Changes in the Burden of Comorbidities in Patients with COPD and Asthma–COPD Overlap According to the GOLD 2017 Recommendations
Comorbidities associated with chronic obstructive pulmonary disease (COPD) affect quality of life and increase mortality. Asthma–COPD overlap (ACO) may express a different profile of comorbidities compared to COPD alone. It is unclear how recent changes in GOLD recommendations affect the profile of comorbidities in COPD and ACO.
Eight hundred and thirty-four patients with COPD were recruited from 67 Hungarian secondary care outpatient clinics, 469 of them had ACO. Comorbidities were defined by respiratory specialists based on medical history, patient report, and medications. COPD grades were defined according to the old 2016 and the new 2017 GOLD document. Comorbidities were compared along COPD ABCD groups determined by the old and new GOLD.
66 and 72% of the COPD patients in groups C and D (GOLD 2016) were recategorized to groups A and B (GOLD 2017), respectively. There was no difference in the prevalence of disorders along the 2016 GOLD categories except for osteoporosis in ACO (p = 0.01). When the patients were categorized according to the 2017 GOLD criteria, the prevalence of osteoporosis (p = 0.01) was different among the four groups in all COPD patients. Subgroup analysis of non-ACO COPD patients revealed inter-group differences for cardiac arrhythmia (p < 0.01). No alteration was seen in the prevalence of coronary artery disease, hypertension, diabetes, or the total number of comorbidities.
A significant number of patients are recategorized according to the GOLD 2017 criteria. This change only marginally affects the profile of comorbidities; still this needs to be considered when assessing the patients in daily practice.
KeywordsAsthma Asthma–COPD overlap Comorbidities COPD
The study has been funded by the Chiesi Hungary Ltd. This publication was supported by the Janos Bolyai Research Scholarship of the Hungarian Academy of Sciences to András Bikov. The funders have no role in statistical analysis or manuscript preparation.
Compliance with Ethical Standards
Conflict of interest
András Bikov received honoraria for data analysis. Zoltán Bártfai have received honoraria for presentation from Chiesi Hungary Ltd. Alpár Horváth and Gábor Tomisa are full time employees of Chiesi Hungary Ltd. The authors report no further conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Global Initiative for Chronic Obstructive Lung Disease (2017) Available from: http://www.goldcopd.org
- 4.Park HJ, Leem AY, Lee SH, Song JH, Park MS, Kim YS, Kim SK, Chang J, Chung KS (2015) Comorbidities in obstructive lung disease in Korea: data from the fourth and fifth Korean National Health and Nutrition Examination Survey. Int J Chronic Obstr Pulm Dis 10:1571–1582. https://doi.org/10.2147/copd.s85767 Google Scholar
- 6.Konecny T, Park JY, Somers KR, Konecny D, Orban M, Soucek F, Parker KO, Scanlon PD, Asirvatham SJ, Brady PA, Rihal CS (2014) Relation of chronic obstructive pulmonary disease to atrial and ventricular arrhythmias. Am J Cardiol 114(2):272–277. https://doi.org/10.1016/j.amjcard.2014.04.030 CrossRefPubMedGoogle Scholar
- 7.Shibata Y, Watanabe T, Osaka D, Abe S, Inoue S, Tokairin Y, Igarashi A, Yamauchi K, Kimura T, Kishi H, Aida Y, Nunomiya K, Nemoto T, Sato M, Konta T, Kawata S, Kato T, Kayama T, Kubota I (2011) Impairment of pulmonary function is an independent risk factor for atrial fibrillation: the Takahata study. Int J Med Sci 8(7):514–522CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Casanova C, Marin JM, Martinez-Gonzalez C, de Lucas-Ramos P, Mir-Viladrich I, Cosio B, Peces-Barba G, Calle-Rubio M, Solanes-Garcia I, Aguero R, de Diego-Damia A, Feu-Collado N, Alfageme I, Irigaray R, Balcells E, Llunell A, Galdiz JB, Marin M, Soler-Cataluna JJ, Lopez-Campos JL, Soriano JB, de-Torres JP (2014) New GOLD classification: longitudinal data on group assignment. Respir Res 15:3. https://doi.org/10.1186/1465-9921-15-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Jones PW, Brusselle G, Dal Negro RW, Ferrer M, Kardos P, Levy ML, Perez T, Soler-Cataluna JJ, van der Molen T, Adamek L, Banik N (2011) Health-related quality of life in patients by COPD severity within primary care in Europe. Respir Med 105(1):57–66. https://doi.org/10.1016/j.rmed.2010.09.004 CrossRefPubMedGoogle Scholar
- 11.Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, MacNee W, Miller BE, Rennard S, Silverman EK, Tal-Singer R, Wouters E, Yates JC, Vestbo J (2010) Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res 11:122. https://doi.org/10.1186/1465-9921-11-122 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Cabrera Lopez C, Casanova Macario C, Marin Trigo JM, de-Torres JP, Sicilia Torres R, Gonzalez JM, Polverino F, Divo M, Pinto Plata V, Zulueta JJ, Celli B (2018) Comparison of the 2017 and 2015 global initiative for chronic obstructive lung disease reports. Impact on grouping and outcomes. Am J Respir Crit Care Med 197(4):463–469. https://doi.org/10.1164/rccm.201707-1363OC CrossRefPubMedGoogle Scholar
- 14.Kahnert K, Alter P, Young D, Lucke T, Heinrich J, Huber RM, Behr J, Wacker M, Biertz F, Watz H, Bals R, Welte T, Wirtz H, Herth F, Vestbo J, Wouters EF, Vogelmeier CF, Jorres RA (2018) The revised GOLD 2017 COPD categorization in relation to comorbidities. Respir Med 134:79–85. https://doi.org/10.1016/j.rmed.2017.12.003 CrossRefPubMedGoogle Scholar
- 15.Global Initiative for Asthma (2017) Global strategy for asthma management and prevention, Available from: http://www.ginasthma.org
- 18.Agusti A, Hurd S, Jones P, Fabbri LM, Martinez F, Vogelmeier C, Vestbo J, Rodriguez-Roisin R (2013) FAQs about the GOLD 2011 assessment proposal of COPD: a comparative analysis of four different cohorts. Eur Respir J 42(5):1391–1401. https://doi.org/10.1183/09031936.00036513 CrossRefPubMedGoogle Scholar
- 19.Horvath A, Tomisa G, Meszaros A, Barfai L, Bartfai Z (2017) Assessing the characteristics of patients with COPD and asthma-COPD overlap syndrome within the framework of a real-life prospective study. Med Thoracalis 70(1):53–62Google Scholar
- 20.Tudoric N, Koblizek V, Miravitlles M, Valipour A, Milenkovic B, Barczyk A, Somfay A, Zykov K, Kostov K, Zbozinkova Z, Svoboda M, Sorli J, Krams A, Tkacova R (2017) GOLD 2017 on the way to a phenotypic approach? Analysis from the phenotypes of COPD in Central and Eastern Europe (POPE) Cohort. Eur Respir J. https://doi.org/10.1183/13993003.02518-2016 PubMedCentralGoogle Scholar
- 22.Sakurai-Iesato Y, Kawata N, Tada Y, Iesato K, Matsuura Y, Yahaba M, Suzuki T, Ikari J, Yanagawa N, Kasahara Y, West J, Tatsumi K (2017) The relationship of bone mineral density in men with chronic obstructive pulmonary disease classified according to the global initiative for chronic obstructive lung disease (GOLD) combined chronic obstructive pulmonary disease (COPD) assessment system. Intern Med 56(14):1781–1790. https://doi.org/10.2169/internalmedicine.56.6910 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Agusti A, Edwards LD, Celli B, Macnee W, Calverley PM, Mullerova H, Lomas DA, Wouters E, Bakke P, Rennard S, Crim C, Miller BE, Coxson HO, Yates JC, Tal-Singer R, Vestbo J (2013) Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort. Eur Respir J 42(3):636–646. https://doi.org/10.1183/09031936.00195212 CrossRefPubMedGoogle Scholar
- 25.Han MK, Muellerova H, Curran-Everett D, Dransfield MT, Washko GR, Regan EA, Bowler RP, Beaty TH, Hokanson JE, Lynch DA, Jones PW, Anzueto A, Martinez FJ, Crapo JD, Silverman EK, Make BJ (2013) GOLD 2011 disease severity classification in COPDGene: a prospective cohort study. Lancet Respir Med 1(1):43–50. https://doi.org/10.1016/s2213-2600(12)70044-9 CrossRefPubMedGoogle Scholar
- 27.Miyazaki M, Nakamura H, Chubachi S, Sasaki M, Haraguchi M, Yoshida S, Tsuduki K, Shirahata T, Takahashi S, Minematsu N, Koh H, Nakamura M, Sakamaki F, Terashima T, Sayama K, Jones PW, Asano K, Betsuyaku T (2014) Analysis of comorbid factors that increase the COPD assessment test scores. Respir Res 15:13. https://doi.org/10.1186/1465-9921-15-13 CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Koblizek V, Milenkovic B, Barczyk A, Tkacova R, Somfay A, Zykov K, Tudoric N, Kostov K, Zbozinkova Z, Svancara J, Sorli J, Krams A, Miravitlles M, Valipour A (2017) Phenotypes of COPD patients with a smoking history in Central and Eastern Europe: the POPE Study. Eur Respir J. https://doi.org/10.1183/13993003.01446-2016 PubMedCentralGoogle Scholar
- 37.Lucke T, Herrera R, Wacker M, Holle R, Biertz F, Nowak D, Huber RM, Sohler S, Vogelmeier C, Ficker JH, Muckter H, Jorres RA (2016) Systematic analysis of self-reported comorbidities in large cohort studies—a novel stepwise approach by evaluation of medication. PLoS One 11(10):e0163408. https://doi.org/10.1371/journal.pone.0163408 CrossRefPubMedPubMedCentralGoogle Scholar