Cited by 660Chronic Obstructive Pulmonary Disease (COPD) ResearchAsthma and respiratory diseasesSmoking Behavior and Cessation

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Complex chronic comorbidities of COPD

Open access

Fabbri, L. M., Luppi, F., Beghé, B., Rabe, K. F.·2008·European Respiratory Journal

DOI 10.1183/09031936.00114307

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Abstract

Chronic obstructive pulmonary disease (COPD) is defined by fixed airflow limitation associated with an abnormal pulmonary and systemic inflammatory response of the lungs to cigarette smoke. The systemic inflammation induced by smoking may also cause chronic heart failure, metabolic syndrome and other chronic diseases, which may contribute to the clinical manifestations and natural history of COPD. Thus COPD can no longer be considered a disease only of the lungs, as it is often associated with a wide variety of systemic consequences. A better understanding of the origin and consequences of systemic inflammation, and of potential therapies, will most likely lead to better care of patients with COPD. Medical textbooks and clinical guidelines still largely ignore the fact that COPD seldom occurs in isolation. As the diagnosis and assessment of severity of COPD may be greatly affected by the presence of comorbid conditions, the current authors believe that lung function measurement, noninvasive assessment of cardiovascular and metabolic functions, and circulating inflammatory markers (e.g. C-reactive protein) might help to better characterise these patients. Similarly, preventive and therapeutic interventions should address the patient in their complexity.

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“COPD often coexists with conditions such as ischemic cardiovascular disease, heart failure, diabetes mellitus, and frequently undiagnosed CKD [46 , 47 ].”
EPOC y alteraciones endocrinometabólicas
Martín, M. J. C., de Miguel‐Díez, J., Moreno, A. F., & Muñoz, G. S. (2009) · Archivos de Bronconeumología · doi:10.1016/s0300-2896(09)72863-7 · Cited by 8
“Estos 2 factores de riesgo pueden ac-tuar de forma sinérgica, ya que se asocian con la resistencia insulíni-ca, el estrés oxidativo y el incremento de diversas citocinas y marca-dores de inﬂ amación 11 .”
Chronic obstructive pulmonary disease: The golden decade. Implications for the diagnosis, prevention and treatment of chronic obstructive pulmonary disease
López-Giraldo, A., Rodriguez‐Roisin, R., & Agustí, A. G. N. (2015) · Medicina Clínica (English Edition) · doi:10.1016/j.medcle.2015.12.010 · Cited by 8
Study the association of chronic obstructive pulmonary disease with early endothelial dysfunction and its impact on cardiovascular system by estimating urinary albumin creatinine ratio
Agrawal, A., Garg, R. K., Sahu, D., & Kumar, M. (2017) · Lung India · doi:10.4103/0970-2113.201299 · Cited by 8
“Lung India • Volume 34 • Issue 2 • March - April 2017 139 demonstrates important extrapulmonary manifestations and multiple comorbidities for which several cytokines and inflammatory mediators have been implicated.[4,5] The link between COPD and its systemic expressions is still not well understood.”
Background
Acute exacerbation of COPD increases the risk of hip fractures: a nested case-control study from the Korea National Health Insurance Service
Gu, K.-M., Yoon, S.-W., Jung, S., Baek, M. S., Kim, W., Jung, J., Choi, J.-C., Shin, J., Kim, J. Y., Choi, B.-W., et al. (2022) · The Korean Journal of Internal Medicine · doi:10.3904/kjim.2021.152 · Cited by 8
“In patients with COPD, osteoporosis is one of the most common comorbidities that increases the risk of hip fractures [24], and treatment of AE-COPD with systemic steroids could also increase the risk of hip fractures [25].”
Background
Future Perspectives of Revaluating Mild COPD
Radovanovic, D., Contoli, M., Braido, F., Maniscalco, M., Micheletto, C., Solidoro, P., Santus, P., & Carone, M. (2022) · Respiration · doi:10.1159/000524102 · Cited by 8
Comorbidities according to airflow limitation severity: data from comprehensive health examination in Japan
Masuda, S., Omori, H., Onoue, A., Lu, X., Kubota, K., Higashi, N., Ogata, Y., & Katoh, T. (2017) · Environmental Health and Preventive Medicine · doi:10.1186/s12199-017-0620-0 · Cited by 8
“While the causal relationship between COPD and comorbidities is not entirely clear, inactivity and systemic inflammation have been suggested as part of the mechanism for the comorbidities associated with COPD and may relate to the natural course of the disease [30, 31].”
Background
Chronic Obstructive Pulmonary Disease and Heart Failure: Closer than Close
Ostojić, J. (2017) · Acta Clinica Croatica · doi:10.20471/acc.2017.56.02.10 · Cited by 8
Use of cluster analysis to describe desaturator phenotypes in COPD: correlations between pulmonary function tests and nocturnal oxygen desaturation
Toraldo, D. M., Nuccio, F. D., Gaballo, & Nicolardi, G. (2011) · International Journal of COPD · doi:10.2147/copd.s25383 · Cited by 8
“The question arises as to whether systemic inflammation is the result of a local inflammation spillover into the systemic compartments or a systemic component of COPD not necessarily related to local inflammatory processes in the lung.(7,8) As a point of interest, it should be noted that systemic inflammation has fail…”
Self-reported symptoms of chronic cough and breathlessness in working-age men in the city of Izhevsk, Russia: associations with cardiovascular disease risk factors and comorbidities
Cook, S., Quint, J. K., Vasiljev, M., & Leon, D. A. (2015) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2015-000104 · Cited by 8
Discriminative and predictive properties of disease-specific and generic health status indexes in elderly COPD patients
Conte, M. E., Pedone, C., Forastiere, F., Bellia, V., & Incalzi, R. A. (2008) · BMC Pulmonary Medicine · doi:10.1186/1471-2466-8-14 · Cited by 8
“Given that the mean age of COPD patients is continuously rising [5] and older age is associated with comorbidity [6], we expect that comorbidity will more and more contribute to shape the health status profile and to affect the prognosis of COPD patients.”
Systemic Effects of COPD: Just the Tip of the Iceberg
Agustí, A. G. N. (2008) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412550802237317 · Cited by 8
“Last but not least, the realization that patients with COPD often suffer from other concurrent diseases, either caused directly by COPD (systemic effects) and/or by common risk factors such as smoking or aging (comorbidities) (16), have direct implications on patient care.”
Background
Facilitators and Barriers of Adherence to Multi-Disease Exacerbation Action Plans in COPD Patients – A Qualitative Study
Schrijver, J., Effing, T., Brusse-Keizer, M. G. J., van der Palen, J. A. M., van der Valk, P., & Lenferink, A. (2023) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412555.2023.2240408 · Cited by 8
MicroRNAs as promising drug delivery target to ameliorate chronic obstructive pulmonary disease using nano-carriers: a comprehensive review
Khanna, V., & Singh, K. (2024) · Molecular and Cellular Biochemistry · doi:10.1007/s11010-024-05110-0 · Cited by 7
“Skeletal muscle wasting and dysfunction that result in osteoporosis have been identified as a contributing factor to the increasing dyspnea experienced by COPD patients due to skeletal muscle fatigue [10].”
End Stage Chronic Obstructive Pulmonary Disease
Ambrosino, N., Gherardi, M., & Carpenè, N. (2009) · Advances in respiratory medicine · doi:10.5603/arm.27836 · Cited by 7
“systems in addition to the lungs [8].”
Large peripheral vessel remodeling in patients with chronic obstructive pulmonary disease and in hypertension co-morbidity
Gaynitdinova, V. V., & Avdeev, S. N. (2015) · PULMONOLOGIYA · doi:10.18093/0869-0189-2015-25-1-50-57 · Cited by 7
Efficacy and safety of eco-friendly inhalers: focus on combination ipratropium bromide and albuterol in chronic obstructive pulmonary disease
Panos, R. J. (2013) · International Journal of COPD · doi:10.2147/copd.s31246 · Cited by 7
Precision in Diagnosing and Classifying COPD: Comparison of Historical Height with Current Height and Arm Span to Predict FEV1
Ansari, K. A., Keaney, N., Price, M., Munby, J., Kay, A., Taylor, I., & King, K. (2012) · The Open Respiratory Medicine Journal · doi:10.2174/1874306401206010054 · Cited by 7
“corticosteroids which are often used to treat exacerbations in COPD [9, 10].”
Background
Rhinitis is associated with a greater risk of intermittent claudication in adults
Ferrari, M., Pesce, G., Marcon, A., Vallerio, P., Pasini, A. M. F., & de Marco, R. (2014) · Allergy · doi:10.1111/all.12354 · Cited by 7
“FEV1 > 12% and >200 ml after 400 lg of salbutamol); • Cases of rhinitis (both allergic and nonallergic): one among (1) lifetime nasal allergies, including ‘hay fever’; (2) lifetime problem with sneezing, or a runny or a blocked nose (without cold/flu); (3) recurrent nasal/eye symptoms in the presence of dust, pollens…”
BackgroundResultInfluential
Integrated care of the COPD patient: a pulmonary rehabilitation perspective
ZuWallack, R. L., & Nici, L. L. (2010) · Breathe · doi:10.1183/18106838.0604.313 · Cited by 7
“For example, smoking tobacco is a common and potent aetiologic agent for many of these conditions; spill-over systemic infl ammation from COPD itself may contribute to systemic effects and comorbidities [3, 4].”
Background
Systemic manifestations of COPD.
Mohan, B. V. M., Sen, T., & Ranganath, R. (2012) · PubMed · Cited by 7
Prevalence and Implications of Abnormal Respiratory Patterns in Cardiac Surgery: A Prospective Cohort Study
Ponomarev, D., Kamenskaya, O. V., Klinkova, A. S., Loginova, I. Y., Ломиворотов, В. В., Kornilov, I. A., Анатольевич, Ш. В., Chernavskiy, A., Landoni, G., & Karaskov, A. M. (2016) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2016.12.005 · Cited by 7
Characteristics associated with mortality in patients with chronic obstructive pulmonary disease (COPD)–heart failure coexistence
Plachi, F., Balzan, F. M., Sanseverino, R. A., Palombini, D. V., Marques, R. D., Clausell, N., Knorst, M. M., Neder, J. A., & Berton, D. C. (2018) · Primary Health Care Research & Development · doi:10.1017/s1463423618000117 · Cited by 7
“Patients initially diagnosed with one disorder even without clear evidence of the other may pass unnoticed, once they share clinical, etiological and epidemiological factors (Fabbri et al., 2008; Rutten, 2013).”
Background
Medical Director Responsibilities for Outpatient Pulmonary Rehabilitation Programs in the United States: 2019
Carlin, B. W., Bauldoff, G. S., Collins, E. G., Garvey, C., Marciniuk, D. D., Ries, A. L., Limberg, T. M., & ZuWallack, R. (2020) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000515 · Cited by 7
The Impact of COPD in Trends of Urinary Tract Infection Hospitalizations in Spain, 2001–2018: A Population-Based Study Using Administrative Data
de Miguel‐Díez, J., Albaladejo‐Vicente, R., Palacios‐Ceña, D., Carabantes-Alarcón, D., Zamorano‐León, J. J., López‐Herránz, M., & López‐de‐Andrés, A. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9123979 · Cited by 7
Des définitions aux phénotypes de BPCO
Burgel, P. (2014) · La Presse Médicale · doi:10.1016/j.lpm.2014.09.004 · Cited by 7
The making of theERJ: behind the scenes and Editors' cut
Dinh‐Xuan, A. T., & Brusasco, V. (2010) · European Respiratory Journal · doi:10.1183/09031936.00074210 · Cited by 7
Long-Term Effects of COVID-19 on Chronic Obstructive Pulmonary Disease
Lee, C.-T., Wang, P.-H., & Cheng, S.-L. (2025) · International Journal of COPD · doi:10.2147/copd.s523149 · Cited by 6
“14,15 Although the COVID-19 pandemic has subsided, long-term complications among patients with COPD remain a significant concern.”
The Laboratory-Based Intermountain Validated Exacerbation (LIVE) Score Identifies Chronic Obstructive Pulmonary Disease Patients at High Mortality Risk
Blagev, D., Collingridge, D. S., Rea, S., Horne, B. D., Press, V. G., Churpek, M. M., Carey, K. A., Mularski, R. A., Zeng, S., & Arjomandi, M. (2018) · Frontiers in Medicine · doi:10.3389/fmed.2018.00173 · Cited by 6
“Peptic ulcer disease 1,321 (14) 150 (8) 426 (14) 470 (17) 214 (19) 61 (19) <0.”
Background
Relationship of Clinical Parameters and Inflammation Markers with Pulmonary Hypertension in Patients with Stable Chronic Obstructive Pulmonary Disease
Baykal, H., & Bulcun, E. (2022) · Sağlık Bilimlerinde Değer · doi:10.33631/sabd.1054814 · Cited by 6
Chronic obstructive pulmonary disease (COPD) and metabolic fatty liver syndromes: a dangerous but neglected liaison
Lonardo, A., Beghé, B., & Fabbri, L. M. (2022) · Metabolism and Target Organ Damage · doi:10.20517/mtod.2022.06 · Cited by 7
Bone mineral density among elderly patients with chronic obstructive pulmonary disease patients in India
Gaude, G., & Hattiholi, J. (2013) · Nigerian Medical Journal · doi:10.4103/0300-1652.122329 · Cited by 6
Defining COPD: from simplistic approach to multilateral assessment of COPD
Corlăteanu, A., Siafakas, N. M., & Botnaru, V. (2012) · Current Respiratory Care Reports · doi:10.1007/s13665-012-0023-z · Cited by 6
Przewlekła Obturacyjna Choroba Płuc i Choroby Sercowo-Naczyniowe—“Kontinuum Sercowo-PłUcne”
Batura‐Gabryel, H., & Grabicki, M. (2014) · Advances in respiratory medicine · doi:10.5603/piap.2014.0078 · Cited by 6
The importance of dyspnoea in the diagnosis of chronic obstructive pulmonary disease – a descriptive analysis of a stable cohort in Portugal (SAFE Trial)
Bárbara, C., Moita, J. J., Cardoso, J., Costa, R. L. B., Redondeiro, R., & Gaspar, M. (2011) · Revista Portuguesa de Pneumologia · doi:10.1016/s2173-5115(11)70029-x · Cited by 6
Outcomes and predictors of success of noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease
Shaheen, M., Daabis, R. G. A., & Elsoucy, H. (2018) · Egyptian Journal of Bronchology · doi:10.4103/ejb.ejb_112_17 · Cited by 8
An impact of cardiovascular comorbidity on course and prognosis of chronic obstructive pulmonary disease
Gaynitdinova, V. V., Avdeev, S. N., Nekludova, G. V., Nuralieva, G. S., & Baytemerova, I. V. (2019) · PULMONOLOGIYA · doi:10.18093/0869-0189-2019-29-1-35-42 · Cited by 6
“Точный механизм взаимовлияния ХОБЛ и заболеваний сердца до конца не изучен, но системное воспаление, окислительный стресс и гипоксемия являются основными предполагаемыми факторами их развития, из которых системное воспаление поддерживается наибольшим количеством доказательств [9].”
Initiating Low-Value Inhaled Corticosteroids in an Inception Cohort with Chronic Obstructive Pulmonary Disease
Spece, L. J., Donovan, L. M., Griffith, M. F., Keller, T. L., Feemster, L. C., Smith, N. L., & Au, D. H. (2020) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201911-854oc · Cited by 6
Comprehensive Cluster Analysis for COPD Including Systemic and Airway Inflammatory Markers
Zahraei, H. N., Guissard, F., Paulus, V. A., Henket, M. A., Donneau, A., & Louis, R. E. (2020) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412555.2020.1833853 · Cited by 6
Reasons for ICU Demand and Long-term Follow-up of a Chronic Obstructive Pulmonary Disease Cohort
Takır, H. B., Karakurt, Z., Saltürk, C., Kargın, F., Balcı, M. K., Yalçınsoy, M., Özmen, İ., Yazıcıoğlu, Ö. M., Güngör, G., Burunsuzoğlu, B., et al. (2014) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.3109/15412555.2014.898041 · Cited by 6
“atrial fi brillation), hypertension, congestive heart failure, coronary artery disease (CAD), and depression were recorded (14, 15).”
Background
Estimates of Medication Expenditure for Ischemic Heart Disease Accompanying Chronic Obstructive Pulmonary Disease
Rysiak, E., Prokop, I., Zaręba, I., & Mróz, R. M. (2018) · Advances in experimental medicine and biology · doi:10.1007/5584_2018_201 · Cited by 6
Body composition alterations in chronic obstructive pulmonary disease.
Roca, M., Mitu, F., Roca, I.-C., & Mihăescu, T. (2013) · The Medical-Surgical Journal · Cited by 6

Authors: Fabbri, L. M., Luppi, F., Beghé, B., & Rabe, K. F.
Affiliations: University of Modena and Reggio Emilia (IT)
ORCID: Fabbri, L. M.
Luppi, F.
Beghé, B.
Rabe, K. F.
Venue: European Respiratory Journal
Publisher: European Respiratory Society (ERS)
Published: 2007-12-31
Volume: 31
Issue: 1
Pages: 204-212
ISSN: 0903-1936 (ISSN-L)
1399-3003
DOI: 10.1183/09031936.00114307
OpenAlex: W2165340553
Cited by: 660
References: 139
Citations by year: 2026: 8 · 2025: 16 · 2024: 20 · 2023: 17 · 2022: 26 · 2021: 19 · 2020: 35 · 2019: 25 · 2018: 36 · 2017: 48 · 2016: 31 · 2015: 50 · 2014: 68 · 2013: 55 · 2012: 59
FWCI: 28.24
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: cc-by
Locations: European Respiratory Journal (publishedVersion)
PubMed (publishedVersion)
BOA (University of Milano-Bicocca) (submittedVersion)
IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
INFM-OAR (INFN Catania) (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
Keywords: chronic obstructive pulmonary disease, comorbidities, systemic inflammation, chronic heart failure, metabolic syndrome, cigarette smoking, C-reactive protein, inflammatory markers, COPD severity assessment, cardiovascular function, COPD management
MeSH terms: Chronic Disease, Health Status, Humans, Inflammation, Lung, Models, Biological, Prognosis, Risk Factors, Smoking, Pulmonary Medicine, Comorbidity, Guidelines as Topic, Pulmonary Disease, Chronic Obstructive, Overweight

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