Comorbidities reduce survival and quality of life in COPD with severe lung hyperinflation

Else A M D Ter Haar; Dirk-Jan Slebos; Karin Klooster; Simon D Pouwels; Jorine E Hartman

doi:10.1183/23120541.00268-2024

Comorbidities reduce survival and quality of life in COPD with severe lung hyperinflation

ERJ Open Res. 2024 Nov 18;10(6):00268-2024. doi: 10.1183/23120541.00268-2024. eCollection 2024 Nov.

Authors

Else A M D Ter Haar^{1

2}, Dirk-Jan Slebos^{1

2}, Karin Klooster^{1

2}, Simon D Pouwels^{1

2

3}, Jorine E Hartman^{1

2}

Affiliations

¹ University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands.
² University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands.
³ University of Groningen, University Medical Centre Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands.

Abstract

Rationale and aim: Patients with COPD often present with a significant number of comorbidities, which are thought to be related to a higher mortality risk. Our aim was to investigate the prevalence and impact of comorbidities on survival and quality of life (QoL), specifically in patients with emphysema characterised by severe lung hyperinflation.

Patients and methods: Data were prospectively collected from patients who visited our hospital for evaluating their eligibility for a bronchoscopic lung volume reduction treatment and were included in the Groningen Severe COPD cohort (NCT04023409). Comorbidities were patient-reported by a questionnaire and were validated with patients' medical records. QoL was assessed with the St Georges Respiratory Questionnaire.

Results: We included 830 COPD patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage III and IV. The total number of comorbidities was an independent predictor of survival when adjusting for other factors influencing survival (HR 1.12, 95% CI 1.05-1.20, p<0.001). Of the individual comorbidities, pulmonary arterial hypertension (HR 1.53, 95% CI 1.01-2.32, p=0.045), low body mass index (HR 1.63, 95% CI 1.16-2.27, p=0.004) and anxiety (HR 1.46, 95% CI 1.11-1.92, p=0.007) were independently associated with worse survival. Moreover, patients having 3, 4 or >5 comorbidities had a significantly (all p<0.05) worse QoL, in comparison to patients without comorbidities.

Conclusion: Our results show that comorbidities were associated with lower survival and poor QoL in emphysema patients characterised by severe hyperinflation. Appropriate treatment of treatable traits, including anxiety, low body mass index and pulmonary arterial hypertension, could lead to a survival benefit and improvement in QoL in this specific patient population.