A new study published online in the American Journal of Respiratory and Critical Care Medicine reveals that comorbidities amongst patients with chronic obstructive pulmonary disease (COPD) are common, and that several of these comorbidities are independently linked to a higher risk of mortality.
Leading author Miguel Divo, MD, a physician in the Pulmonary and Critical Division at Brigham and Women’s Hospital, who is also an Instructor in Medicine at Harvard Medical School, said:
“We followed 1,664 COPD patients recruited from five pulmonary clinics in the United States and Spain for a median of 51 months. Among the 79 comorbidites we observed in these patients, 12 were significantly and independently associated with an increased risk of death.”
The 12 comorbidities with the strongest mortality risk are breast, lung pancreatic and esophageal cancer, atrial fibrillation/flutter, pulmonary fibrosis, congestive heart failure, coronary artery disease, gastric/duodenal ulcers, liver cirrhosis, diabetes with neuropathy and anxiety.
Dr. Divo explained:
“We used these 12 comorbidities to develop a new comorbidity risk index (the COPD specific CO-morbidity Test, or COTE). After adjustment for age, gender, race, and BODE (Body Mass Index; FEV1; Dyspnea and Exercise capacity) index, an increased COTE index was a significant predictor of death in our cohort of COPD patients.”
They discovered that the average number of comorbidities per study participant was 6.0 (±3.5) overall. The average number of comorbidities was considerably higher in those who did not survive (6.5 ±3.8) as compared with those who did (5.8 ±3.3).
Dr. Divo added:
“These easily identifiable comorbidities could be screened by health care providers caring for COPD patients, as there may be effective interventions that may help decrease the risk of death.”
The researchers were aware of the study’s limitations, i.e. the low proportion of women in the study (11%) and that some patients were excluded at baseline due to comorbidities that may cause early death, such as a recent myocardial infarction, severe congestive heart failure, and untreated cancer. The patients were also recruited from specialty clinics and may therefore fail to represent all COPD patients.
Dr. Divo concluded:
“In this study we have confirmed earlier observations that patients with COPD frequently suffer from comorbidities, and have shown that 12 specific comorbidities are associated with an increased mortality risk in these patients. The simple comorbidity risk index we developed based on these 12 comorbidities complements the BODE index and can be used to help predict an increased risk of death in COPD patients in both clinical and research settings.”
Written By Petra Rattue