About COPD and associated comorbidities


People with chronic obstructive pulmonary disease (COPD) often have other chronic diseases and long-term conditions. These are referred to as comorbidities—two or more health problems present at the same time. Comorbidities often share common risk factors, and are increasingly seen as acting together to determine the health outcome.

As people age, they are more likely to have more than one chronic condition. Because COPD is more likely to occur in older people, people with COPD also commonly report a range of other chronic conditions [1, 2, 3]. These comorbidities contribute to ill health and risk of death in all stages of COPD, and the incidence of hospitalisation for non-respiratory causes is increased in patients with COPD [3, 4]. As well, when people are admitted for non-respiratory causes, they have a longer length of hospital stay and are more likely to die if they also have COPD [5].

The chronic conditions that have been selected for this analysis are: asthma, cardiovascular disease, back problems, mental health problems, arthritis, diabetes and cancer. They have been selected because they are common in the general community and cause significant burden. Other chronic conditions that are found commonly in people with COPD, and that can impact on COPD, include chest infections, bronchiectasis, diabetes, obstructive sleep apnoea and osteoporosis [6].

Having a history of asthma is a major risk factor for being given a diagnosis of COPD, particularly for smokers [7, 8]. Around 15–20% of people with COPD also have a diagnosis of asthma; this is often called asthma–COPD overlap or asthma–COPD overlap syndrome (ACOS) [9, 10]. Due to the overlap in the definitions for asthma and COPD, it can be difficult to make an accurate diagnosis of these conditions [11].

Treatment and management

Comorbidities can complicate management options and multiply the effects of chronic conditions [7, 12]. Physicians may need to prescribe medications for one condition that may exacerbate another existing comorbid condition. For example, some bronchodilator medications prescribed for COPD may worsen glaucoma (increased pressure in the eyes), or can cause urinary problems in men with an enlarged prostate. Use of steroid tablets for COPD exacerbations (or flare-ups) may contribute to weakening of the bones (osteoporosis).

COPD has a high rate of comorbidity with cardiovascular disease (CVD) [13]. Beta-blocker medications are recommended for management of acute coronary syndromes, cardiac failure and sometimes for irregular heartbeat and hypertension. However, these medications can cause severe flare-ups in people with asthma and so have frequently been withheld from people with COPD. Despite this, recent evidence suggests that beta-blockers may be safe and helpful for managing COPD [14]. This highlights the importance of taking a person-centred, integrated, multidisciplinary approach to management and treatment of comorbid chronic conditions.

Establishing a better understanding of the common comorbidities of COPD may help with the diagnosis of comorbid conditions. For example, coronary artery disease is common in patients with COPD and is underdiagnosed [15]. As there are limited therapeutic options for COPD, the diagnosis and treatment of comorbidities is particularly important [6].

Prevention and diagnosis can be improved by a better understanding of risk factors for the development of COPD. Tobacco smoking, poor nutrition, air pollution, and serious childhood lung infections are all known risk factors for developing COPD [6].

Treatment strategies that target modifiable behaviours can be used to manage various chronic diseases, for example, diet, exercise, weight control, and smoking cessation or reduction [16]. For COPD, only smoking cessation has been shown to change prognosis.


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