As if struggling to breathe every day weren’t difficult enough, many patients with chronic obstructive pulmonary disease — a progressive, incurable lung disease that makes it harder to breathe over time — have one or more additional health problems to contend with. These associated diseases are called comorbidities, and according to a 2015 article in the journal Multidisciplinary Respiratory Medicine, nearly 80 percent of COPD patients have at least one comorbidity that requires treatment. That same study found nearly 70 percent of patients had two comorbidities and almost 50 percent had three.
Dr. Umur Hatipoglu, director of the COPD Center at the Respiratory Institute at Cleveland Clinic, says the most common of these comorbidities is cardiovascular disease. These heart issues may include coronary artery disease, congestive heart failure and atrial fibrillation, “which is a rhythm abnormality of the heart. It’s relatively common as we age to get atrial fibrillation. But with COPD there seems to be a higher incidence of that,” Hatipoglu says. In addition, “some studies report up to one third of patients have coronary artery disease and we know that about 1 in 5 COPD patients have evidence of congestive heart failure,” he says. Hypertension, or high blood pressure, is also common among COPD patients.
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Patients with COPD may also be at higher risk for certain types of cancer. “Apart from lung cancer, one might encounter esophageal cancer, pancreatic cancer and breast cancer. These are all related in some form and magnitude to smoking,” Hatipoglu says. Smoking is also the number one risk factor for developing COPD.
Dr. Philip Diaz, a pulmonary specialist at The Ohio State University Wexner Medical Center in Columbus, Ohio, says other common comorbidities include diabetes, metabolic syndrome and cachexia, a muscle wasting syndrome that causes patients to lose weight and become weak.
Hatipoglu says some patients also experience “peptic ulcers and gastric ulcers that may complicate COPD.” Some patients may also deal with musculoskeletal issues like arthritis or osteoporosis — a thinning of the bones that can lead to potentially life-threatening fractures. In addition, “we see a fair amount of anxiety and depression, especially when the disease gets severe,” Hatipoglu says.
Clearly, there’s no shortage of additional health problems many COPD patients may be coping with every day. And these problems don’t just diminish quality of life. They can also shorten the length of a COPD patient’s life.
When asked whether these diseases are caused by COPD or just happen alongside it, Hatipoglu says, “that’s the $60 million question” and an area of ongoing research. “The data we have suggests that there may be a component attributable to COPD, but mostly the common thread is smoking.” Although it can’t be said for certain that one disease causes or contributes directly to the development of the other, the rate of incidence of these comorbidities suggests there could be a connection, Hatipoglu says.
“If you consider cardiovascular disease, for example, we know that strokes and heart attacks occur much more frequently around the time of an exacerbation of COPD,” which is a worsening of the disease that requires a change in treatment protocol, Hatipoglu says. “COPD exacerbation is associated by inflammation, and that is thought to induce vascular abnormalities that eventually lead to strokes and myocardial infarction,” meaning a heart attack.
Diaz also points to inflammation as an important aspect of both COPD and these other comorbidities. “There’s a thought that there’s inflammation in the lungs and that may spill over into the rest of the body and contribute to other diseases. There’s a systemic aspect of COPD that could be involved, so some of the same kind of mediators of inflammation that might be important in COPD might be happening in other conditions,” he says.
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Still, Hatipoglu says that based on the current scientific evidence, it’s not possible to say for sure that COPD causes these disorders. “But there seems to be a link that one makes the other worse.” And that theory is bolstered by the fact that these comorbidities are more prevalent among COPD patients than among the general public at the same age.
If you have one or more comorbidities alongside a COPD diagnosis, it’s important to work with your doctor to manage all the various conditions you’re dealing with. Although these may not be curable problems, they can be managed, and your doctor can determine the best way to treat these illnesses.
For the most part, the treatment approach for most of these comorbidities will be the same in COPD patients are as it would be for someone who doesn’t have COPD, with one notable exception — the use of certain drugs for some heart conditions. Cardiac medications called beta blockers may constrict airways. But a subset of these medications called cardioselective beta blockers target beta receptors in the heart only and don’t affect the airways. They’re now considered safe for use in patients with COPD. “I would say that apart from that little nuance — don’t use nonselective beta blockers, use selective beta blockers for coronary artery disease — treatment for these comorbidities is the same as in the general population,” Hatipoglu says.
In any event, it’s important to speak with your doctor about all your medications and conditions so that you can be sure any potential drug interaction problems can be avoided. “The point is that you have to be cognizant of the drugs that you’re using and the different conditions,” Diaz says.
Your doctor should monitor you for the most common comorbidities. Hatipoglu says that some patients who meet certain criteria may be screened for lung cancer, so you may want to ask your doctor whether that’s a good option for you.
Another comorbidity that can be managed before it gets severe is osteoporosis. Hatipoglu says the corticosteroids in many of the most commonly prescribed medications for COPD can cause osteoporosis. This bone loss may be compounded by the sedentary lifestyle of many COPD patients. “Since patients are short of breath, they don’t tend to move around much. Such immobilization is also a risk factor for osteoporosis.” Therefore, if you have severe COPD or have been taking inhaled or systemic corticosteroids for an extended period, it may be a good idea to have routine bone scans to measure bone strength.
Because depression and anxiety are such common conditions among COPD patients, particularly as the disease progresses, pay attention to your moods and how you’re feeling mentally and emotionally. Hatipoglu says doctors at the Cleveland Clinic screen for these issues by asking, “Have you felt hopeless over the past two weeks? Have you felt down and depressed over the past two weeks?” These symptoms can be addressed in a number of ways, including therapy or medications.
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And lastly, Diaz says pulmonary rehabilitation, a program of exercises and education that most COPD patients are prescribed at diagnosis, can improve cachexia and improve overall health in patients no matter which comorbidities they have. “In patients who have decreased muscle mass and cachexia or weakness and decreased endurance, exercise training like in pulmonary rehab is really important.” Exercise is also important for people with cardiovascular disease, osteoporosis, depression, diabetes and a host of other chronic conditions, so it’s almost always a good idea to get as much exercise as you can. “We think it’s beneficial in a lot of different conditions and different comorbidities and I think it can be helpful in a variety of ways,” Diaz says.
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What Complications or Comorbidities Are Associated With COPD? originally appeared on usnews.com
