Managing multimorbidity in primary care in patients with chronic respiratory conditions

Abstract

The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams.

Multimorbidity medications and poor asthma prognosis

“…Second, we showed that half of the patients belonging to the predominantly metabolic multimorbidity profile used drugs for psychological disorders. This novel finding emphasises that asthma management of these multimorbid patients should consider both physical and mental health dimensions [25]. Third, our results reinforce that the "current one-size-fits-all" therapeutic management in asthma has to be reconsidered towards personalised medicine integrating the multimorbidity dimension [40].…”

“…Our findings have relevant clinical implications. First, among elderly women with asthma, we identified a common subgroup of women with complex multimorbidities (allergic or metabolic), who most likely require a continuity of care by a physician and regular consultations to review their chronic conditions and related medications [25,40]. Second, we showed that half of the patients belonging to the predominantly metabolic multimorbidity profile used drugs for psychological disorders.…”

“…However, studies in elderly men with asthma are needed to address the generalisability of our findings. Indeed, although there is no clear evidence for sex differences in the rate of multimorbidity in asthma [25], the distribution of the multimorbidity medication profiles might differ between sexes because of differences in disease perception, in hormonal, environmental and occupational factors, and in adherence to medications between men and women with asthma [26]. Second, the population focused on women with ever-asthma covers a wide range of asthma phenotypes, and therefore allows addressing the role of disease activity and severity in multimorbidity.…”

Comorbidities in adults with asthma: Population‐based cross‐sectional analysis of 1.4 million adults in Scotland

“…Asthma is a world‐wide public health problem associated with a high economic cost and is the second most common chronic illness in primary care with 6.0% of the UK population being actively treated . Comorbidities are important to recognize in people with asthma because they can complicate the clinical care of patients with asthma in a variety of ways . First, comorbidities may present with similar symptoms as those associated with poor asthma control.…”

“…1,2 Comorbidities are important to recognize in people with asthma because they can complicate the clinical care of patients with asthma in a variety of ways. 3,4 First, comorbidities may present with similar symptoms as those associated with poor asthma control. This could lead to under-or overtreatment of asthma through misdiagnosis, increasing treatment burden and unnecessary cost.…”