Multimorbidity Patients Unit. Internal Medicine Department, H. Mutua Terrassa University Hospital, Plaza del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.
Department of Pneumology, Hospital Arnau de Vilanova-Lliria, Medicine Department, València University and CIBERES, Valencia, Spain.
BMC Pulm Med. 2024 Jan 2;24(1):6. doi: 10.1186/s12890-023-02758-0.
Chronic obstructive pulmonary disease (COPD) frequently coexists with other chronic diseases, namely comorbidities. They negatively impact prognosis, exacerbations and quality of life in COPD patients. However, no studies have been performed to explore the impact of these comorbidities on COPD clinical control criteria.
Determine the relationship between individualized comorbidities and COPD clinical control criteria.
Observational, multicenter, cross-sectional study performed in Spain involving 4801 patients with severe COPD (< 50 predicted forced expiratory volume in the first second [FEV%]). Clinical control criteria were defined by the combination of COPD assessment test (CAT) scores (≤16 vs ≥17) and exacerbations in the previous three months (none vs ≥1). Binary logistic regression adjusted by age and FEV% was performed to identify comorbidities potentially associated with the lack of control of COPD. Secondary endpoints were the relationship between individualized comorbidities with COPD assessment test and exacerbations within the last three months.
Most frequent comorbidities were arterial hypertension (51.2%), dyslipidemia (36.0%), diabetes (24.9%), obstructive sleep apnea-hypopnea syndrome (14.9%), anxiety (14.1%), heart failure (11.6%), depression (11.8%), atrial fibrillation (11.5%), peripheral arterial vascular disease (10.4%) and ischemic heart disease (10.1%). After age and FEV% adjustment, comorbidities related to lack of clinical control were cardiovascular diseases (heart failure, peripheral vascular disease and atrial fibrillation; p < 0.0001), psychologic disorders (anxiety and depression; all p < 0.0001), metabolic diseases (diabetes, arterial hypertension and abdominal obesity; all p < 0.001), sleep disorders (p < 0.0001), anemia (p = 0.015) and gastroesophageal reflux (p < 0.0001). These comorbidities were also related to previous exacerbations and COPD assessment test scores.
Comorbidities are frequent in patients with severe COPD, negatively impacting COPD clinical control criteria. They are related to health-related quality of life measured by the COPD assessment test. Our results suggest that comorbidities should be investigated and treated in these patients to improve their clinical control.
TAKE-HOME POINTS: Study question: What is the impact of comorbidities on COPD clinical control criteria?
Among 4801 patients with severe COPD (27.5% controlled and 72.5% uncontrolled), after adjustment by age and FEV%, comorbidities related to lack of clinical control were cardiovascular diseases (heart failure, peripheral vascular disease and atrial fibrillation; p < 0.0001), psychologic disorders (anxiety and depression; p < 0.0001), metabolic diseases (diabetes, arterial hypertension and abdominal obesity; p < 0.001), obstructive sleep apnea-hypopnea syndrome (p < 0.0001), anaemia (p = 0.015) and gastroesophageal reflux (p < 0.0001), which were related to previous exacerbations and COPD assessment test scores.
Comorbidities are related to health-related quality of life measured by the COPD assessment test scores and history of exacerbations in the previous three months.
慢性阻塞性肺疾病（COPD）常与其他慢性疾病并存，即合并症。它们对 COPD 患者的预后、加重和生活质量产生负面影响。然而，目前还没有研究探讨这些合并症对 COPD 临床控制标准的影响。
确定个体化合并症与 COPD 临床控制标准之间的关系。
这是一项在西班牙进行的观察性、多中心、横断面研究，涉及 4801 例严重 COPD（<50%预计用力呼气量第一秒[FEV%]）患者。通过 COPD 评估测试（CAT）评分（≤16 分与≥17 分）和前三个月的加重情况（无加重与≥1 次加重）的组合来定义 COPD 临床控制标准。采用二元逻辑回归对年龄和 FEV%进行调整，以确定与 COPD 控制不佳可能相关的合并症。次要终点是个体化合并症与 COPD 评估测试和前三个月内加重之间的关系。
最常见的合并症为动脉高血压（51.2%）、血脂异常（36.0%）、糖尿病（24.9%）、阻塞性睡眠呼吸暂停低通气综合征（14.9%）、焦虑（14.1%）、心力衰竭（11.6%）、抑郁（11.8%）、心房颤动（11.5%）、外周动脉血管疾病（10.4%）和缺血性心脏病（10.1%）。在年龄和 FEV%调整后，与缺乏临床控制相关的合并症为心血管疾病（心力衰竭、外周血管疾病和心房颤动；p<0.0001）、心理障碍（焦虑和抑郁；均 p<0.0001）、代谢疾病（糖尿病、动脉高血压和腹型肥胖；均 p<0.001）、睡眠障碍（p<0.0001）、贫血（p=0.015）和胃食管反流（p<0.0001）。这些合并症也与前三个月的加重和 COPD 评估测试评分相关。
严重 COPD 患者合并症较为常见，对 COPD 临床控制标准产生负面影响。它们与 COPD 评估测试所测量的健康相关生活质量有关。我们的研究结果表明，这些患者应调查和治疗合并症，以改善其临床控制。
研究问题：合并症对 COPD 临床控制标准有何影响？
在 4801 例严重 COPD 患者中（27.5%得到控制，72.5%未得到控制），经过年龄和 FEV%的调整，与临床控制不佳相关的合并症为心血管疾病（心力衰竭、外周血管疾病和心房颤动；p<0.0001）、心理障碍（焦虑和抑郁；p<0.0001）、代谢疾病（糖尿病、动脉高血压和腹型肥胖；p<0.001）、阻塞性睡眠呼吸暂停低通气综合征（p<0.0001）、贫血（p=0.015）和胃食管反流（p<0.0001），这些合并症与前三个月的加重和 COPD 评估测试评分有关。
合并症与 COPD 评估测试评分所测量的健康相关生活质量以及前三个月的加重情况有关。
