Prevalence of different comorbidities in COPD patients by gender and GOLD stage

Abstract

Background: Several comorbidities frequently affect COPD progression. Aim of the study was to assess the prevalence of main comorbidities by gender and disease severity in a cohort of COPD patients referring for the first time to a specialist institution. Methods: The study was a non-interventional, cross-sectional investigation carried out via automatic and anonymous selection from the institutional data base over the period 2012–2015. Inclusion criteria were: subjects of both sex aged ≥40 years; diagnosis of COPD according to GOLD guidelines 2014; the availability of a complete clinical record file. Variables collected were: lung function; smoking history; BMI; the Charlson Comorbidity Index (CCI); number and kind of comorbidities for each patient. Results: At least one comorbidity of clinical relevance was found in 78.6 % of patients, but at least two in 68.8 %, and three or more were found in 47.9 % of subjects. Mean CCI was 3.4 ± 1.6sd. The overall prevalence was 2.6 comorbidities per patient, but 2.5 in males, and 3.0 in females, respectively (p < 0.05). Cardio-vascular disorders were the most frequent, but significantly more frequent in males (44.7 vs 30.7 %, respectively), while the metabolic, the digestive and the osteo-articular disorders were prevailing in females (12.4 vs 9.2; 14.2 vs 4.8, and 6.0 vs 3.8, respectively). In particular, chronic cor pumonale and arrhythmias mainly prevailed in men and congestive heart failure in females, while arterial hypertension resulted equally distributed. As concerning respiratory disorders, pneumonia, pleural effusions and chronic respiratory failure were more frequently found in men, while bronchiectasis and asthma-COPD overlap syndrome (ACOS) in females. Anaemia, gall bladder stones, osteoporosis and spontaneous fractures mostly prevailed in females, while gastric disorders of inflammatory origin and arthrosis were more frequent in males. Cognition disorders, dementia and signs of degenerative brain disorders were more frequently found in men, while depression in females. Finally, lung cancer was at the first place in men, but at the second in females. Conclusions: All comorbidities increased their prevalence progressively up to the last stage of COPD severity, except the cardio-vascular and the metabolic ones which dropped in the IV GOLD stage, presumably due to the high mortality rate in this severe COPD stage. The gender-dependency of comorbidities was confirmed in general terms, even if lung cancer proved a dramatic increase almost independently of sex.

Blood Eosinophil Counts, Withdrawal of Inhaled Corticosteroids and Risk of COPD Exacerbations and Mortality in the Clinical Practice Research Datalink (CPRD)

“…The following covariates were considered as potential confounders, and identified at the start of each interval: a history of congestive heart failure, ischemic heart disease, anxiety, chronic liver disease, cancer excluding non-melanoma skin cancer, stroke, rheumatoid arthritis, diabetes mellitus, hypertension, inflammatory bowel disease, solid organ transplant, atopic dermatitis, renal dialysis, human immunodeficiency virus or osteoporosis. In addition, the use of the following drugs within 6 months prior to the start of an interval were considered as potential confounders: antihistamines, proton pump inhibitors, antipsychotics, or antidepressants (19)(20)(21)(22). We statistically adjusted our analyses for proxy indicators of the severity of obstructive airway disease, as previously defined as use of short-and longacting b-agonists, short-and long-acting anti-muscarinic agents, xanthine derivatives or oral corticosteroids (23,24)…”

A Comparison of Clinical Profile and Prevalence of Comorbidities Among Biomass and Tobacco Smoke-Induced Copd Patients at a Tertiary Care Centre in North India

“…The presence of comorbidities depends on gender, disease severity and COPD phenotype. 10 Persistent inflammation is the cause of most of the comorbidities associated with COPD. Also, common risk factors and genetic predisposition play a role in the development of these comorbidities.…”

CT image registration-based lung mechanics In COPD

“…Chronic obstructive pulmonary disease (COPD) is currently the third-ranked cause of death in the United States behind cancer and heart disease [7,8]. Although it is largely preventable, the morbidity and mortality associated with COPD is ever increasing [9]. Our limited understanding of the underlying pathophysiology and minimal access to targeted therapies for COPD has made prevention difficult.…”

“…The inspiratory and expiratory CT images were registered for each subject. A lung mass preserving registration method was used to capture the large volume changes between these two images (9). This method uses a similarity metric called the sum of squared tissue volume difference (SSTVD), which estimates the local tissue and air fraction by minimizing local tissue mass difference [58,59].…”

“…The Jacobian or Jacobian determinant measures the local volume change under deformation from the inspiration to the expiration. The Jacobian determinant is a measurement to estimate the point wise volume expansion and contraction during the deformation (9,24). If the Jacobian value is one at a given voxel, then there is no deformation happened.…”