The impact of comorbidities on chronic obstructive pulmonary disease

Abstract

Introduction. Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide, often associated with multiple comorbidities that may complicate its clinical course. These comorbidities can exacerbate respiratory symptoms, impair lung function, alter imaging findings, and significantly affect prognosis. Material and methods. This analytical, observational, cross-sectional study included 80 patients with confirmed chronic obstructive pulmonary disease, divided into two equal subgroups according to spirometric severity: GOLD 1-2 (n = 40) and GOLD 3-4 (n = 40). Clinical, functional, and radiological parameters were evaluated. Comorbidity burden was assessed using validated composite indices: Charlson Comorbidity Index, COTE, COPDCoRi, CODEX, and COMCOLD. Associations between comorbidity scores, pulmonary function, high-resolution computed tomography findings, and clinical outcomes were analyzed using SPSS v22.0. A p-value < 0.05 was considered statistically significant. Results. The presence of comorbidities was high across all domains, with only minor differences between spirometric stages. Structural abnormalities (emphysema, bronchiectasis, pulmonary hypertension) were more prevalent in GOLD 3-4 patients. A strong correlation was observed between composite indices and parameters such as forced expiratory volume in 1 second, dyspnea, exacerbation rate, radiological findings, and GOLD stages. Logistic regression models showed that the combination of COPD-specific indices (COTE, CODEX, COPDCoRi) significantly outperformed the Charlson index in predicting severe COPD (AUC 0.86 vs. 0.63). High-resolution computed tomography findings variables also demonstrated strong predictive value (AUC 0.81). Conclusions. Comorbidities play a central role in shaping chronic obstructive pulmonary disease severity and prognosis. The integration of composite comorbidity indices and imaging biomarkers enhances multidimensional patient stratification, aligning with GOLD 2024 recommendations for personalized care.