Comorbidities in COPD Patients Affect Outcomes, Further Study Needed

At the 2023 symposium American Thoracic Society (ATS) International Conference encourages attendees to “think outside the lungs”, with expert presenters outlining common comorbidities requiring consideration for patients presenting with: Did. chronic obstructive pulmonary disease (COPD).

This session broadly discussed the comorbidity burden in COPD, focusing on three common comorbidities: anxiety and depression, cardiovascular disease, and skeletal muscle dysfunction. Challenges and opportunities for screening comorbidities in COPD patients were also the focus of the presentation.

Miguel J. Dibo, M.D., assistant professor of medicine at Harvard Medical School and clinician at Brigham and Women’s Hospital in Boston, Massachusetts, MPH, discusses the incidence of comorbidities across COPD and their impact on patient outcomes. gave insight.

“Roughly every patient we diagnose will have four to six different co-morbidities, which are not the cause of COPD,” said a study of 27,000 patients in Spain. Citing research, Dibo said. When compared to a similarly sized cohort of people without a diagnosis of COPD, regardless of age group, those with COPD had two more comorbidities than those without, he explained. .

Moreover, these comorbidities have been occurring between COPD and undiagnosed patients with COPD for about 15 years.

Dibo also highlighted quality-of-life and mortality data that quality of life is likely to deteriorate as the number of comorbidities increases. Moreover, having more complications is directly related to increased mortality, he said.

“So what is the culprit? [and] Cancer, cardiovascular disease, musculoskeletal disease, metabolic and endocrine disease, and mental health play a major role in all other aspects of patient-centered outcomes. “

COPD and mental health

Anxiety and depression in COPD are so prevalent in the population that they are important comorbidities to be examined, says FAASM’s Victor Kim, professor of thoracic medicine and surgery at Temple University in Philadelphia, Pennsylvania. said the doctor of medicine. While there is evidence supporting a link between mood disorders and COPD, anxiety and depression may be underestimated in clinical practice, he said.

“Despite its prevalence, half of people with anxiety and depression do not seek medication. It may not have been sufficiently recognized or given a low priority by the public,” Kim said.

Depression is even more prevalent in COPD patients, Kim noted, with 26% of the COPD cohort reporting symptoms of depression, compared with 12% and 7% of smokers and nonsmokers, respectively. emphasized the analysis that In the matched cohort, signs of depression were significantly more common in those with airflow obstruction.

In this cohort, depressive symptoms were more common in those with posterior airflow obstruction, current smokers, females, and younger and older patients. Similar data replicated in other cohorts regarding the prevalence of depressive symptoms in COPD, Kim said.

Another study showed that anxiety and depression were more common among people with more severe respiratory symptoms and exacerbations, based on the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) scores. Kim said it was. And depression, he noted, is associated with other outcomes.

For example, one study revealed an interesting correlation between the 6-minute walking distance test result and depression. Patients in the study showed only modest differences in lung function, but depressed patients walked about 50 meters less than non-depressed patients.

Concomitant anxiety and depression may also predict worsening respiratory symptoms, according to studies in two large cohorts of COPD patients. Kim explained that patients with both anxiety and depression are at higher risk of exacerbations. In other treatment settings, such as cardiovascular disease, mood disorders are also thought to worsen outcomes.

With the current data in mind, Kim concluded that treating the patient as a whole with comorbidities in mind is critical to improving outcomes for respiratory and other illnesses. .

Cardiovascular disease and COPD

Cardiovascular disease has long been known to be common in patients with COPD, and their comorbidity is often the subject of research. But less has been done to advance the management of concurrent COPD and cardiovascular disease, says Dr Jennifer K. Quint, FRCP, MSc, Professor of Respiratory Epidemiology, Imperial College London, UK explains.

Many potential risk factors contribute to the combination of cardiovascular disease and COPD, including smoking, physical inactivity, diet, and air pollution.

“All of this leads to accelerated inflammation,” says Quint. “We also know that exacerbation of COPD itself can affect cardiovascular disease.”

Although current guidelines for the treatment of cardiovascular disease in patients with COPD are clear and recommend treatment as for any other cardiovascular disease, patients with both conditions should be treated with beta-to-cardiovascular disease. Studies have shown that blockers are administered less frequently than in COPD patients. No co-occurring COPD.

Because of the overlap in symptomatic mechanisms, some of the therapies used for COPD may affect cardiovascular disease, and cardiovascular disease therapies may affect COPD. he pointed out. Research in this area is important, and some previous research suggests that some treatments for COPD may be protective from a cardiovascular perspective, Quint said.

While such concepts have been reported many times, a critical next step is to determine how care can be coordinated when these conditions occur simultaneously. Similarly, there is considerable overlap in the biological mechanisms and risk factors of COPD and cardiovascular disease, so research into how predisposition to cardiovascular disease occurs in the COPD population is needed, Quint said. It pointed out.

“Undiagnosed and unmanaged, ultimately you cannot change the outcome,” she says.

Skeletal muscle dysfunction and COPD

Dr. Harry B. Rossiter, a researcher at the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center in Torrance, Calif., found that between 12% and 40% of people with COPD experience muscle weakness and weakness. I started part of the presentation by pointing out that It then describes the cycle of muscle loss these patients can go through.

“Usually when we think of COPD and skeletal muscle, we think of the fact that these patients have difficulty breathing if they don’t forcefully exercise, which leads to muscle wasting and consequent increased demand for ventilators. ‘, said Rossiter. “So these patients have a higher need for a ventilator and a lower ventilatory capacity.”

The effects of muscle loss can be severe, he added, noting that in a study of about 200,000 hospitalized patients, about 10% of COPD patients exhibited a muscle-loss phenotype, and this is the reason patients are hospitalized. We emphasized that it was also the second strongest predictor of duration extension. Accompanied by exacerbation of COPD.

Professor Rossiter explained that physical inactivity alone is not the only mechanism of muscle wasting, and that physical inactivity alone cannot explain the decline in muscle mass and mitochondrial function experienced by people with COPD. Many factors may be involved, but the mechanism is not yet fully clear.

Rossiter noted that he has been working on clinical trials involving myostatin inhibitors and selective androgen receptor modulators for treatments that could break the cycle of weakness and weakness in people with COPD. From our experience in clinical trials, we have found that adding exercise to pharmacological interventions for muscle mass loss is key to concomitant strength gains.

Screening feasibility and barriers to implementation

While it would be ideal to simply screen all patients diagnosed with COPD for known comorbidities to facilitate timely and beneficial treatment, such an extensive process should be implemented. That’s easier said than done, said Jessica Vonn, M.D., associate professor of medicine. Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

Vonn reiterated the prevalence of comorbidities in patients with COPD and pointed out that the guidelines for screening these patients are vague. GOLD now comprehensively discusses comorbidities such as cardiovascular disease and osteoporosis, recognizing that they occur in all severities of COPD, but screening guidelines essentially stop there, says Bonn. said Mr.

“The problem is that we know that some of these comorbidities are high-risk and that general guidelines may not be sufficient,” said Vonn, referring to the comorbidities discussed in the session. is still underdiagnosed, he added.

Going forward, the development of extensive, relevant and cost-effective screening protocols will be required to reduce the gaps in identifying comorbidities in patients with COPD.