title: Co-morbidities in patients with gold stage 4 chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Chronic Obstructive Pulmonary Disease (COPD) is associated with several co-morbidities, however their prevalence varies from one study to another.
  
  
  OBJECTIVE
  To determine the prevalence of several co-morbidities in patients with COPD severity score GOLD 4 (The Global Initiative for Chronic Obstructive Lung Disease, 2010) followed in ambulatory care, in a University Hospital.
  
  
  METHODS
  A questionnaire was designed and carried out in order to characterize COPD and its co-morbidities. Clinical files were consulted in order to complete the data.
  
  
  RESULTS
  89 patients (87% male) with a mean age of 68 years old, of which 79% were ex-smokers, were included. The average value of FEV1 (forced expiratory volume in one second) was 38% of the expected values and all the patients presented chronic respiratory failure. Thirty-five patients (39%) were frequent exacerbators. Thirty-seven patients (42%) had been hospitalized at least once due to exacerbation of their respiratory disease in the previous year, and 66 patients (74%) hospitalized in the previous five years. Most of the patients (97%) presented at least one comorbidity, with an average of 4 co-morbidities per patient and an average Charlson index of 2. The most frequent co-morbidities were cardiovascular diseases (69%), osteoarticular pathology (51%), erectile dysfunction (48%), sleep apnoea syndrome (43%) dyslipidaemia (35%), cataracts (31%), gastroesophageal reflux (29%) and diabetes (20%). Frequent exacerbators presented an increased risk of having two or more co-morbidities (Odds Ratio of 5), as well as a higher prevalence of gastroesophageal reflux (p=0.0006) and more hospitalizations in the last year and in the previous 5 years (p <0.001).
  
  
  CONCLUSIONS
  This study confirmed the high prevalence and the association of co-morbidities in patients with COPD severity score GOLD 4, thus justifying the need for a comprehensive and integrating therapeutic approach.
authors.affiliation: Serviço de Pneumologia, Hospital de Faro, Faro, Portugal. Electronic address: vandareias@hotmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Areias
authors.affiliation: Serviço de Pneumologia II, Centro Hospitalar Lisboa Norte, Hospital Pulido Valente, Lisboa, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Carreira
authors.affiliation: Serviço de Pneumologia II, Centro Hospitalar Lisboa Norte, Hospital Pulido Valente, Lisboa, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Anciães
authors.affiliation: Serviço de Pneumologia II, Centro Hospitalar Lisboa Norte, Hospital Pulido Valente, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Pinto
authors.affiliation: Serviço de Pneumologia I e II, Centro Hospitalar Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Bárbara
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Chronic obstructive pulmonary disease; Co-morbidities; Comorbilidades; Doença pulmonar obstrutiva crónica; Exacerbation; Exacerbação