Disease Progression and Age as Factors Underlying Multimorbidity in Patients with COPD: Results from COSYCONET

Int J Chron Obstruct Pulmon Dis. 2022 Jul 29:17:1703-1713. doi: 10.2147/COPD.S364812. eCollection 2022.

Abstract

Background: Multimorbidity plays an important role in chronic obstructive pulmonary disease (COPD) but is also a feature of ageing. We estimated to what extent increases in the prevalence of multimorbidity over time are attributable to COPD progression compared to increasing patient age.

Methods: Patients with COPD from the long-term COSYCONET (COPD and Systemic Consequences - Comorbidities Network) cohort with four follow-up visits were included in this analysis. At each visit, symptoms, exacerbation history, quality of life and lung function were assessed, along with the comorbidities heart failure (HF), coronary artery disease (CAD), peripheral arterial disease (PAD), hypertension, sleep apnea, diabetes mellitus, hyperlipidemia, hyperuricemia and osteoporosis. Using longitudinal logistic regression analysis, we determined what proportion of the increase in the prevalence of comorbidities could be attributed to patients' age or to the progression of COPD over visits.

Results: Of 2030 patients at baseline, 878 completed four follow-up visits (up to 4.5 years). CAD prevalence increased over time, with similar effects attributable to the 4.5-year follow-up, used as indicator of COPD progression, and to a 5-year increase in patients' age. The prevalence of HF, diabetes, hyperlipidemia, hyperuricemia, osteoporosis and sleep apnea showed stronger contributions of COPD progression than of age; in contrast, age dominated for hypertension and PAD. There were different relationships to patients' characteristics including BMI and sex. The results were not critically dependent on the duration of COPD prior to enrolment, or the inclusion of patients with all four follow-up visits vs those attending only at least one of them.

Conclusion: Analyzing the increasing prevalence of multimorbidity in COPD over time, we separated age-independent contributions, probably reflecting intrinsic COPD-related disease progression, from age-dependent contributions. This distinction might be useful for the individual assessment of disease progression in COPD.

Keywords: chronic obstructive pulmonary disease; comorbidities; disease progression; multimorbidity; prognosis.

MeSH terms

  • Diabetes Mellitus* / diagnosis
  • Diabetes Mellitus* / epidemiology
  • Disease Progression
  • Humans
  • Hyperlipidemias*
  • Hypertension* / epidemiology
  • Hyperuricemia* / diagnosis
  • Hyperuricemia* / epidemiology
  • Multimorbidity
  • Osteoporosis* / diagnosis
  • Osteoporosis* / epidemiology
  • Pulmonary Disease, Chronic Obstructive* / diagnosis
  • Pulmonary Disease, Chronic Obstructive* / epidemiology
  • Quality of Life
  • Sleep Apnea Syndromes*

Grants and funding

We are grateful to all COSYCONET study centers, especially to all study nurses, for their excellent and enduring work in data collection, as well as to all patients who were willing to participate in this study. COSYCONET is supported by the German Federal Ministry of Education and Research (BMBF) Competence Network Asthma and COPD (ASCONET) and performed in collaboration with the German Center for Lung Research (DZL). The project is funded by the BMBF with grant number 01 GI 0881 and is supported by unrestricted grants from AstraZeneca GmbH, Bayer Schering Pharma AG, Boehringer Ingelheim Pharma GmbH & Co. KG, Chiesi GmbH, GlaxoSmithKline, Grifols Deutschland GmbH, MSD Sharp & Dohme GmbH, Mundipharma GmbH, Novartis Deutschland GmbH, Pfizer Pharma GmbH, Takeda Pharma Vertrieb GmbH & Co. KG, Teva GmbH for patient investigations and laboratory measurements. For the present study, an additional grant for data management was given by Novartis Pharma GmbH. The funding body had no involvement in the design of the study, or the collection, analysis or interpretation of the data.