Prevalence of different comorbidities in COPD patients by gender and GOLD stage

BACKGROUND: Several comorbidities frequently affect COPD progression. Aim of the study was to assess the prevalence of main comorbidities by gender and disease severity in a cohort of COPD patients referring for the first time to a specialist institution. METHODS: The study was a non-interventional, cross-sectional investigation carried out via automatic and anonymous selection from the institutional data base over the period 2012–2015. Inclusion criteria were: subjects of both sex aged ≥40 years; diagnosis of COPD according to GOLD guidelines 2014; the availability of a complete clinical record file. Variables collected were: lung function; smoking history; BMI; the Charlson Comorbidity Index (CCI); number and kind of comorbidities for each patient. RESULTS: At least one comorbidity of clinical relevance was found in 78.6 % of patients, but at least two in 68.8 %, and three or more were found in 47.9 % of subjects. Mean CCI was 3.4 ± 1.6sd. The overall prevalence was 2.6 comorbidities per patient, but 2.5 in males, and 3.0 in females, respectively (p < 0.05). Cardio-vascular disorders were the most frequent, but significantly more frequent in males (44.7 vs 30.7 %, respectively), while the metabolic, the digestive and the osteo-articular disorders were prevailing in females (12.4 vs 9.2; 14.2 vs 4.8, and 6.0 vs 3.8, respectively). In particular, chronic cor pumonale and arrhythmias mainly prevailed in men and congestive heart failure in females, while arterial hypertension resulted equally distributed. As concerning respiratory disorders, pneumonia, pleural effusions and chronic respiratory failure were more frequently found in men, while bronchiectasis and asthma-COPD overlap syndrome (ACOS) in females. Anaemia, gall bladder stones, osteoporosis and spontaneous fractures mostly prevailed in females, while gastric disorders of inflammatory origin and arthrosis were more frequent in males. Cognition disorders, dementia and signs of degenerative brain disorders were more frequently found in men, while depression in females. Finally, lung cancer was at the first place in men, but at the second in females. CONCLUSIONS: All comorbidities increased their prevalence progressively up to the last stage of COPD severity, except the cardio-vascular and the metabolic ones which dropped in the IV GOLD stage, presumably due to the high mortality rate in this severe COPD stage. The gender-dependency of comorbidities was confirmed in general terms, even if lung cancer proved a dramatic increase almost independently of sex

Comorbidity in chronic obstructive pulmonary disease. Related to disease severity?

Jose M Echave-Sustaeta,1 Lorena Comeche Casanova,1 Borja G Cosio,2 Juan Jose Soler-Catalu&ntilde;a,3 Ricardo Garcia-Lujan,1 Xavier Ribera41Respiratory Department, Hospital Universitario Quir&oacute;n Madrid, Madrid, Spain; 2Respiratory Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain; 3Respiratory Department, Hospital Arnau de Vilanova, Valencia, Spain; 4Medical Deparment, Boehringer Ingelheim, Barcelona, SpainBackground and objective: Several diseases commonly co-exist with chronic obstructive pulmonary disease (COPD), especially in elderly patients. This study aimed to investigate whether there is an association between COPD severity and the frequency of comorbidities in stable COPD patients.Patients and methods: In this multicenter, cross-sectional study, patients with spirometric diagnosis of COPD attended to by internal medicine departments throughout Spain were consecutively recruited by 225 internal medicine specialists. The severity of airflow obstruction was graded using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and data on demographics, smoking history, comorbidities, and dyspnea were collected. The Charlson comorbidity score was calculated.Results: Eight hundred and sixty-six patients were analyzed: male 93%, mean age 69.8 (standard deviation [SD] 9.7) years and forced vital capacity in 1 second 42.1 (SD 17.7)%. Even, the mean (SD) Charlson score was 2.2 (2.2) for stage I, 2.3 (1.5) for stage II, 2.5 (1.6) for stage III, and 2.7 (1.8) for stage IV (P=0.013 between stage I and IV groups), independent predictors of Charlson score in the multivariate analysis were age, smoking history (pack-years), the hemoglobin level, and dyspnea, but not GOLD stage.Conclusion: COPD patients attended to in internal medicine departments show high scores of comorbidity. However, GOLD stage was not an independent predictor of comorbidity.Keywords: Charlson, comorbidity, COP

Inhaler Adherence in COPD: A Crucial Step Towards the Correct Treatment

Miguel Tur&eacute;gano-Yedro,1 Eva Trillo-Calvo,2 Fernando Navarro i Ros,3,4 Jos&eacute; David Maya-Viejo,5 Cruz Gonz&aacute;lez Villaescusa,6,7 Jose Maria Echave Sustaeta,8 Esperanza Do&ntilde;a,9 Bernardino Alc&aacute;zar Navarrete10,11 1Centro de Salud Casar de C&aacute;ceres, Casar de C&aacute;ceres, C&aacute;ceres, Spain; 2Centro de Salud Campo de Belchite, Belchite, Zaragoza, Spain; 3Centro de Salud Ingeniero J Benlloch, Valencia, Spain; 4Red Investigadores SEMERGEN, Madrid, Spain; 5Unidad de Gesti&oacute;n Cl&iacute;nica de Camas, Distrito Sanitario Aljarafe-Sevilla Norte, Camas, Sevilla, Spain; 6Servicio de Neumolog&iacute;a, Hospital Cl&iacute;nico Universitario de Valencia, Valencia, Spain; 7Instituto de Investigaci&oacute;n Sanitaria INCLIVA, Valencia, Spain; 8Servicio de Neumolog&iacute;a, Hospital Universitario Quironsalud, Universidad Europea de Madrid, Madrid, Spain; 9Unidad M&eacute;dico-Quir&uacute;rgica de Enfermedades Respiratorias, Hospital Regional Universitario de M&aacute;laga, M&aacute;laga, Spain; 10Servicio de Neumolog&iacute;a, Hospital Universitario Virgen de las Nieves, Granada, Spain; 11Instituto de Investigaci&oacute;n Biosanitaria, Ibs- Granada, Granada, SpainCorrespondence: Miguel Tur&eacute;gano-Yedro, Centro de Salud Casar de C&aacute;ceres, Casar de C&aacute;ceres, C/ Barrionuevo Bajo, 49, Casar de C&aacute;ceres, C&aacute;ceres, 10190, Spain, Tel +34-927291531, Email [email protected]: COPD is a typical example of chronic disease. As such, treatment adherence tends to be as low as between 30% and 50%, with specific issues in COPD due to the use of inhaled therapies. Decreased adherence in COPD is associated with worse outcomes, with increased risk for exacerbations and long-term mortality. Factors that impact adherence are multiple, some related to patient, some related to clinicians and finally some related to healthcare system. Among clinician factors, prescription of simplified treatment regimens delivered by an inhaler adapted to the patient&rsquo;s characteristics is crucial. Although it has been observed a huge improvement in the design and usability of inhaler devices for COPD in the last two centuries, there is still a clear gap in this field. Smart inhalers as well as simplified treatment regimens could improve adherence and therefore improve long-term outcomes in COPD.Plain Language Summary: Treatment adherence in COPD is crucial as in many other chronic diseases, with specific issues due to inhaled route, and many factors involved. Low adherence in COPD has been linked to an increased risk of exacerbations and future mortality. Many interventions have been developed to improve treatment adherence in COPD. This review summarizes the current knowledge and future prospects for this important aspect of COPD treatment.Keywords: COPD, inhaled therapies, adherence, persistence, posolog

Polypharmacy Patterns: Unravelling Systematic Associations between Prescribed Medications

OBJECTIVES: The aim of this study was to demonstrate the existence of systematic associations in drug prescription that lead to the establishment of patterns of polypharmacy, and the clinical interpretation of the associations found in each pattern. METHODS: A cross-sectional study was conducted based on information obtained from electronic medical records and the primary care pharmacy database in 2008. An exploratory factor analysis of drug dispensing information regarding 79,089 adult patients was performed to identify the patterns of polypharmacy. The analysis was stratified by age and sex. RESULTS: Seven patterns of polypharmacy were identified, which may be classified depending on the type of disease they are intended to treat: cardiovascular, depression-anxiety, acute respiratory infection (ARI), chronic obstructive pulmonary disease (COPD), rhinitis-asthma, pain, and menopause. Some of these patterns revealed a clear clinical consistency and included drugs that are prescribed together for the same clinical indication (i.e., ARI and COPD patterns). Other patterns were more complex but also clinically consistent: in the cardiovascular pattern, drugs for the treatment of known risk factors—such as hypertension or dyslipidemia—were combined with other medications for the treatment of diabetes or established cardiovascular pathology (e.g., antiplatelet agents). Almost all of the patterns included drugs for preventing or treating potential side effects of other drugs in the same pattern. CONCLUSIONS: The present study demonstrated the existence of non-random associations in drug prescription, resulting in patterns of polypharmacy that are sound from the pharmacological and clinical viewpoints and that exist in a significant proportion of the population. This finding necessitates future longitudinal studies to confirm some of the proposed causal associations. The information discovered would further the development and/or adaptation of clinical patient guidelines to patients with multimorbidity who are taking multiple drugs