Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

Abstract

An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high‐income countries, due to increased exposure to tobacco, and in low‐income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender‐based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast...

Epilogue to contemporary perspectives in COPD: New Horizons

“…A targeted approach to medication choice, based on the frequency of exacerbations and the presence of eosinophilia, has enabled recommendations which narrow the most suitable population for inhaled corticosteroids (ICS) and should reduce the use of unnecessary and ineffective treatments, and significantly prevent some of the adverse effects associated with continuous high-dose ICS. 16 This series, encompassing patient burden, 17 the role of gender, the trajectories of multimorbidity, the causes and consequences of exacerbations, 18 the role of pharmacotherapy, 19 the lifetime evolution and mechanisms for COPD, 20 points out that we still have a long way to go in achieving optimal outcomes for patients with COPD. Although pharmacotherapy is a vital tool in reducing exacerbations, and although we talk about it as preventing exacerbations, it only does this to a certain degree 18 and we have few clinical indicators of the key characteristics of the majority of patients with COPD who are not frequent exacerbators and are not proportionately represented in clinical trials.…”

“…This series, encompassing patient burden, 17 the role of gender, the trajectories of multimorbidity, the causes and consequences of exacerbations, 18 the role of pharmacotherapy, 19 the lifetime evolution and mechanisms for COPD, 20 points out that we still have a long way to go in achieving optimal outcomes for patients with COPD. Although pharmacotherapy is a vital tool in reducing exacerbations, and although we talk about it as preventing exacerbations, it only does this to a certain degree 18 and we have few clinical indicators of the key characteristics of the majority of patients with COPD who are not frequent exacerbators and are not proportionately represented in clinical trials 13,21 .…”

“…Non‐communicable diseases (NCDs) now account for the majority of the burden of disease globally 33 . As outlined in the paper on trajectories of multimorbidity, NCDs have interconnecting features and multimorbidity adds complexity to COPD presentation, management and impact 17 . Some of these morbidities are extremely difficult to disentangle from the manifestations of COPD and may have major clinical consequences during an exacerbation.…”

The “Slow Horse Racing Effect” on Lung Function in Adult Life in Chronic Obstructive Pulmonary Disease Associated to Biomass Exposure

“…Women exposed to indoor smoke are more likely to develop chronic bronchitis than women who cook with other sources of energy (electricity or gas) ( 28 ). As a matter of fact, it may be considered a disease almost exclusively for women because the prevalence, comparatively in men, is much higher ( 29 ). In this sense, it may be a double public health issue; first of all because affects only women, and secondly because of the worldwide growing number of ill women ( 30 ).…”

Impact of Sex on Circulating Leukocytes Composition in COPD Patients

“…However, COPD cannot be longer considered a disease that predominantly affects men, since in the last decade the prevalence of COPD among women has equaled that of men. 8 Furthermore, several sex-based differences concerning susceptibility to tobacco exposure, phenotypic differences, symptoms, clinical parameters, quality of life, and therapeutic implication have been recently reviewed. 9 Nevertheless, only few studies addressed the difference in circulating leukocyte in male and female COPD.…”