Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD

Abstract

BackgroundCOPD often coexists with chronic conditions that may influence disease prognosis. We investigated associations between chronic (co)morbidities and exacerbations in primary care COPD patients.MethodRetrospective cohort study based on 2012–2013 electronic health records from 179 Dutch general practices. Comorbidities from patients with physician-diagnosed COPD were categorized according to International Classification of Primary Care (ICPC) codes. Chi-squared tests, uni- and multivariable logistic, and Cox regression analyses were used to study associations with exacerbations, defined as oral corticosteroid prescriptions.ResultsFourteen thousand six hundred three patients with COPD could be studied (mean age 67 (SD 12) years, 53% male) for two years. At baseline 12,826 (88%) suffered from ≥1 comorbidities, 3263 (22%) from ≥5. The most prevalent comorbidities were hypertension (35%), coronary heart disease (19%), and osteoarthritis (18%). Several comorbidities showed statistically significant associations with frequent (i.e., ≥2/year) exacerbations: heart failure (odds ratio [OR], 95% confidence interval: 1.72; 1.38–2.14), blindness & low vision (OR 1.46; 1.21–1.75), pulmonary cancer (OR 1.85; 1.28–2.67), depression 1.48; 1.14–1.91), prostate disorders (OR 1.50; 1.13–1.98), asthma (OR 1.36; 1.11–1.70), osteoporosis (OR 1.41; 1.11–1.80), diabetes (OR 0.80; 0.66–0.97), dyspepsia (OR 1.25; 1.03–1.50), and peripheral vascular disease (OR 1.20; 1.00–1.45). From all comorbidity categories, having another chronic respiratory disease beside COPD showed the highest risk for developing a new exacerbation (Cox hazard ratio 1.26; 1.17–1.36).ConclusionChronic comorbidities are highly prevalent in primary care COPD patients. Several chronic comorbidities were associated with having frequent exacerbations and increased exacerbation risk.

COPD‐X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update

“…COPD is associated with many comorbidities 22 , 23 . Anxiety and depression are major contributors to hospital bed usage and readmissions, and should be optimally managed.…”

“…COPD is associated with many comorbidities. 22,23 Anxiety and depression are major contributors to hospital bed usage and readmissions, and should be optimally managed. Mortality from COPD is more associated with cardiac events than respiratory failure, 24 and the importance of avoiding prolonged overuse of b 2 -agonists is becoming increasingly recognised.…”

Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life

“…Additionally, heart failure, visual impairment, lung cancer, depression, prostate disorders, asthma, osteoporosis, diabetes, gastroesophageal reflux, and peripheral vascular disease are significantly associated with frequent (≥2 per year) exacerbations [32,81]. Coexisting asthma has also been shown to significantly increase the frequency of severe exacerbations [82].…”

Real‐world study of acute exacerbations of COPD reveals real gaps in care

“…Co‐morbidities play a major role in the risk of an ED presentation in patients with COPD, and we do not know the rate of concurrent diagnoses of other diseases that often complicate AECOPD, including pneumonia, heart failure, myocardial ischaemia and diabetes in this study. It is crucial to address these also during an admission, as it has been observed that over half of the readmissions in patients hospitalized for COPD may not be COPD‐related .…”