Integrative evaluation of comorbidities in chronic obstructive pulmonary disease: clinical, functional and imaging impact

Abstract

Background. Chronic obstructive pulmonary disease (COPD) is a multisystem condition frequently associated with numerous comorbidities. These comorbid conditions influence the clinical expression of the disease, functional severity, and prognosis. The integrative approach is essential for evaluating comorbidity burden. Objective(s). To evaluate the impact of comorbidities on the clinical, functional and imaging severity of COPD, aiming to support the development of a multidimensional prognostic stratification. Materials and methods. An analytical, cross-sectional observational study was conducted on a sample of patients diagnosed with COPD and comorbidities, divided equally into two subgroups based on spirometric severity (GOLD stages 1-2 and GOLD stages 3-4). Clinical parameters, laboratory data, comorbidity scores and high-resolution CT findings were assessed. Results. The analysis revealed a higher prevalence of cardiovascular, metabolic and respiratory comorbidities in the subgroup with more severe COPD. Composite clinical scores showed consistent associations with spirometric severity and were useful in evaluating exacerbation frequency and hospitalization burden. HRCT imaging evaluation identified both pulmonary and extrapulmonary abnormalities such as bronchiectasis, emphysema, coronary artery calcifications and osteoporosis, which were more frequently encountered in advanced stages and carried significant prognostic implications. These findings highlight the heterogeneity of COPD. Conclusion(s). Integrating clinical, functional, imaging data and validated comorbidity scores, ensures a more accurate assessment of COPD burden. This multidimensional approach supports improved risk stratification and personalized care. These findings highlight the need to implement structured assessment tools.