecting that up to 60% [of patients] it may have some degree of deterioration, involve the phase of the disease, hypoxemia or degree of inflammation. On the other hand, it has also been related to Parkinson’s disease Y gastroesophageal refluxamong many more that arise from the cardiovascular field.”
A paper reveals that more than 78% of patients with chronic obstructive pulmonary disease have one associated comorbidity, almost 69% two and 47.9% three.
“According to gender, comorbidities are different. In women, it is well observed that anxiety, depression and osteoporosis are more common. However, hypertension, ischemic heart disease and diabetes are more common in men with disease chronic obstructive pulmonary disease,” he said. fixed.
“The lung disease in question also progresses differently in men and women. In women, the onset is at earlier ages, between 40 and 50 years, and in men, from 50. Likewise, it seems that the disease progresses more rapidly, which coincides with a poorer quality of life (since dyspnea is less tolerated) and overcomes anatomical differences, where hormonal influences play a preponderant role”, Alonso emphasizes.
Alonso stated: “The prognostic importance of comorbidities in the disease is reciprocal. In other words, if there are comorbidities that we do not look for or treat, they will have a negative influence on chronic obstructive pulmonary disease. progress further and increase the risk of exacerbations (the most important prognostic factor of this disease), in turn, if we are not treating the disease well, not only pharmacologically, it will have a negative impact on comorbidities, it will progress and have negative effects. connotations, such as diabetes or ischemic heart disease.
The aforementioned ECCO and ESMI studies include internal medicine patients with exacerbations where the most frequent comorbidities have been mapped, although there is also extensive research on comorbidities in patients admitted to services other than internal medicine. “Regarding the prognostic implications, our very clearly observed comorbidities and comorbidity, that solar system that appears so much in congresses and medical forums, which implies that proximity to the center of that solar system is more related to mortality, anxiety, depression and breast cancer. Other pathologies, such as ischemic heart disease or dyslipidemia, are outside of that higher-risk territory, in which we have been more pioneers than other groups”, Alonso points out.
The current trend is that the age of these patients is increasing, and there are more and more women with this pathology. According to the latest report from the Ministry of Health on respiratory diseases, the prevalence of chronic obstructive pulmonary disease among the population aged 40 and over is around 33.9 cases per 1,000 inhabitants, more than double in men than in women. (47.7 vs 21.3). ). The prevalence increases with age from 40 years progressively until reaching the highest frequency in the age group of 80 to 84 years.
In 2019, the number of deaths from chronic obstructive pulmonary disease in Spain was 13,808 (9,907 men and 3,901 women), with a crude mortality rate of 29.3 deaths per 100,000 inhabitants. This number decreased compared to 2018. Chronic obstructive pulmonary disease causes 2.5 times more deaths in men than in women. From 2001 to 2019, mortality from this pathology decreased by 43% in men and women. The decrease was almost 50% in men and 33% in women.
Prevalent Overlap Syndrome
Dr. Javier Sánchez Lora, from the Internal Medicine Service of the Virgen de la Victoria University Clinical Hospital in Malaga, spoke about chronic obstructive pulmonary disease and sleep disorders. More specifically, he spoke of the overlap syndrome: chronic obstructive pulmonary disease plus Obstructive sleep apnea. According to the international consensus document on obstructive sleep apnea, diagnosis requires an apnea-hypopnea index (AHI) equal to or greater than 15 per hour or equal to or greater than 5. The patient must also have one or more of the following factors: excessive daytime sleepiness, sleep that is not restorative, excessive tiredness and deterioration of the quality of life related to sleep and not justified by other causes.
“The overlap syndrome affects 3-66% of chronic obstructive pulmonary diseases and 7-55% of obstructive sleep apneas,” said Sánchez. This syndrome has important effects on different systems: cardiovascular (arterial and pulmonary hypertensionheart failure, stroke, arrhythmias, ischemic heart disease, pulmonary thromboembolism), metabolic effects (insulin resistance, diabetes, metabolic syndrome), neurocognitive effects (dementia, depression), and neoplastic effects (lung, pancreas, esophagus).
“These patients have a worse prognosis than those with these pathologies alone. During sleep they experience more frequent episodes of oxygen desaturation and have a longer total sleep time with hypoxemia and hypercapnia than those with obstructive apnea alone without chronic obstructive pulmonary disease,” Sánchez said.
Patients with the syndrome have more profound hypoxemia and arrhythmias, as well as being more susceptible to developing pulmonary hypertension than those with chronic obstructive pulmonary disease or sleep apnea alone. “The good news is that in patients with overlap, the use of positive-pressure ventilation reduces all causes of hospitalization and emergency room visits, as well as moderate and severe exacerbations of disease.”
Sánchez referred to a series of recommendations in clinical practice for the diagnosis and treatment of overlap syndrome: screening, combined therapy of hygienic-dietary measures and the use of continuous positive respiratory pressure. Oxygen therapy to correct isolated nocturnal desaturations has not shown a survival benefit, although a benefit trial of symptoms attributed to nocturnal hypoxaemia can be performed in patients with significant comorbidity.
“During the panel we also talked about the importance that as internal medicine we must make an effort to reduce the underdiagnosis of chronic lung disease and its comorbidities. Internal medicine specialists must be aware that this pathology is not only pulmonary, but also multisystemic, complex, heterogeneous and highly variable even in the same patient,” said Sánchez.
Alonso said: “Regarding the importance of diagnosing this disease, we continue with an underdiagnosis of more than 70% in men and 80% in women. Secondly, we must actively search for comorbidities associated with chronic obstructive pulmonary disease, even taking advantage of the admission of these patients with exacerbations, which are unwanted and frequent.
“Regarding ongoing trials, we have a study that began during the COVID-19 pandemic, ADEG-COPD, which deals with the adaptation and impact of severe and very severe exacerbations in patients admitted to our services” , indicated the specialist.
“In the group we also plan to publish an updated agreement, which we already did in 2014, on the most common and important comorbidities associated with chronic obstructive pulmonary disease.” The agreement discusses the 20 most important comorbidities. In addition, the Gold Guide 2023, published in November 2022, includes a new chapter on updated treatment and the latest news.
In the last 5 years, Alonso has collaborated with Abbott, AstraZeneca, Boehringer Ingelheim, Chiesi, FAES, Ferrer, Fresenius Kabi, GSK, Nestlé, Novo Nordisk, Nutricia and Menarini. Sánchez has collaborated with AstraZeneca, Boehringer Ingelheim, Chiesi, FAES, GSK and Menarini.
Follow Javier Cotelo, MD, of Medscape Spanish Edition on Twitter @Drjavico.
This article was translated from Medscape Spanish edition.