Comorbidity, variable obstruction and COPD. A problem with many unknowns?

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the frequent diseases that most multimorbid patients have and, in turn, is one of the most important comorbid conditions that negatively affects the outcomes of other diseases.

Aim: Study of comorbid conditions in respondents with COPD and variable obstruction aged 35 to 70 years, residents of two cities in the NorthWest region of Russia

Materials and methods. Cohort study with variable obstruction (n=90) and COPD patients (n=53) identified at the population phase of the RESPECT study was performed. Demographic data and risk factors were studied, spirometry with bronchodilator test were performed. Comorbidity was considered using the modified Charlson index, quality of life was assessed.

Results and discussion. The mean age of the participants was 57.5±8.2 years, and did not differ between those with variable obstruction and COPD. Respondents with COPD were predominantly male (79.2% vs 43.3%), ever smokers (94.3% vs 67.4%); this group had a higher proportion of individuals with severe symptoms. The proportion of persons with high risk of exacerbations was equally low in both groups. The most common comorbidity was arterial hypertension (56.3%). The frequency of comorbidity and the level of comorbidity index did not differ between the two groups. The modified comorbidity index was associated with the number of years of smoking (β=0.025, p=0.034), anxiety and depression (β=0.092, p=0.009). More than half of those with COPD and variable obstruction were multimorbid (52.8% and 53.3%, p>0.05). Self-assessed quality of life worsened with age (β=0.027, p=0.045), was associated with multimorbidity (β=0.80, p=0.000), was not dependent on gender, and did not differ between respondents with COPD and those with variable obstruction.

Conclusion. Comorbidity should be assessed not only in individuals with COPD, but also in individuals with variable obstruction with mutual risk factors.

1. Drapkina O. M., Kontsevaya A. V., Kalinina A. M. et al. Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines. Cardiovascular Therapy and Prevention. 2024;23(3):3996 (In Russ.). https://doi.org/10.15829/1728-8800-2024-3996.

2. Drapkina O. M., Shutov A. M., Efremova E. V. Comorbidity, multimorbidity, dual diagnosis – synonyms or different terms? // Cardiovascular therapy and prevention. 2019;18(2):65–69. (In Russ.). https://doi.org/10.15829/1728-8800-2019-2-65-69.

3. Primary health care, public health and health organization. Handbook of concepts and terms. Comp. Kalinina A. M., Savchenko D. O., Voshev D. V. et al. Moscow, ROPNIZ, LLC “Silicea-Polygraph”, 2023. 76 p. (In Russ.). https://doi.org/10.15829/ROPNIZ-k1-2023.

4. Multimorbidity: clinical assessment and management. NICE guideline. 2016. URL: https://www.nice.org.uk/guidance/ng56/ (accessed: 20.12.24).

5. Skou S. T., Mair F. S., Fortin M. et al. Multimorbidity. Nat Rev Dis Primers. 2022;8(1):48. https://doi.org/10.1038/s41572-022-00376-4.

6. Aisanov Z. R., Chuchalin A. G., Kalmanova E. N. Chronic obstructive pulmonary disease and cardiovascular comorbidity. Kardiologiia. 2019;59(8S):24–36. (In Russ.). https://doi.org/10.18087/cardio.2572.

7. Mariniello D. F, D’Agnano V., Cennamo D. et al. Comorbidities in COPD: Current and Future Treatment Challenges. J Clin Med. 2024;13(3):743. https://doi.org/10.3390/jcm13030743.

8. Santos N. C. D., Miravitlles M., Camelier A. A. et al. Prevalence and Impact of Comorbidities in Individuals with Chronic Obstructive Pulmonary Disease: A Systematic Review. Tuberc Respir Dis (Seoul). 2022;85(3):205–220. https://doi.org/10.4046/trd.2021.0179.

9. The Global Strategy for the Diagnosis, Management and Prevention of Сhronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2024. URL: http://www.goldcopd.org/ (accessed: 20.12.24).

10. André S., Conde B., Fragoso E. et al. COPD and Cardiovascular Disease. Pulmonology. 2019;25(3):168–176. https://doi.org/10.1016/j.pulmoe.2018.09.006.

11. Charlson M. E., Carrozzino D., Guidi J., Patierno C. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. Psychother Psychosom. 2022;91(1):8–35. https://doi.org/10.1159/000521288.

12. Charlson Comorbidity Index. URL: https://www.mdcalc.com/calc/3917/charlson-comorbidity-index-cci.

13. Xiang Y., Luo X. Extrapulmonary Comorbidities Associated with Chronic Obstructive Pulmonary Disease: A Review. Int J Chron Obstruct Pulmon Dis. 2024;19:567–578. https://doi.org/10.2147/COPD.S447739.

14. Negewo N. A., Gibson P. G., McDonald V. M. COPD and its comorbidities: Impact, measurement and mechanisms. Respirology. 2015;20(8):1160–71. https://doi.org/10.1111/resp.12642.

15. Wijnant S. R. A., De Roos E., Kavousi M. et al. Trajectory and mortality of preserved ratio impaired spirometry: the Rotterdam Study. Eur Respir J. 2020;55(1):1901217. https://doi.org/10.1183/13993003.01217-2019.

16. Huang J., Li W., Sun Y. et al. Preserved Ratio Impaired Spirometry (PRISm): A Global Epidemiological Overview, Radiographic Characteristics, Comorbid Associations, and Differentiation from Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis. 2024;19:753–764. https://doi.org/10.2147/COPD.S453086.

17. Andreeva E., Pokhaznikova M., Lebedev A. et al. The RESPECT study: RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related etiology: a study protocol. BMC Public Health. 2015;15:831. https://doi.org/10.1186/s12889-015-2161-z.

18. Рokhaznikova M. A., Andreeva E. A., Ovakimyan K. V. et al. The prevalence of comorbidity in patients with chronic obstructive pulmonary disease in the North-West region of Russia based of the cross-sectional population study. The Bulletin of Contemporary Clinical Medicine. 2017;10(5):46–51. (In Russ.). https://doi.org/10.20969/vskm.2017.10(5).46-51.

19. Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 1983;(67):361–370.

20. EQ-5D. URL: http://www.euroqol.org/about-eq-5d/how-touse-eq-5d.html (accessed: 20.12.24).

21. Buhr R. G., Barjaktarevic I. Z., Quibrera P. M. et al. Reversible Airflow Obstruction Predicts Future Chronic Obstructive Pulmonary Disease Development in the SPIROMICS Cohort: An Observational Cohort Study. Am J Respir Crit Care Med. 2022;206(5):554–562. https://doi.org/10.1164/rccm.202201-0094OC.

22. Balanova Y. A., Shalnova S. A., Imaeva A. E. et al. Prevalence, Awareness, Treatment and Control of Hypertension in Russian Federation (Data of Observational ESSE-RF-2 Study). Rational Pharmacotherapy in Cardiology. 2019;15(4):450–466. (In Russ.). https://doi.org/10.20996/1819-6446-2019-15-4-450-466.

23. Makovski T. T., Schmitz S., Zeegers M. P. et al. Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev. 2019;53:100903. https://doi.org/10.1016/j.arr.2019.04.005.

24. Buttery S. C., Zysman M., Vikjord S. A. A. et al. Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity. Respirology. 2021;26(5):419–441. https://doi.org/10.1111/resp.14032.