News Release

Comorbidities are common in patients with COPD

Peer-Reviewed Publication

American Thoracic Society

ATS 2012, SAN FRANCISCO – The majority of patients with chronic obstructive pulmonary disease (COPD) referred for pulmonary rehabilitation have multiple extra-pulmonary comorbidities, according to a new study from the Netherlands.

"Comorbidities were common in our sample of 213 COPD patients from the CIRO Comorbidity (CIROCO) study, and most patients had varying combinations of comorbidities," said Lowie Vanfleteren, MD, of CIRO+, a center of expertise in chronic organ failure in Horn, the Netherlands, which is connected to the Maastricht University Medical Center. "The presence of these comorbidities may complicate the management of these patients and may ultimately influence their prognosis."

The results of the study will be presented at the ATS 2012 International Conference in San Francisco. Comorbidities were objectively assessed by measuring triglycerides, HDL cholesterol, hemoglobin, glucose, resting systolic and diastolic blood pressure, renal function (using estimated glomerular filtration rate), arterial stiffness (using aortic pulse wave velocity), subclinical atherosclerosis (using carotid intima-media thickness); bone mineral density (using DXA scans of the hip and lumbar spine), body weight, fat-free mass (using electrical bio impedance), and symptoms of anxiety and depression (using the Hospital Anxiety and Depression rating scale). Abnormal values were defined based on well-established cut-offs. The most common comorbidities observed were hyperglycemia (54%), subclinical atherosclerosis (53%), hypertension (48%), dyslipidemia (36%) and osteoporosis (31%). Obesity (23%), underweight (14%), muscle wasting (28%), renal impairment (22%), anxiety (21%) and depression (16%) were also present in a substantial percentage of patients.

Almost all (98%) patients had two or more comorbidities, and 54% had four or more. Using data mining software, five unique groups of patients with different combinations of comorbidities were identified.

"Identifying patients with particular clusters of comorbidities may ultimately lead to the development of patient-tailored treatment," said Dr. Vanfleteren.

"Most previous studies of comorbidities in COPD patients have used self-report data, limiting their validity, and have only examined comorbidities individually," said Dr. Vanfleteren. "By using objective measures of a range of comorbidities in our study, we have shown that not only are comorbidities common in COPD patients, but they often occur in groups."

"Future COPD practice guidelines should specifically address the treatment of comorbidities in these patients," Dr. Vanfletern concluded.

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"Objectified Co-Morbidities In Patients With COPD: The CIROCO Study" (Session B97, Monday, May 21, 2:00-4:30 p.m., Room 3020-3022, Moscone Center; Abstract 30329)

* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Abstract 30329
Objectified Co-Morbidities In Patients With COPD: The CIROCO Study
Type: Scientific Abstract
Category: 15.06 - Pulmonary Rehabilitation: Patient Assessment (PR)
Authors: L. Vanfleteren1, M.A. Spruit2, F. Franssen1, M. Groenen2, E.F.M. Wouters3; 1CIRO - Horn/NL, 2CIRO+ - Horn/NL, 3Maastricht University Medical Center - Maastricht/NL

Abstract Body

BACKGROUND

Extra-pulmonary co-morbidities significantly influence the prognosis of patients with COPD. To date, most co-morbidities have been studied individually, while combinations are most probably common; and most studies used self-reported co-morbidity data, which limits validity. Therefore, we studied the frequency of co-morbidities as well as combinations of co-morbidities in patients with COPD, using the baseline data of the CIRO CO-morbidity (CIROCO) study.

METHODS

In 127 patients with COPD (61% men; mean (SD) age: 64 (7) years; FEV1: 52 (18) % predicted) referred for pulmonary rehabilitation, we assessed levels of Triglycerides and HDL, haemoglobin, glucose resting systolic and diastolic blood pressure, renal function (using Cockroft-Gault's estimated glomerular filtration rate, eGFR), arterial stiffness (using aortic pulse wave velocity, APWV), subclinical atherosclerosis (using carotid intima-media thickness, c-IMT); bone mineral density (using DXA scans of hip and lumbar spine), body weight, fat-free mass (using electrical bio impedance), and symptoms of anxiety and depression (using HADS). Abnormal values were defined based on well-known cut-offs identified in the peer-reviewed English literature.

RESULTS

Frequencies of objectified co-morbidities are shown in figure 1. Most co-morbidities were substantially present. Overweight, glucose-intolerance, hypertension, arterial stiffness and subclinical atherosclerosis were most prevalent. 98% of the patients had ≥2 comorbidities, 50% had ≥5 co-morbidities. Various combinations of co-morbidities were found (figure 2). Moreover, specific clusters of co-morbidities could be identified.

CONCLUSION

About 50% of the patients with COPD, referred for pulmonary rehabilitation, have ≥5 objectified co-morbidities, which may complicate COPD management. Indeed, various combinations of co-morbidities have been identified. The presence of one co-morbidity is associated with the presence of others. Therefore, future clinical practice guidelines need to provide explicit guidance on treatment of (combinations of) co-morbidities in patients with COPD.

Funded by: Astra Zeneca


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