Prevalence of comorbidities and impact on pulmonary rehabilitation outcomes

Abstract

BackgroundThe presence of comorbid conditions could impact performance in pulmonary rehabilitation (PR) programmes. We aimed to compare the comorbidity prevalence among those with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) and evaluate the impact on PR response.MethodsWe performed a retrospective cohort study, recording comorbidities for all patients with COPD or ILD referred to PR. Participants were classified as responders to PR if they met the minimal important difference for exercise capacity and health-related quality of life (HRQoL). The prevalence of comorbidities and impact on PR outcomes were compared by lung disease and by sex using a univariate analysis and multivariate logistic regression.ResultsThe mean number of comorbidities was similar among those with COPD (3.3±2.1, n=242) and ILD (3.2±1.9, n=66) (p>0.05). Females had a higher number of comorbidities than males in both COPD (p=0.001) and ILD (p=0.017) populations. Circulatory (64%) and endocrine/metabolic (45%) conditions were most common in COPD. In ILD, digestive (55%) and circulatory (53%) comorbidities were most prevalent. In people with ILD, those over 65 years, with musculoskeletal/connective tissue disease or circulatory disease were less likely to obtain meaningful improvements in exercise capacity. There was no impact of comorbidities on exercise capacity in COPD or on HRQoL in ILD.ConclusionsThe majority of patients with COPD or ILD enrolled in PR programmes have multiple comorbidities that may affect improvements in exercise capacity. PR programmes may be less effective for older adults with ILD and comorbid circulatory or musculoskeletal disease.

A cluster-based analysis evaluating the impact of comorbidities in fibrotic interstitial lung disease

“…Comorbidities have been associated with reduced quality of life, lower functional capacity, increased hospitalization rates, and mortality in patients with ILD [3][4][5][6]. However, it is unclear whether comorbidities lead to negative outcomes because of their direct health effects or if they could also influence ILD progression.…”

The Importance of Appropriate Diagnosis in the Practical Management of Chronic Obstructive Pulmonary Disease

“…Although the prevalence of lung cancer is estimated to be about 3 % in COPD patients [ 16 ], the coexistence rate of COPD was more than 40% in resected lung cancer patients [ 17 ]. A therapeutic option, other than surgery, such as chemotherapy and/or radiation, might be selected for the older lung cancer patients with COPD [ 17 , 18 , 19 ].…”

Current developments and future directions in COPD

“…Women often present with pronounced dyspnoea and comorbidities such as anxiety, depression or osteoporosis [21]. In a pulmonary rehabilitation programme, females had a higher number of comorbidities than male COPD patients [22]. COPD under-diagnosis is more frequent in females than males and this requires increased awareness.…”

“…Physical activity limitations among patients with COPD can be due to the inter-related factors of airflow obstruction, dynamic hyperinflation, impaired gas exchange, cardiac dysfunction and skeletal muscle dysfunction, manifesting as breathlessness and fatigue [22,80]. Researchers continue to seek how best to target these different disease components to allow individually tailored therapies.…”