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COPD: ageing and multimorbidity, a new risk defined

Evidence-based medicine

Gerry Morrow

Thursday, 15 November 2018

AdobeStock_181476552_COPD.JPGIt is estimated that more than 3 million people in the UK have chronic obstructive pulmonary disease or COPD. Approximately 2 million of these will be living with COPD without a formal diagnosis. Most people are not diagnosed until they are 50 years of age or older.

The prevalence of COPD increases with age and is linked to social deprivation. A GP practice in the UK which cares for about 7,000 people will have around 200 people with COPD on its practice list. This equates to about 1.4 million primary care consultations each year in the UK.

In the UK, one in eight = 130,000 emergency hospital admissions is for COPD. Which is the second largest cause of emergency admissions, and one of the most expensive inpatient conditions treated by the NHS. COPD is often associated with other co-morbid conditions.

Multimorbidity is defined as the presence of two or more long-term health conditions, including defined physical or mental health conditions, such as COPD or diabetes. The prevalence of multimorbidity in the UK is around 23–27%, which increases significantly with age and socioeconomic deprivation. Multimorbidity is almost universal in older adults.

Multimorbidity is associated with a reduced quality of life, and reduce life expectancy, high treatment burden including polypharmacy and higher rates of adverse drug events, increased use of health services, and ultimately reduced life expectancy. 

Recent research* in Spain has provided an insight into the significance of COPD for an individuals’ risk of living with multimorbidity, premature ageing and a significantly shorter lifespan. The authors focused on the fact that patients with COPD appear to have a greater number of comorbidities than non-COPD subjects.

Their underlying premise was to investigate the idea that in people with COPD the development of comorbidities, usually found in the elderly, occur at an earlier age.

They analysed over 27,000 patients, over the age of 40, coded as having COPD and compared these to an age and sex matched cohort, without COPD. Importantly they replicated this same analysis in a smokers’ subgroup to correct for the confounding variable of cigarette smoking.

What they discovered was that patients with COPD were more likely to suffer from comorbidities and died at a younger age compared to the control/non-COPD group.

The comparison indicated that the number of comorbidities, the prevalence of diseases characteristic of ageing (such as dementia, chronic renal disease and atherosclerosis) in the COPD group aged 56–65 were comparable to those of non-COPD in the 75 plus age group. These findings persisted when smoking was also removed as confounding variable.

Therefore, although we know that multimorbidity increases with age, in patients with a diagnosis of COPD, these comorbidities are seen at an earlier age. Considering this research we can conceive that COPD can be viewed an independent variable when it comes to ageing, risk of multimorbidity and premature death.

Although we know that COPD is not curable, given this new information relating to COPD and overall life risk, we should be more mindful than ever when advising patients to stop smoking that they will not only be potentially adding years to their life but also adding life to their years.

*Celli D, et al. 2018. Chronic Obstructive Pulmonary Disease (COPD) as a disease of early aging: Evidence from the EpiChron Cohort. PLoS ONE 13 (2): e0193143. DOI:10.1371/journal.pone.0193143

Author's Image

Gerry Morrow

With a keen interest in evidence-based medicine and patient involvement, Gerry has over twenty years’ experience working as a GP, based initially in Worcester and then in the rural practice of Allendale. Now Medical Director of Clarity Informatics, a leading IT healthcare solutions provider, Gerry is leading a globally recognised team of clinicians and researchers, and is also directly responsible for the production and delivering of Clarity’s clinical guidance which forms the clinical content of NICE’s Clinical Knowledge Summaries (CKS) service. Gerry is also a clinical non-executive director of the North East Ambulance Service, responsible for operating patient transport and ambulance response services across a region covering 3,200 square miles and a population of 2.7 million people.
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