https://orcid.org/0000-0002-2115-1743
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Abstract
Background
Multimorbidity plays an important role in chronic obstructive pulmonary disease (COPD) but is also a feature of ageing. We estimated to what extent increases in the prevalence of multimorbidity over time are attributable to COPD progression compared to increasing patient age.
Methods
Patients with COPD from the long-term COSYCONET (COPD and Systemic Consequences - Comorbidities Network) cohort with four follow-up visits were included in this analysis. At each visit, symptoms, exacerbation history, quality of life and lung function were assessed, along with the comorbidities heart failure (HF), coronary artery disease (CAD), peripheral arterial disease (PAD), hypertension, sleep apnea, diabetes mellitus, hyperlipidemia, hyperuricemia and osteoporosis. Using longitudinal logistic regression analysis, we determined what proportion of the increase in the prevalence of comorbidities could be attributed to patients’ age or to the progression of COPD over visits.
Results
Of 2030 patients at baseline, 878 completed four follow-up visits (up to 4.5 years). CAD prevalence increased over time, with similar effects attributable to the 4.5-year follow-up, used as indicator of COPD progression, and to a 5-year increase in patients’ age. The prevalence of HF, diabetes, hyperlipidemia, hyperuricemia, osteoporosis and sleep apnea showed stronger contributions of COPD progression than of age; in contrast, age dominated for hypertension and PAD. There were different relationships to patients’ characteristics including BMI and sex. The results were not critically dependent on the duration of COPD prior to enrolment, or the inclusion of patients with all four follow-up visits vs those attending only at least one of them.
Conclusion
Analyzing the increasing prevalence of multimorbidity in COPD over time, we separated age-independent contributions, probably reflecting intrinsic COPD-related disease progression, from age-dependent contributions. This distinction might be useful for the individual assessment of disease progression in COPD.
Abbreviations
CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; COSYCONET, COPD and Systemic Consequences - Comorbidities Network; EQ-5D-3L VAS, visual analog scale of the EuroQoL 5 dimension; FEV1, forced expiratory volume in 1 sec; GLI, Global Lung Function Initiative; GOLD, Global Initiative for Chronic Obstructive Lung Disease; PAD, peripheral artery disease.
Data Sharing Statement
COSYCONET is an ongoing, long-term, multi-center observational study the data of which are not intended to be available without demand. If there is interest in the analysis of specific questions, however, there is a formalized procedure for submitting an application to the study office, which will be evaluated by the steering committee on scientific grounds. There is no limitation for this application except proven expertise in COPD studies.
Ethics Approval
The study protocol was approved by the central ethical committee in Marburg (Ethikkommission FB Medizin Marburg) and the respective local ethical committees: Bad Reichenhall (Ethikkommission Bayerische Landesärztekammer); Berlin (Ethikkommission Ärztekammer Berlin); Bochum (Ethikkommission Medizinische Fakultät der RUB); Borstel (Ethikkommission Universität Lübeck); Coswig (Ethikkommission TU Dresden); Donaustauf (Ethikkommission Universitätsklinikum Regensburg); Essen (Ethikkommission Medizinische Fakultät Duisburg-Essen); Gießen (Ethikkommission Fachbereich Medizin); Greifswald (Ethikkommission Universitätsmedizin Greifswald); Großhansdorf (Ethikkommission Ärztekammer Schleswig-Holstein); Hamburg (Ethikkommission Ärztekammer Hamburg); MHH Hannover/Coppenbrügge (MHH Ethikkommission); Heidelberg Thorax/Uniklinik (Ethikkommission Universität Heidelberg); Homburg (Ethikkommission Saarbrücken); Immenhausen (Ethikkommission Landesärztekammer Hessen); Kiel (Ethikkommission Christian-Albrechts-Universität zu Kiel); Leipzig (Ethikkommission Universität Leipzig); Löwenstein (Ethikkommission Landesärztekammer Baden-Württemberg); Mainz (Ethikkommission Landesärztekammer Rheinland-Pfalz); München LMU/Gauting (Ethikkommission Klinikum Universität München); Nürnberg (Ethikkommission Friedrich-Alexander-Universität Erlangen Nürnberg); Rostock (Ethikkommission Universität Rostock); Berchtesgadener Land (Ethikkommission Land Salzburg); Schmallenberg (Ethikkommission Ärztekammer Westfalen-Lippe); Solingen (Ethikkommission Universität Witten-Herdecke); Ulm (Ethikkommission Universität Ulm); Würzburg (Ethikkommission Universität Würzburg). The study was performed in accordance with the declaration of Helsinki, and all participants gave their written informed consent.
Acknowledgments
We are grateful to all COSYCONET study centers, especially to all study nurses, for their excellent and enduring work in data collection, as well as to all patients who were willing to participate in this study over an extended period of time. We also thank David Young for helpful comments on the manuscript.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
Dr Franziska C Trudzinski reports personal fees from Novartis AG, non-financial support from CSL Behring, personal fees from Boehringer Ingelheim, personal fees from GlaxoSmithKline, personal fees from Chiesi, outside the submitted work. Professor Dr Robert Bals reports grants from BMBF, grants from Marburg University, during the conduct of the study; grants, personal fees from Various, outside the submitted work. Prof Dr Stefan Andreas reports grants from Boehringer, personal fees from Altana, Boehringer, AZ, GSK, Chiesi, GSK, Novartis, Menerini, outside the submitted work. Professor Dr Tobias Welte reports grants from German Ministry of Research and Education, during the conduct of the study. Dr Antonia Sassmann-Schweda reports Contractual payments for conduction of study visits; payments were made to Research Center Borstel, Center for Clinical Studies from Philipps University of Marburg, during the conduct of the study. Professor Dr Joachim H Ficker reports personal fees, non-financial support from CSL Behring, personal fees from Novartis, personal fees from AstraZeneca, personal fees from Boehringer, personal fees from Pfizer, outside the submitted work; Prof Dr Claus F Vogelmeier reports personal fees from Aerogen, grants, personal fees from AstraZeneca, grants, personal fees from Boehringer Ingelheim, grants, personal fees from CSL Behring, grants, personal fees from Chiesi, grants, personal fees from GlaxoSmithKline, grants, personal fees from Grifols, personal fees from Menarini, grants, personal fees from Novartis, personal fees from Nuvaira, personal fees from MedUpdate, outside the submitted work. The authors report no other conflicts of interest in this work.