title: Comorbidities associated with COPD in the Middle East and North Africa region: association with severity and exacerbations.
abstract: OBJECTIVE
  To assess the frequency of comorbidities in subjects with COPD and their association with respiratory symptom severity and COPD exacerbations.
  
  
  METHODS
  This was an analysis of the BREATHE study, a cross-sectional survey of COPD conducted in the general population of eleven countries in the Middle East and North Africa, including Pakistan. The study population consisted of a sample of subjects with COPD for whom the presence of comorbidities was documented. Three questionnaires were used. The screening questionnaire identified subjects who fulfilled an epidemiological case definition of COPD and documented any potential comorbidities; the detailed COPD questionnaire collected data on respiratory symptoms, COPD exacerbations, and comorbidities associated with COPD; the COPD Assessment Test collected data on the impact of respiratory symptoms on well-being and daily life.
  
  
  RESULTS
  A total of 2,187 subjects were positively screened for COPD, of whom 1,392 completed the detailed COPD questionnaire. COPD subjects were more likely to report comorbidities (55.2%) than subjects without COPD (39.1%, P<0.0001), most frequently cardiovascular diseases. In subjects who screened positively for COPD, the presence of comorbidities was significantly (P=0.03) associated with a COPD Assessment Test score ≥10 and with antecedents of COPD exacerbations in the previous 6 months (P=0.03).
  
  
  CONCLUSIONS
  Comorbidities are frequent in COPD and associated with more severe respiratory symptoms. This highlights the importance of identification and appropriate management of comorbidities in all subjects with a diagnosis of COPD.
authors.affiliation: Department of Pulmonary Medicine and Allergy, University of Sharjah, Sharjah, United Arab Emirates.
authors.forename: Bassam
authors.initials: B
authors.lastname: Mahboub
authors.affiliation: Respirology Division, Zayed Military Hospital, Abu Dhabi, United Arab Emirates.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Alzaabi
authors.affiliation: Department of Pulmonary Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
authors.forename: Mohammed Nizam
authors.initials: MN
authors.lastname: Iqbal
authors.affiliation: Foxymed, Paris, France.
authors.forename: Hocine
authors.initials: H
authors.lastname: Salhi
authors.affiliation: MS Health, Rabat, Morocco.
authors.forename: Aïcha
authors.initials: A
authors.lastname: Lahlou
authors.affiliation: GlaxoSmithKline, Dubai, United Arab Emirates.
authors.forename: Luqman
authors.initials: L
authors.lastname: Tariq
authors.affiliation: GlaxoSmithKline, Dubai, United Arab Emirates.
authors.forename: Abdelkader
authors.initials: A
authors.lastname: El Hasnaoui
mesh_terms: D000328:Adult; D000352:Africa, Northern / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D010154:Pakistan / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D000067251:Symptom Flare Up
keywords: COPD exacerbation; MENA region; cardiovascular disease; comorbidity; diabetes