Multimorbidities in COPD are Associated With Increased Exacerbations and Health Care Resource Utilization in Real-World Patients from a U.S. Database.

Background: Patients with COPD often develop other morbidities, suggesting a systemic component to this disease. This retrospective non-interventional cohort study investigated relationships between multimorbidities in COPD and their impact on COPD exacerbations and COPD-related healthcare resource utilization (HCRU) using real-world evidence from Optum's de-identified Clinformatics® Data Mart Database. Methods: Demographic and clinical characteristics were assessed. Overall comorbidity burden and proportion of individuals with gastroesophageal reflux disease (GERD), diabetes or osteoporosis/osteopenia were compared in age-matched COPD versus non-COPD cohorts using descriptive statistics. COPD exacerbations and COPD-related HCRU (hospitalizations and emergency room visits) were compared between age-matched cohorts of COPD patients with and without specific common morbidities (GERD, diabetes and osteoporosis/osteopenia). Additional weight-matching was performed for matched cohorts of COPD patients with and without diabetes, and with and without osteoporosis/osteopenia. Follow-up period was five years. Results: Age-matched cohorts with and without COPD each comprised 158,106 patients. Morbidities were more common in the COPD cohort than the cohort without COPD (GERD: 44.9% vs 27.8%; diabetes: 40.8% vs 31.1%; osteoporosis/osteopenia: 18.8% vs 14.1%, respectively). Compared with matched cohorts with COPD only, cohorts of COPD patients with either GERD, diabetes or osteoporosis/osteopenia, experienced increased risk of severe exacerbations (odds ratio [OR]=1.819, OR=1.119 and OR=1.373, respectively), moderate exacerbations (OR=1.699, OR=1.102 and OR=1.322, respectively) or any exacerbations OR=1.848, OR=1.099 and OR=1.384, respectively, p<0.001 for all comparisons and increased risk of COPD-related HCRU (ER visits: OR=1.983, OR=1.098 and OR=1.343, respectively; Hospitalization visits: OR=2.222, OR=1.26 and OR=1.368, respectively; p<0.001 for all comparisons). Conclusion: These real-world data confirm that GERD, diabetes, and osteoporosis are common morbidities in patients with COPD and, moreover, that they affect frequency of exacerbation and HCRU. Determining and addressing the mechanisms behind the systemic effects of COPD may be beneficial for COPD patients and may also help reduce COPD exacerbations.

Potential systemic effects of acquired CFTR dysfunction in COPD.

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, respiratory symptoms, inflammation of the airways, and systemic manifestations of the disease. Genetic susceptibility and environmental factors are important in the development of the disease, particularly exposure to cigarette smoke which is the most notable risk factor. Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene are the cause of cystic fibrosis (CF), which shares several pathophysiological pulmonary features with COPD, including airway obstruction, chronic airway inflammation and bacterial colonization; in addition, both diseases also present systemic defects leading to comorbidities such as pancreatic, gastrointestinal, and bone-related diseases. In patients with COPD, systemic CFTR dysfunction can be acquired by cigarette smoking, inflammation, and infection. This dysfunction is, on average, about half of that found in CF. Herein we review the literature focusing on acquired CFTR dysfunction and the potential role in the pathogenesis of comorbidities associated with COPD and chronic bronchitis.