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In a recent paper, researchers recommended prompt screening methods and management strategies for comorbidities that occur commonly in patients with COPD.

Comorbid diseases are common in patients with COPD and may result in worse outcomes. Despite the high prevalence of comorbidities, many go undiagnosed or are identified on a delayed timeline. Clinicians discussed strategies for prompt diagnosis and management in a recent paper for Breathe.

“We don’t have clear guidance on comorbidity screening, and some of the diagnostic tests that we might use in the general population may not be as accurate in COPD. I’m hopeful that over the next few years we should have a bit more guidance on it,” says corresponding author Breda Cushen, PhD, in an interview with Physician’s Weekly. “For now, the important thing for physicians is to have an open mind and a high index of suspicion and take a good clinical history.”

Common COPD Comorbidities

The article listed the most common COPD comorbidities, including obstructive sleep apnea, osteoporosis, depression, and frailty, among many others (Figure 1). While COPD shares risk factors with many of these conditions, it is also an independent risk factor for each.

“The diagnosis of comorbid disease in the presence of COPD is challenging due to overlapping symptoms and difficulties interpreting routine diagnostic tests in the presence of coexistent COPD,” the authors wrote. “It is important to remember that the presence of COPD does not significantly alter the management strategy of most common comorbid diseases.”

Screening For Comorbidities

While the comorbidities listed in the article are relatively common, Dr. Cushen highlights lung disease, coronary artery disease, and osteoporosis as the most common.

“[Patients with COPD], in particular, have a very high risk of lung cancer. And we do have some guidelines now on screening for lung cancers,” Dr. Cushen says. “The next big comorbidity, and probably one of the biggest causes of death in our population, is cardiac comorbidities, and that’s both from acute coronary syndromes and from arrhythmias.”

She notes that though COPD is an independent risk factor for coronary artery disease, there isn’t currently a set protocol on when to screen patients.

“At the moment, it’s very challenging to know how we should be screening and if we should be undergoing screening in these patients. I think we need to have a very high index of suspicion. Certainly, when you’re meeting a patient, you should be doing a comprehensive assessment of their risk factors,” Dr. Cushen says.

Dr. Cushen adds that osteoporosis flies “under the radar a little bit.” She adds that there are clear guidelines on when to screen patients with COPD for osteoporosis, with DEXA scans being the preferred screening tool. Treatment options include bone-protective therapy and calcium and Vitamin D supplementation.

Viewing COPD as a Multisystem Disease

The authors recommend viewing and managing COPD as a multisystem disease, which includes screening, diagnosing, and treating any comorbidities.

“COPD is truly a multisystem disease; the additive effect of these comorbidities has a detrimental effect on patients with COPD in terms of mortality, exacerbation frequency, symptom burden, and overall quality of life,” the authors wrote.

When comorbidities are detected, the next step is to develop a treatment plan, often in conjunction with other specialists. Treatment for comorbidities should be unaltered due to the presence of COPD.

This can be tricky to do in practice, though Dr. Cushen offers some suggestions.

“What I’ve seen some other centers do is run joint cardiorespiratory clinics for [patients with COPD],” she says. “If you’re running a COPD service, have good pathways with your colleagues and…minimum set criteria for when you might refer. Certainly, that’s something I’ve started to do in my practice. For example, in terms of osteoporosis, I have a threshold above which I’m not happy to manage it myself, and where I refer up.”

“We should approach COPD in the way we do any other condition,” Dr. Cushen concludes, “which is having multidisciplinary meetings and collaboration with our other specialist colleagues.”