Comorbid Conditions in Chronic Obstructive Pulmonary Disease: Potential Therapeutic Targets for Unmet Needs

Abstract

The management of chronic obstructive pulmonary disease (COPD) has improved significantly due to advances in therapeutic agents, but it has also become apparent that there are issues that remain difficult to solve with the current treatment algorithm. COPD patients face a number of unmet needs concerning symptoms, exacerbations, and physical inactivity. There are various risk factors and triggers for these unmet needs, which can be roughly divided into two categories. One is the usual clinical characteristics for COPD patients, and the other is specific clinical characteristics in patients with comorbid conditions, such as asthma, cardiovascular disease, and bronchiectasis. These comorbidities, which are also associated with the diversity of COPD, can cause unmet needs resistance to usual care. However, treatable conditions that are not recognized as therapeutic targets may be latent in patients with COPD. We again realized that treatable traits should be assessed and treated as early as possible. In this article, we categorize potential therapeutic targets from the viewpoint of pulmonary and systemic comorbid conditions, and address recent data concerning the pathophysiological link with COPD and the impact of intervention on comorbid conditions in order to obtain evidence that could enable us to provide personalized COPD management.

A New Dyspnea Evaluation System Focusing on Patients’ Perceptions of Dyspnea and Their Living Disabilities: The Linkage between COPD and Frailty

“…The frailty group in the patients with PROMs-D score 1-2 had a higher CCI score than the non-frailty group. Since comorbid conditions in COPD are closely related to respiratory symptoms, exacerbations, and physical inactivity, it is important to identify therapeutic targets for these unmet medical needs [25]. Several studies have reported that comorbidities in COPD are associated with an increased risk of frailty [21,22].…”

“…The Kihon Checklist (KCL) is a self-administered questionnaire developed by the Japanese Ministry of Health, Labor, and Welfare to predict functional decline in community-dwelling elderly [29]. The KCL consists of 25 "yes/no" questions and divided into seven domains: 1 7depressive mood (questions [21][22][23][24][25]. The total KCL score, which is a sum of 25 answers, ranges from 0 (no frailty) to 25 (severe frailty).…”

“…KCL has a wide application not only in Japan, but has also been translated into English, Brazilian Portuguese, Spanish, and Chinese and shown to be adequate for cross-cultural studies [29][30][31][32][33]. We categorized patient frailty status as robust (0-3), prefrail (4-7), or frail (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), as previously reported [34].…”

“…Actually, patients with COPD have a greater risk for frailty than patients without COPD [19,20]. Moreover, patients with comorbid COPD and frailty have even worse outcomes (exacerbations, hospitalization, mortality, and worse quality of life) [18,[21][22][23][24][25]. Therefore, there is strong linkage of COPD, dyspnea and frailty.…”

Identification of Inflammation-Related Biomarker Lp-PLA2 for Patients With COPD by Comprehensive Analysis

“…Chronic obstructive pulmonary disease (COPD) is a complex and persistent lung disease, kills more than 3 million people worldwide every year (1). Despite progress in comprehensive therapies and prevention of acute exacerbations over past decades, therapeutic advances in ameliorate disease progression or reduce mortality remains few (2,3). Therefore, it is needed to have a better understanding of the complex disease mechanisms and explore better biomarkers to assess and monitor disease risk and prognosis.…”