Dr. Varun Yadav* and Dr. Ulhas Jadhav


Introduction: Chronic Obstructive Pulmonary Disease (COPD) is one of the major cause of chronic morbidity and mortality around the globe. Now-a-days COPD patients suffer from multi-morbidity (i.e. presence of two or more morbidities) and COPD is present in multi-morbid patients. Multiple comorbidities in COPD patients frequently affect diesease progression. Aim: Aim of the study was to assess the pattern & profile of cardio-respiratory comorbidities in COPD patients attending at AVBRH, Sawangi Meghe. Method &Materials: This was a cross-sectional study conducted in Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe) in indoor patients. The study was conducted from October 2015 to September 2017. Inclusion criteria were: patients with history of cough with expectoration of at least 3 months duration in 2 consecutive years; patients with history of breathlessness of long standing duration with or without cough; patients diagnosed and staged according to GOLD guidelines by spirometry; age 40 years and above of both sexes. Pulmonary function test, smoking history, BMI, 2D-ECHO, ECG, ABG, sputum for gram stain, ZN stain & culutre and chest radiography were collected of all the patients, consequently associated cardio-respiratory comorbidities were noted for patients. Results: At least one comorbidity of clinical relevance was found in 78.6% of patients, but at least two in 68.8 %, and three or more were found in 47.9 % of subjects. Mean CCI was 3.4 ± 1.6sd. The overall prevalence was 2.6 comorbidities per patient, but 2.5 in males, and 3.0 in females, respectively (p < 0.05). Cardio-vascular disorders were the most frequent, but significantly more frequent in males (44.7 vs 30.7 %, respectively), while the metabolic, the digestive and the osteo-articular disorders were prevailing in females (12.4 vs 9.2; 14.2 vs 4.8, and 6.0 vs 3.8, respectively). In particular, chronic cor pumonale and arrhythmias mainly prevailed in men and congestive heart failure in females, while arterial hypertension resulted equally distributed. As concerning respiratory disorders, pneumonia, pleural effusions and chronic respiratory failure were more frequently found in men, while bronchiectasis and asthma-COPD overlap syndrome (ACOS) in females. Anaemia, gall bladder stones, osteoporosis and spontaneous fractures mostly prevailed in females, while gastric disorders of inflammatory origin and arthrosis were more frequent in males. Cognition disorders, dementia and signs of degenerative brain disorders were more frequently found in men, while depression in females. Finally, lung cancer was at the first place in men, but at the second in females. Conclusions: All comorbidities increased their prevalence progressively up to the last stage of COPD severity, except the cardio-vascular and the metabolic ones which dropped in the IV GOLD stage, presumably due to the high mortality rate in this severe COPD stage. The gender-dependency of comorbidities was confirmed in general terms, even if lung cancer proved a dramatic increase almost independently of sex.

Keywords: Comorbidities, COPD, GOLD severity, BMI, CRP, mMRC grade, smoking.

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