COPD, Comorbidities and Pulmonary Rehabilitation

Background: Comorbidities are extremely prevalent in people with COPD, yet current evidence-based guidelines continue to manage COPD as a single disease. Aim: To explore the impact of comorbidities... [ view full abstract ]

Background: Comorbidities are extremely prevalent in people with COPD, yet current evidence-based guidelines continue to manage COPD as a single disease.
Aim: To explore the impact of comorbidities on the health status of people with COPD presenting for pulmonary rehabilitation.
Methods: Secondary analysis of data from the PRINCE study was undertaken. The PRINCE study, a cluster RCT, provided this study with a sample of 350 patients with moderate and severe COPD presenting for pulmonary rehabilitation in primary healthcare settings in the North Western, Western and Midlands areas of Ireland.
Results: Of the 350 participants with COPD, 93% reported having one or more comorbidities. Hypertension and hypercholesterolemia (40.6%), osteoarticular conditions (39.7%), cardiovascular diseases (29.4%), other respiratory diseases (28.6%), gastrointestinal tract disorders (25.4%), ENT and ophthalmology conditions (16.3%), mental health disorders (15.7%) and diabetes (14.3%) were the most prevalent comorbidities. COPD patients with cardiovascular diseases, osteoarticular conditions and those with higher Charlson Comorbidity Index scores were found to have significantly reduced exercise tolerance at baseline assessment. In addition, COPD patients with mental health disorders significantly reported the worst HRQoL at baseline. Worryingly, 16% of the participants (n=55) were discovered to be at higher risk of mortality within one year, as determined by the Charlson Comorbidity Index. Medication usage was also found to be high, with participants prescribed an average of 7 medications (ranging from 1 to 19). Sixty percent of participants were prescribed six medications or more, indicating polypharmacy. Conclusion: The high prevalence of comorbidities discovered in people with COPD presenting for pulmonary rehabilitation, along with the significant burden found to be associated with specific comorbidities, highlights the need to ensure that COPD is no longer seen as a single chronic disease. Evidence-based guidelines for the management of COPD should be developed to include the most prevalent comorbidities found in this study.