“There is great interest in understanding the clinical expression of COPD in people who develop the disease at a younger age (<50), known as ‘Early or Young COPD,’” explains Miquel J. Divo, MD, PhD. “COPD is typically diagnosed in patients in their 60s and prior studies have shown that these patients frequently suffer from more
comorbidities than patients without the diagnosis. These comorbidities independently increase the risk for death. However, whether the type and pattern of comorbidities and their relationship to risk for death holds true for patients with Young COPD remains unknown.”

For a study published in Respiratory Research, Dr. Divo and colleagues compared comorbidity prevalence, number, and type in three groups of individuals from the BODE cohort with 10 or more pack-years of smoking: an Old COPD group (>50; N=1,860); a Young COPD group (≤50; N=160), and an age-balanced control group without airflow obstruction (N=125). An ongoing observational prospective registry, the BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) cohort, monitors people at risk for or living with COPD attending pulmonary clinics around the world.

Survival was also compared between the Young COPD group and control subjects. The study team assessed the comorbidities linked with mortality risk and generated comorbidities for both Young and Old COPD groups using a Cox proportional model.

Younger Patients Had Nine-Fold Greater Mortality Risk Vs Control

Dr. Divo and colleagues observed that the occurrence of at least one comorbidity was 86% for older patients with COPD, 77% for the Young COPD group, and 31% for controls, after adjusting for pack-years, sex, and age. However, after adjustment for covariates, patients in the Young COPD group had a ninefold greater mortality risk (P<0.0001) compared with the control group.

They also found that the type of comorbidities differed between the Young and Old COPD groups. Increased mortality risk was linked with substance abuse, tuberculosis, and bipolar disorders in the Young COPD group. Lung cancer was notably linked with mortality in both groups, according to Dr. Divo. Atrial fibrillation, congestive heart failure, coronary artery disease, gastroduodenal ulcers, pulmonary hypertension, pulmonary fibrosis, and liver cirrhosis were specific for the older group (Figure).

‘We Need to Discover a Window’ of Intervention

Dr. Divo and colleagues believe this to be the first study describing the prevalence, pattern, and impact of mortality of comorbidities observed in a cohort patients aged 50 and younger with COPD followed for at least5 years until death. “Comparing age-matched controls without airflow obstruction, patients with Young COPD have a higher prevalence and mortality risk,” Dr. Divo says. “When compared with the ‘typical’ patients with COPD (average age, 67), both groups had similar disease severity, despite a 20-year age difference. Younger patients, however, differed in the comorbidities pattern and the nature of the disease associated with increased mortality risk. Behavioral related comorbidities play a key role in mortality for the younger group.”

Therefore, the study team concurs, these findings support a need to address the multimorbid profile that younger patients with COPD develop, to help prevent premature death in this high-risk group of patients. “Future research should focus on the early origins of the
disease and its precursors, such as tobacco and other substances,” Dr. Divo notes. “We cannot reverse the course of the disease, but we need to discover a window when we could intervene and prevent the full development of COPD
and comorbidities, a stage when we can best control symptoms and prevent exacerbations.”