INDACO project: COPD and link between comorbidities, lung function and inhalation therapy

Giorgio Fumagalli, Fabrizio Fabiani, Silvia Forte, Massimiliano Napolitano, Giovanni Balzano, Matteo Bonini, Giuseppe De Simone, Salvatore Fuschillo, Antonella Pentassuglia, Franco Pasqua, Pietro Alimonti, Stefano Carlone, Claudio M. Sanguinetti

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by respiratory and extrarespiratory components referring both to systemic complications of COPD, like skeletal muscle myopathy, weight loss and others, and frequently associated comorbidities, interesting various organs and systems (cardiovascular diseases, malignancies, osteoporosis, diabetes, etc.). These comorbidities may increase the rate of hospitalization of COPD patients and have a huge effect on the outcomes of the respiratory disease. Inhalation therapy of COPD with bronchodilators and steroid is primary driven by airflow obstruction, symptoms like dyspnoea, and acute exacerbations. INDACO project has been developed in 2013 to assess the prevalence and type of comorbidities in COPD patients referred to the outpatient wards of some hospitals in Central and South Italy and a preliminary report has recently been published. In the present study, after widening that database, we evaluate the prevalence of comorbidities and the relationships between comorbidities and sex, age, symptoms, lung function and inhalation therapy in COPD patients. Methods: In each enrolled patient, anthropometric and anamnestic data, smoking habits, respiratory function, GOLD (Global initiative for Chronic Obstructive Lung Disease) severity stage, Body Mass Index (BMI), number of acute COPD exacerbations in previous years, presence and type of comorbidities, and the Charlson Comorbidity Index (CCI) were recorded. Results: We collected data of 569 patients (395 males and 174 females, mean age 73 ± 8.5 yrs). The prevalence of patients with comorbidities was 81.2%. Overall number of comorbidities was not related to airflow obstruction and age, but to acute exacerbation of COPD, dyspnoea measured with MRC scale, and male gender. A subgroup analysis revealed that ischaemic heart disease was predominant in males, whereas mood disorders in females. The use of a more complex (multi-drug) inhalation therapy was related with bronchial obstruction measured by FEV1/FVC (p for trend = 0.003) and number of comorbidities (p for trend = 0.001). In multivariate analysis, only airflow obstruction and number of comorbidities were determinant of complexity of therapy, but not MRC and acute exacerbation of COPD. However, the statistical model reached an extreme low degree of significance (r∧2 = 0.07). Conclusions: Our study showed a high prevalence of comorbidities in COPD, with some differences related to gender. Number of comorbidities and airflow obstruction represent the determinant of inhalation therapy prescription. Dyspnoea and acute exacerbation of COPD, unlikely suggested by guidelines, are not significant drivers of therapy in the real life setting of our study.

Original languageEnglish
Article number4
JournalMultidisciplinary Respiratory Medicine
Volume10
Issue number1
DOIs
Publication statusPublished - 2015

Fingerprint

Respiratory Therapy
Chronic Obstructive Pulmonary Disease
Comorbidity
Lung
Dyspnea
Bronchodilator Agents
Statistical Models
Muscular Diseases
Mood Disorders
Italy
Osteoporosis
Habits
Myocardial Ischemia
Prescriptions
Disease Progression
Weight Loss

Keywords

  • BMI
  • Charlson index
  • Comorbidities
  • COPD
  • COPD exacerbation
  • FEV1
  • Inhaled therapy
  • Smoking

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Fumagalli, G., Fabiani, F., Forte, S., Napolitano, M., Balzano, G., Bonini, M., ... Sanguinetti, C. M. (2015). INDACO project: COPD and link between comorbidities, lung function and inhalation therapy. Multidisciplinary Respiratory Medicine, 10(1), [4]. https://doi.org/10.1186/2049-6958-10-4

INDACO project : COPD and link between comorbidities, lung function and inhalation therapy. / Fumagalli, Giorgio; Fabiani, Fabrizio; Forte, Silvia; Napolitano, Massimiliano; Balzano, Giovanni; Bonini, Matteo; De Simone, Giuseppe; Fuschillo, Salvatore; Pentassuglia, Antonella; Pasqua, Franco; Alimonti, Pietro; Carlone, Stefano; Sanguinetti, Claudio M.

In: Multidisciplinary Respiratory Medicine, Vol. 10, No. 1, 4, 2015.

Research output: Contribution to journalArticle

Fumagalli, G, Fabiani, F, Forte, S, Napolitano, M, Balzano, G, Bonini, M, De Simone, G, Fuschillo, S, Pentassuglia, A, Pasqua, F, Alimonti, P, Carlone, S & Sanguinetti, CM 2015, 'INDACO project: COPD and link between comorbidities, lung function and inhalation therapy', Multidisciplinary Respiratory Medicine, vol. 10, no. 1, 4. https://doi.org/10.1186/2049-6958-10-4
Fumagalli, Giorgio ; Fabiani, Fabrizio ; Forte, Silvia ; Napolitano, Massimiliano ; Balzano, Giovanni ; Bonini, Matteo ; De Simone, Giuseppe ; Fuschillo, Salvatore ; Pentassuglia, Antonella ; Pasqua, Franco ; Alimonti, Pietro ; Carlone, Stefano ; Sanguinetti, Claudio M. / INDACO project : COPD and link between comorbidities, lung function and inhalation therapy. In: Multidisciplinary Respiratory Medicine. 2015 ; Vol. 10, No. 1.
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AU - Fabiani, Fabrizio

AU - Forte, Silvia

AU - Napolitano, Massimiliano

AU - Balzano, Giovanni

AU - Bonini, Matteo

AU - De Simone, Giuseppe

AU - Fuschillo, Salvatore

AU - Pentassuglia, Antonella

AU - Pasqua, Franco

AU - Alimonti, Pietro

AU - Carlone, Stefano

AU - Sanguinetti, Claudio M.

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N2 - Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by respiratory and extrarespiratory components referring both to systemic complications of COPD, like skeletal muscle myopathy, weight loss and others, and frequently associated comorbidities, interesting various organs and systems (cardiovascular diseases, malignancies, osteoporosis, diabetes, etc.). These comorbidities may increase the rate of hospitalization of COPD patients and have a huge effect on the outcomes of the respiratory disease. Inhalation therapy of COPD with bronchodilators and steroid is primary driven by airflow obstruction, symptoms like dyspnoea, and acute exacerbations. INDACO project has been developed in 2013 to assess the prevalence and type of comorbidities in COPD patients referred to the outpatient wards of some hospitals in Central and South Italy and a preliminary report has recently been published. In the present study, after widening that database, we evaluate the prevalence of comorbidities and the relationships between comorbidities and sex, age, symptoms, lung function and inhalation therapy in COPD patients. Methods: In each enrolled patient, anthropometric and anamnestic data, smoking habits, respiratory function, GOLD (Global initiative for Chronic Obstructive Lung Disease) severity stage, Body Mass Index (BMI), number of acute COPD exacerbations in previous years, presence and type of comorbidities, and the Charlson Comorbidity Index (CCI) were recorded. Results: We collected data of 569 patients (395 males and 174 females, mean age 73 ± 8.5 yrs). The prevalence of patients with comorbidities was 81.2%. Overall number of comorbidities was not related to airflow obstruction and age, but to acute exacerbation of COPD, dyspnoea measured with MRC scale, and male gender. A subgroup analysis revealed that ischaemic heart disease was predominant in males, whereas mood disorders in females. The use of a more complex (multi-drug) inhalation therapy was related with bronchial obstruction measured by FEV1/FVC (p for trend = 0.003) and number of comorbidities (p for trend = 0.001). In multivariate analysis, only airflow obstruction and number of comorbidities were determinant of complexity of therapy, but not MRC and acute exacerbation of COPD. However, the statistical model reached an extreme low degree of significance (r∧2 = 0.07). Conclusions: Our study showed a high prevalence of comorbidities in COPD, with some differences related to gender. Number of comorbidities and airflow obstruction represent the determinant of inhalation therapy prescription. Dyspnoea and acute exacerbation of COPD, unlikely suggested by guidelines, are not significant drivers of therapy in the real life setting of our study.

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KW - BMI

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KW - COPD exacerbation

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KW - Inhaled therapy

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