title: Managing comorbidities in COPD.
abstract: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Age and smoking are common risk factors for COPD and other illnesses, often leading COPD patients to demonstrate multiple coexisting comorbidities. COPD exacerbations and comorbidities contribute to the overall severity in individual patients. Clinical trials investigating the treatment of COPD routinely exclude patients with multiple comorbidities or advanced age. Clinical practice guidelines for a specific disease do not usually address comorbidities in their recommendations. However, the management and the medical intervention in COPD patients with comorbidities need a holistic approach that is not clearly established worldwide. This holistic approach should include the specific burden of each comorbidity in the COPD severity classification scale. Further, the pharmacological and nonpharmacological management should also include optimal interventions and risk factor modifications simultaneously for all diseases. All health care specialists in COPD management need to work together with professionals specialized in the management of the other major chronic diseases in order to provide a multidisciplinary approach to COPD patients with multiple diseases. In this review, we focus on the major comorbidities that affect COPD patients. We present an overview of the problems faced, the reasons and risk factors for the most commonly encountered comorbidities, and the burden on health care costs. We also provide a rationale for approaching the therapeutic options of the COPD patient afflicted by comorbidity.
authors.affiliation: Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Hillas
authors.affiliation: Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece.
authors.forename: Fotis
authors.initials: F
authors.lastname: Perlikos
authors.affiliation: Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece ; Department of General Practice, University Medical Centre of Groningen, Groningen, The Netherlands.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Tsiligianni
authors.affiliation: Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tzanakis
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003131:Combined Modality Therapy; D015897:Comorbidity; D003299:Cooperative Behavior; D019468:Disease Management; D017048:Health Care Costs; D006801:Humans; D033183:Interdisciplinary Communication; D001523:Mental Disorders / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D008659:Metabolic Diseases / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D010348:Patient Care Team; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome
keywords: chronic obstructive pulmonary disease; comorbid major diseases; health care costs; management; treatment