<scp>COPD</scp> and its comorbidities: Impact, measurement and mechanisms

Negewo, Netsanet A; Gibson, Peter G.; McDonald, Vanessa M.

doi:10.1111/resp.12642

Cited by 220 publications

(157 citation statements)

References 103 publications

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“…Multidimensional indices are important in the management of COPD due to their ability to stratify and prognosticate 41. Despite this, however, they have not been widely used outside the research setting.…”

Section: Discussionmentioning

confidence: 99%

Treatment burden, clinical outcomes, and comorbidities in COPD: an examination of the utility of medication regimen complexity index in COPD

Negewo¹,

Gibson

Wark

et al. 2017

COPD

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BackgroundCOPD patients are often prescribed multiple medications for their respiratory disease and comorbidities. This can lead to complex medication regimens resulting in poor adherence, medication errors, and drug–drug interactions. The relationship between clinical outcomes and medication burden beyond medication count in COPD is largely unknown.ObjectivesThe aim of this study was to explore the relationships of medication burden in COPD with clinical outcomes, comorbidities, and multidimensional indices.MethodsIn a cross-sectional study, COPD patients (n=222) were assessed for demographic information, comorbidities, medication use, and clinical outcomes. Complexity of medication regimens was quantified using the validated medication regimen complexity index (MRCI).ResultsParticipants (58.6% males) had a mean (SD) age of 69.1 (8.3) years with a postbronchodilator forced expiratory volume in 1 second % predicted of 56.5 (20.4) and a median of five comorbidities. The median (q1, q3) total MRCI score was 24 (18.5, 31). COPD-specific medication regimens were more complex than those of non-COPD medications (median MRCI: 14.5 versus 9, respectively; P<0.0001). Complex dosage formulations contributed the most to higher MRCI scores of COPD-specific medications while dosing frequency primarily drove the complexity associated with non-COPD medications. Participants in Global Initiative for Chronic Obstructive Lung Disease quadrant D had the highest median MRCI score for COPD medications (15.5) compared to those in quadrants A (13.5; P=0.0001) and B (12.5; P<0.0001). Increased complexity of COPD-specific treatments showed significant but weak correlations with lower lung function and 6-minute walk distance, higher St George’s Respiratory Questionnaire and COPD assessment test scores, and higher number of prior year COPD exacerbations and hospitalizations. Comorbid cardiovascular, gastrointestinal, or metabolic diseases individually contributed to higher total MRCI scores and/or medication counts for all medications. Charlson Comorbidity Index and COPD-specific comorbidity test showed the highest degree of correlation with total MRCI score (ρ=0.289 and ρ=0.326; P<0.0001, respectively).ConclusionIn COPD patients, complex medication regimens are associated with disease severity and specific class of comorbidities.

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Section: Discussionmentioning

confidence: 99%

Treatment burden, clinical outcomes, and comorbidities in COPD: an examination of the utility of medication regimen complexity index in COPD

Negewo¹,

Gibson

Wark

et al. 2017

COPD

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“…When comparing the analysis outcomes of top-ranked DGs with known COPD co-morbidities (such as Type 2 Diabetes (T2D), Cardiovascular Diseases [76, 77] we found all expected diseases but DT2. We computed the associations between COPD (ICD9 code 496) and ICD9 code 250 (Diabetes) by RR (1.027) and Φ (0.005).…”

Section: Resultsmentioning

confidence: 99%

From comorbidities of chronic obstructive pulmonary disease to identification of shared molecular mechanisms by data integration

et al. 2016

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BackgroundDeep mining of healthcare data has provided maps of comorbidity relationships between diseases. In parallel, integrative multi-omics investigations have generated high-resolution molecular maps of putative relevance for understanding disease initiation and progression. Yet, it is unclear how to advance an observation of comorbidity relations (one disease to others) to a molecular understanding of the driver processes and associated biomarkers.ResultsSince Chronic Obstructive Pulmonary disease (COPD) has emerged as a central hub in temporal comorbidity networks, we developed a systematic integrative data-driven framework to identify shared disease-associated genes and pathways, as a proxy for the underlying generative mechanisms inducing comorbidity. We integrated records from approximately 13 M patients from the Medicare database with disease-gene maps that we derived from several resources including a semantic-derived knowledge-base. Using rank-based statistics we not only recovered known comorbidities but also discovered a novel association between COPD and digestive diseases. Furthermore, our analysis provides the first set of COPD co-morbidity candidate biomarkers, including IL15, TNF and JUP, and characterizes their association to aging and life-style conditions, such as smoking and physical activity.ConclusionsThe developed framework provides novel insights in COPD and especially COPD co-morbidity associated mechanisms. The methodology could be used to discover and decipher the molecular underpinning of other comorbidity relationships and furthermore, allow the identification of candidate co-morbidity biomarkers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12859-016-1291-3) contains supplementary material, which is available to authorized users.

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“…COPD without obesity significantly impacts exercise capacity, health status, health-care utilization, and mortality [8]. The burden of COPD with coexisting obesity is amplified, as patients with both conditions may experience increased health-care utilization, have worse dyspnea and poorer healthrelated quality of life, more marked reduction in functional capacity, and increased physical inactivity [7].…”

Section: Copd and Obesitymentioning

confidence: 99%