Strict power of comorbidities successful patients with chronic obstructive pulmonary disease decreases exacerbations, morbimortality, and avoids readmissions. An expanding fig of women person the disease, which progresses otherwise successful women than successful men and adjacent has antithetic comorbidities.
"Comorbidities successful patients with chronic obstructive pulmonary illness are much communal successful older adults, successful those with much precocious pulmonary disease, and successful those that are hospitalized for an acute exacerbation," said Belén Alonso, MD, PhD, coordinator of the COPD Working Group of the Spanish Society of Internal Medicine. Up to 73 comorbidities associated with chronic obstructive pulmonary illness person been described. Alonso made these remarks during her presumption astatine the Comorbidities successful Chronic Obstructive Pulmonary Disease Panel, which took spot during the 43rd Conference of the Spanish Society of Internal Medicine (SEMI), successful Gijón, Spain.
According to the technological society's property release, moderator María Gómez Antúnez, MD, stated, "The close attack and attraction of these comorbidities is cardinal to amended the prime of beingness of the patient, alteration exacerbations, debar readmissions, and alteration morbimortality successful radical with chronic obstructive pulmonary disease."
The antithetic works published, 2 of them by the SEMI COPD Working Group (ECCO and ESMI studies), bespeak that the main comorbidities of patients with that pneumopathy are arterial hypertension, dyslipidemia, diabetes, heart failure, atrial fibrillation, ischemic bosom disease, chronic kidney disease, peripheral arterial disease, and osteoporosis. Chronic hepatopathy, pulmonary neoplasm, depression, and cerebrovascular illness are little common.
73 Comorbidities Described
Alonso told Medscape Spanish edition, "Of those 73 comorbidities, immoderate of the lesser known oregon little attraction grabbing, according to a insubstantial that we brought to the panel, see slumber disorders that encompass insomnia, nightmares, nighttime terrors, slumber apneas, oregon hypopneas. Other lesser-known comorbidities related to cognitive decline, with patterns that bespeak that up to 60% [of patients] whitethorn person immoderate grade of deterioration, impact the illness phase, hypoxemia, oregon grade of inflammation. On the different hand, it has besides been associated with Parkinson's disease and gastroesophageal reflux, among galore much that originate from the cardiovascular sphere."
One paper reveals that much than 78% of patients with chronic obstructive pulmonary illness person 1 associated comorbidity, astir 69% person two, and 47.9% person three.
"Based connected gender, comorbidities are different. In women, it is good observed that anxiety, depression, and osteoporosis are much common. However, hypertension, ischemic bosom disease, and diabetes are much communal successful men with chronic obstructive pulmonary disease," she stated.
"The pulmonary illness successful question besides progresses otherwise successful men and women. In women, onset is astatine younger ages — betwixt 40 and 50 years — and successful men, aft 50. Likewise, it appears that the illness progresses much quickly, which coincides with a worse prime of beingness (since dyspnea is tolerated less) and exceeds the anatomical differences, wherever hormonal influences play a ascendant role," Alonso stressed.
Reciprocal Prognosis
Alonso stated, "The prognostic value of comorbidities successful the illness is reciprocal. In different words, if determination are comorbidities that we bash not look for oregon treat, they are going to person a antagonistic power connected the chronic obstructive pulmonary disease. The illness volition advancement much and elevate the hazard of exacerbations (the astir important prognostic origin of that disease). In turn, if we are not treating the illness well, not lone pharmacologically, it volition person antagonistic repercussions connected the comorbidities. It volition advancement and person antagonistic connotations, specified arsenic diabetes oregon ischemic bosom disease."
The aforementioned ECCO and ESMI studies see patients successful interior medicine with exacerbations wherever the astir communal comorbidities person been mapped out, though determination is besides extended probe connected comorbidities successful patients who are admitted to departments different than interior medicine. "With respect to prognostic implications, our moving radical precise clearly observed the comorbidities and the comorbidome, that star strategy that appears truthful overmuch successful aesculapian conferences and forums, which implies that proximity to the halfway of that star strategy is related much to mortality, anxiety, depression, and bosom cancer. Other pathologies, specified arsenic ischemic bosom illness oregon dyslipidemia, are extracurricular of that territory of greater risk, successful which we person been much pioneering than different groups," said Alonso.
The existent inclination is that the property of these patients is increasing, and determination are much and much women with this pathology. According to the latest study from the Ministry of Health connected respiratory diseases, the prevalence of chronic obstructive pulmonary illness among the colonisation 40 years and older is astir 33.9 cases per 1000 inhabitants, much than doubly arsenic communal successful men than successful women (47.7 vs 21.3). Prevalence increases with property aft 40 years progressively until reaching the top frequence successful the 80- to 84-year-old property group.
In 2019, the fig of deaths owed to chronic obstructive pulmonary illness successful Spain was 13,808 (9907 men and 3901 women), with a crude mortality complaint of 29.3 deaths per 100,000 inhabitants. This toll decreased successful examination with that of 2018. Chronic obstructive pulmonary illness causes 2.5 times much deaths successful men than successful women. From 2001 to 2019, mortality owed to that pathology declined by 43% successful men and women. The alteration was astir 50% successful men and 33% successful women.
Overlap Syndrome Prevalent
Javier Sánchez Lora, MD, of the Internal Medicine Department of the Virgen de la Victoria de Málaga University Clinical Hospital, discussed chronic obstructive pulmonary illness and slumber disorders. More concretely, helium spoke astir overlap syndrome: chronic obstructive pulmonary illness positive obstructive slumber apnea. According to the international statement document connected obstructive slumber apnea, the diagnosis requires an apnea-hypopnea scale (AHI) adjacent to oregon greater than 15 per hr oregon adjacent to oregon greater than 5. The diligent indispensable besides person 1 oregon much of the pursuing factors: excessive daytime sleepiness, slumber that is not restful, excessive fatigue, and deterioration successful prime of beingness related to slumber and not justified by different causes.
"The overlap syndrome affects 3%-66% of chronic obstructive pulmonary diseases and 7%- 55% of obstructive slumber apnea," said Sánchez. This syndrome has important effects connected antithetic systems: astatine the cardiovascular level (arterial and pulmonary hypertension, bosom failure, stroke, arrhythmias, ischemic bosom disease, pulmonary thromboembolism), metabolic effects (insulin resistance, diabetes, metabolic syndrome), neurocognitive (dementia, depression), and neoplastic (lung, pancreas, esophagus) effects.
"These patients person a worse prognosis than those that person these pathologies alone. During sleep, they acquisition much predominant episodes of oxygen desaturation and they person a longer full play of slumber with hypoxemia and hypercapnia than those with obstructive apnea unsocial without chronic obstructive pulmonary disease," said Sánchez.
The apneic events of patients with the syndrome person a much profound hypoxemia and much arrhythmias, successful summation to being much susceptible to processing pulmonary hypertension than those with chronic obstructive pulmonary illness oregon slumber apnea alone. "The bully quality is that successful patients with overlap, the usage of ventilation with affirmative unit reduces each causes of hospitalization and the visits to the exigency room, arsenic good arsenic the mean and terrible exacerbations of the disease."
Sánchez referred to a bid of recommendations successful objective signifier for the diagnosis and attraction of overlap syndrome: screening, combined therapy of hygienic-dietary measures, and the usage of continuous affirmative respiratory pressure. Oxygen therapy to close isolated nocturnal desaturations has not shown benefits successful survival, though a payment proceedings of symptoms attributed to nocturnal hypoxemia successful patients with important comorbidity tin beryllium conducted.
Underdiagnosis
"During the panel, we besides spoke astir the value that arsenic portion of interior medicine we request to marque an effort to trim the underdiagnosis of chronic pulmonary illness and its comorbidities. Specialists successful interior medicine request to go alert that this pathology is not lone pulmonary, but besides multisystemic, complex, heterogenous, and precise adaptable adjacent successful the aforesaid patient," said Sánchez.
Alonso said, "Regarding the value of diagnosis of this disease, we proceed with an underdiagnosis greater than 70% for men and 80% for women. Secondly, we request to actively question retired the comorbidities associated with chronic obstructive pulmonary disease, adjacent taking vantage of the admittance of these patients with exacerbations, which are undesired and common.
"Regarding ongoing trials, we person a survey that started during the COVID-19 pandemic, ADEG-EPOC, that involves the adaptation to and interaction of terrible and precise terrible exacerbations successful patients admitted to our departments," the specializer indicated.
"In the group, we are besides readying to people an updated agreement, which we already made successful 2014, connected the astir communal and important comorbidities associated with chronic obstructive pulmonary disease." The statement discusses the 20 astir important comorbidities. In addition, the 2023 Gold Guide, which appeared successful November 2022, includes a caller section connected updated attraction and the latest developments.
In the past 5 years, Alonso has collaborated with Abbott, AstraZeneca, Boehringer Ingelheim, Chiesi, FAES, Ferrer, Fresenius Kabi, GSK, Nestlé, Novo Nordisk, Nutricia, and Menarini. Sánchez has collaborated with AstraZeneca, Boehringer Ingelheim, Chiesi, FAES, GSK, and Menarini.
Follow Javier Cotelo, MD, of Medscape Spanish Edition connected Twitter @Drjavico.
This nonfiction was translated from the Medscape Spanish edition.
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