<p>Management of the COPD Patient with Comorbidities: An Experts Recommendation Document</p>

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose: To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods: A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results: A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion: This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.

The Role of MDR1 (C3435T) Gene Polymorphism in Patients with Chronic Obstructive Pulmonary Disease Associated with Type 2 Diabetes Mellitus

“…However, not all the mechanisms for the development and advance of this pathology have been fully understood. The development of chronic systemic inflammation is found to be the characteristic of COPD and the appearance of systemic effects [ 11 ], leading to an increased incidence of concomitant pathology [ 12 , 13 ]. The incidence of type 2 diabetes mellitus (DM) with COPD is proved to be higher than in the case of its absence [ 14 - 16 ].…”

The use of beta-blockers in patients with chronic obstructive pulmonary disease and chronic heart failure in real clinical practice

“…Существующие рекомендации по ведению и лечению пациентов с ХОБЛ свидетельствуют о том, что «лечение СН у пациентов с ХОБЛ должно проводиться в соответствии со стандартными рекомендациями, поскольку нет данных о том, что СН следует лечить иначе при наличии ХОБЛ» [2,6]. Таким образом, при определении тактики лечения ХСН у больных ХОБЛ необходимо ориентироваться на Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН [7], а также на рекомендации Российского общества терапевтов по лечению пациентов с ХСН и ХОБЛ [8].…”

“…Особенностью современного пациента является полиморбидность, которая в значительной мере изменяет клиническое течение, прогноз основного заболевания и вносит коррективы в тактику лечения. Наиболее частыми причинами одышки у пожилых больных являются хроническая обструктивная болезнь легких (ХОБЛ) и хроническая сердечная недостаточность (ХСН) [1][2][3][4]. Распространённость сердечной недостаточности колеблется от 5% до 60% в общей популяции ХОБЛ и увеличивается в соответствии с тяжестью ХОБЛ, составляя приблизительно 30% у пациентов, госпитализированных с обострением ХОБЛ и 75% у пациентов, перенёсших искусственную вентиляцию легких [1][2][3][4].…”

Effect of chronic obstructive pulmonary disease combined with ventilator‑associated pneumonia on patient outcomes: A systematic review and meta‑analysis

“…A meta-analysis of 37 studies by Singanayagam et al ( 33 ) reported that low body mass index, cardiac failure, diabetes mellitus, ischemic heart disease and malignancy are significantly associated with increased mortality in patients with acute exacerbations of COPD. It is also reported that the presence of more than one co-morbidity may double the risk of COPD-associated mortality ( 34 ). Furthermore, similar co-morbidities are known to also influence outcomes of VAP ( 18 ).…”