Prevalence of comorbidities according to predominant phenotype and severity of chronic obstructive pulmonary disease.
BACKGROUND
In addition to lung involvement, several other diseases and syndromes coexist in patients with chronic obstructive pulmonary disease (COPD). Our purpose was to investigate the prevalence of idiopathic arterial hypertension (IAH), ischemic heart disease, heart failure, peripheral vascular disease (PVD), diabetes, osteoporosis, and anxious depressive syndrome in a clinical setting of COPD outpatients whose phenotypes (predominant airway disease and predominant emphysema) and severity (mild and severe diseases) were determined by clinical and functional parameters.


METHODS
A total of 412 outpatients with COPD were assigned either a predominant airway disease or a predominant emphysema phenotype of mild or severe degree according to predictive models based on pulmonary functions (forced expiratory volume in 1 second/vital capacity; total lung capacity %; functional residual capacity %; and diffusing capacity of lung for carbon monoxide %) and sputum characteristics. Comorbidities were assessed by objective medical records.


RESULTS
Eighty-four percent of patients suffered from at least one comorbidity and 75% from at least one cardiovascular comorbidity, with IAH and PVD being the most prevalent ones (62% and 28%, respectively). IAH prevailed significantly in predominant airway disease, osteoporosis prevailed significantly in predominant emphysema, and ischemic heart disease and PVD prevailed in mild COPD. All cardiovascular comorbidities prevailed significantly in predominant airway phenotype of COPD and mild COPD severity.


CONCLUSIONS
Specific comorbidities prevail in different phenotypes of COPD; this fact may be relevant to identify patients at risk for specific, phenotype-related comorbidities. The highest prevalence of comorbidities in patients with mild disease indicates that these patients should be investigated for coexisting diseases or syndromes even in the less severe, pauci-symptomatic stages of COPD. The simple method employed to phenotype and score COPD allows these results to be translated easily into daily clinical practice.
Section of Respiratory Medicine, Department of Clinical and Experimental Medicine; Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence.
Gianna
G
Camiciottoli
Section of Respiratory Medicine, Department of Clinical and Experimental Medicine.
Francesca
F
Bigazzi
Section of Respiratory Medicine, Department of Clinical and Experimental Medicine.
Chiara
C
Magni
Section of Respiratory Medicine, Department of Clinical and Experimental Medicine.
Viola
V
Bonti
Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi," University of Bologna, Cesena.
Stefano
S
Diciotti
Department of Diagnostic Imaging, Careggi University Hospital.
Maurizio
M
Bartolucci
Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy.
Mario
M
Mascalchi
Section of Respiratory Medicine, Department of Clinical and Experimental Medicine.
Massimo
M
Pistolesi
D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
COPD phenotypes; COPD severity; comorbidities
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