COPD and multimorbidity: recognising and addressing a syndemic occurrence.

Lies Lahousse, Leonardo M Fabbri, Bartolome R Celli, Alvar Agustí, Gerard J Criner, Mark T Dransfield, Miguel Divo, Jamuna K Krishnan, Maria Montes de Oca, Sundeep S Salvi, Daiana Stolz, Lowie E G W Vanfleteren, Claus F Vogelmeier

Journal: The Lancet. Respiratory medicine 2023;11(11):1020-1034

PMID: 37696283

Full Text on Elsevier Science View on PubMed

Abstract

Most patients with chronic obstructive pulmonary disease (COPD) have at least one additional, clinically relevant chronic disease. Those with the most severe airflow obstruction will die from respiratory failure, but most patients with COPD die from non-respiratory disorders, particularly cardiovascular diseases and cancer. As many chronic diseases have shared risk factors (eg, ageing, smoking, pollution, inactivity, and poverty), we argue that a shift from the current paradigm in which COPD is considered as a single disease with comorbidities, to one in which COPD is considered as part of a multimorbid state-with co-occurring diseases potentially sharing pathobiological mechanisms-is needed to advance disease prevention, diagnosis, and management. The term syndemics is used to describe the co-occurrence of diseases with shared mechanisms and risk factors, a novel concept that we propose helps to explain the clustering of certain morbidities in patients diagnosed with COPD. A syndemics approach to understanding COPD could have important clinical implications, in which the complex disease presentations in these patients are addressed through proactive diagnosis, assessment of severity, and integrated management of the COPD multimorbid state, with a patient-centred rather than a single-disease approach.

Address: Section of Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.; Cátedra Salud Respiratoria, Universitat de Barcelona, Barcelona, Spain; Institut Respiratori, Clínic Barcelona, Barcelona, Spain; Institut d'Investigacions Biomédicas August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Spain.; Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA.; Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, NY, USA.; Department of Bioanalysis, Ghent University, Ghent, Belgium.; School of Medicine, Universidad Central de Venezuela, Caracas, Venezuela; Hospital Centro Medico de Caracas, Caracas, Venezuela.; Pulmocare Research and Education (PURE) Foundation, Pune, India; School of Health Sciences, Symbiosis International Deemed University, Pune, India.; Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany.; COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps University of Marburg, Member of the German Centre for Lung Research, Marburg, Germany. Electronic address: [email protected].

DOI: 10.1016/S2213-2600(23)00261-8

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MeSH Terms: Humans, Multimorbidity, Syndemic, Pulmonary Disease, Chronic Obstructive, Comorbidity, Lung