From systemic effects of COPD to COPD as pulmonary component of multimorbidity
Lowie EGW Vanfleteren 1, Sigrid AA Vikjord 2, Martin Ingvar 3, Leonardo M. Fabbri 4
1 COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 2 HUNT Research Centre, Norwegian University of Technology and Science, NTNU, Levanger, Norway; 3 Osher Center for Integrative Medicine, Karolinska Institutet Stockholm, Stockholm, Sweden; 4 Section of Cardiorespiratory and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
*Correspondence: Leonardo M. Fabbri, Email not available
Abstract
Chronic obstructive pulmonary disease (COPD) was originally defined as a chronic disease of the airways due to an abnormal inflammatory response to tobacco smoking. However, although primarily a pulmonary disease, the systemic consequences of COPD have been subject of intensive research for more than two decades. Extrapulmonary manifestations and/or comorbidities are invariably present in COPD and contribute significantly to morbidity and mortality. These observations warrant a strategy in which COPD should be seen as the pulmonary component of chronic multimorbidity that develops in a patient in response to a spectrum of risk factors. Specific multimorbidity combinations are associated with specific COPD phenotypes, suggesting that lung and other organ disease trajectories are entangled from an early disease state onwards. The management of the patient with multimorbid COPD should include an active search for the most impactful comorbidities and a patient-tailored multidisciplinary shared-decision treatment plan embedded in clinical pathways with supportive informatics.
