Association of COPD stages and comorbidities in Italian general practices: The COMODHES study

Background : Chronic obstructive pulmonary disease (COPD) represents an important and increasing burden worldwide. COPD often coexists with other diseases that may have an impact on prognosis. Aims : to evaluate the association between different COPD severity levels and comorbidity in Italian patients of general practitioners (GP). Methods : prospective observational study in different Italian areas. 176 GP enrolled 2288 patients with COPD diagnosis. Questionnaires were used to collect data on COPD management, health status and risk factors. Univariate analyses were used to assess the relationship between COPD severity levels (mild, moderate, severe, very severe) and demographic characteristics (age, sex), smoking habits, comorbidities. Multinomial regression analysis was used to assess the relationship between COPD severity levels and comorbidity adjusting for demographic characteristics and smoking habits. Results : Univariate analyses showed a significantly higher frequency of high severity levels in males, older age, ex-smokers, subjects with cardiovascular diseases, osteoporosis/skeletal muscle dysfunction, anaemia, depression and weight loss. The Multinomial regression analysis confirmed the associations between moderate severity COPD and cardiovascular disease (OR 1.30); severe COPD and cardiovascular disease (OR 1.35), osteoporosis/skeletal muscle dysfunction (OR 1.43), anaemia (OR 2.06) and weight lost (OR 2.77); very severe COPD and weight loss (OR 6.34) and depression (OR 2.50). Conclusions : this study indicates that COPD stages are significantly associated with different kinds of comorbidities which need to be taken into account in disease management.