INDACO project: COPD and link between comorbidities, lung function and inhalation therapy
Original research article
Multidisciplinary Respiratory Medicine 2015, 10:4Â
doi:10.1186/2049-6958-10-4
Published: 27 January 2015
Abstract (provisional)
Background
Chronic Obstructive Pulmonary Disease (COPD) is characterized by respiratory and extrarespiratory
components referring both to systemic complications of COPD, like skeletal muscle
myopathy, weight loss and others, and frequently associated comorbidities, interesting
various organs and systems (cardiovascular diseases, malignancies, osteoporosis, diabetes,
etc.). These comorbidities may increase the rate of hospitalization of COPD patients
and have a huge effect on the outcomes of the respiratory disease. Inhalation therapy
of COPD with bronchodilators and steroid is primary driven by airflow obstruction,
symptoms like dyspnoea, and acute exacerbations. INDACO project has been developed
in 2013 to assess the prevalence and type of comorbidities in COPD patients referred
to the outpatient wards of some hospitals in Central and South Italy and a preliminary
report has recently been published. In the present study, after widening that database,
we evaluate the prevalence of comorbidities and the relationships between comorbidities
and sex, age, symptoms, lung function and inhalation therapy in COPD patients.
Methods
In each enrolled patient, anthropometric and anamnestic data, smoking habits, respiratory
function, GOLD (Global initiative for Chronic Obstructive Lung Disease) severity stage,
Body Mass Index (BMI), number of acute COPD exacerbations in previous years, presence
and type of comorbidities, and the Charlson Comorbidity Index (CCI) were recorded.
Results
We collected data of 569 patients (395 males and 174 females, mean age 73 +/- 8.5
yrs). The prevalence of patients with comorbidities was 81.2%. Overall number of comorbidities
was not related to airflow obstruction and age, but to acute exacerbation of COPD,
dyspnoea measured with MRC scale, and male gender. A subgroup analysis revealed that
ischaemic heart disease was predominant in males, whereas mood disorders in females.
The use of a more complex (multi-drug) inhalation therapy was related with bronchial
obstruction measured by FEV1/FVC (p for trend = 0.003) and number of comorbidities
(p for trend = 0.001). In multivariate analysis, only airflow obstruction and number
of comorbidities were determinant of complexity of therapy, but not MRC and acute
exacerbation of COPD. However, the statistical model reached an extreme low degree
of significance (r^2 = 0.07).
Conclusions
Our study showed a high prevalence of comorbidities in COPD, with some differences
related to gender. Number of comorbidities and airflow obstruction represent the determinant
of inhalation therapy prescription. Dyspnoea and acute exacerbation of COPD, unlikely
suggested by guidelines, are not significant drivers of therapy in the real life setting
of our study.