Common Comorbidities of COPD
Patients with COPD typically have multiple
comorbidities, many that share risk factors. In particular, smoking cigarettes and obesity are
well-documented causes of inflammation. Systemic inflammation — the activity of immune-related cells
in the body that promote inflammation — increases risk for COPD as well as a variety of other chronic
conditions, such as cardiovascular or metabolic conditions. Having COPD can increase risk for
developing a comorbid condition or vice versa. In addition, COPD comorbidities may exist because COPD
and common comorbid conditions frequently occur in older age. Common comorbidities of COPD include:
Various forms of cardiovascular disease, including hypertension, coronary artery disease, and heart failure, are
the most common and most notable COPD
comorbidities, because they have a significant impact on mortality. One systematic review found
that patients with COPD had 2.5 times higher odds of developing any form of cardiovascular disease, including
ischemic heart disease, cardiac dysrhythmia, heart failure, and arterial diseases like hypertension.
Diabetes and Metabolic Syndrome
The prevalence of diabetes among COPD
patients ranges from 10% to 19%; the prevalence of metabolic syndrome among COPD patients has been
estimated to be between 20% and 50%, depending on COPD severity. Research on COPD and type 2 diabetes
suggests that systemic inflammation may increase the risk for or impact the trajectory of each
condition. Lung inflammation is the hallmark of COPD; systemic inflammation, in part driven by
obesity, can reduce insulin resistance and increase risk for type 2 diabetes. In addition, the use of
inhaled steroids – a common medication for COPD treatment – increases risk for the development of
diabetes and influences disease progression.
Osteoporosis results in reduced bone density and increased risk for bone fractures. Smoking and
systemic inflammation increase risk for both COPD and osteoporosis; some research suggests that steroid use may also
be a risk factor for osteoporosis. Fractures due to falls among older adults are more severe among
individuals with osteoporosis, and functional impairment and physical limitations resulting from COPD
can increase that risk. Declining
health status due to older age increases risk for both osteoporosis and COPD.
Individuals with low lung function are 2 to 4 times more likely to have lung
cancer compared to those with normal lung function. Exposure to respiratory irritants, such as
cigarette smoke or environmental pollutants, are risk factors for both conditions. Symptoms of COPD,
such as obstructed airflow, respiratory exacerbations in the past year, and visual emphysema, have
been shown to increase the odds of developing lung cancer.
Mood disorders, particularly depression, are common among individuals with COPD. The prevalence of
depression among individuals with COPD is estimated to range from 20% to 60%, depending on
COPD severity and screening techniques. Most research suggests that mood disorders may result from or
be amplified by COPD. Functional impairment resulting from depression can reduce a COPD patient's
ability to socialize, which may increase isolation. COPD and various comorbidities may also cause an
individual distress that could contribute to depression, such as declining health status, reduced
quality of life, or overwhelming financial burdens. In addition, age can influence the relationship
between depression and COPD. Older adults are more likely to experience social isolation, which has
negative mental health impacts, and are more likely to have COPD due to declining health status and
the cumulative impact of smoking and other respiratory irritants.
Approximately 10% of COPD patients have
obstructive sleep apnea and about 20% of people with sleep apnea are also diagnosed with COPD.
Overlap of the two conditions can result in even lower oxygen levels in the blood while an individual
sleeps, but it is still unclear whether the two respiratory conditions lead to worse health impacts
compared to each condition separately. In general, patients with COPD often report greater sleep
disturbances than individuals without COPD, including interrupted sleep and less deep sleep.
Since patients may manage a large quantity of pharmacologic treatments for multiple conditions,
medication reconciliation is a critical component of COPD management. Patients should take the
correct medications at the appropriate dosages and frequencies. For example, it is important that
patients stop taking certain medications when directed or that they not accidentally take someone
else's medication. In addition, some medications may produce adverse effects when combined, so it is
important that healthcare providers keep an accurate and updated record of a patient's prescription
medications to avoid medication-related complications.