The document summarizes research on patients with chronic obstructive pulmonary disease (COPD) and common comorbidities. It found that 87.5% of COPD patients studied had two or more comorbidities, with the most frequent being cardiovascular diseases (65%), tuberculosis (42.5%), and lung cancer (10%). Treatment costs increased substantially with more severe COPD stages and additional comorbidities. Effectively treating COPD and associated illnesses is important since comorbidities greatly influence COPD progression and outcomes.

1. THE COPD PATIENT – A
PATIENT WITH A COMPLEX
PATHOLOGY
Sandrina Maria Dăscălescu
Scientific Coordinator:
Maria Pănescu
“Gr.T.Popa” University of Medicine and Pharmacy, Iasi

2. GOLD deffinition:
COPD, a common preventable and
treatable disease, is characterized by
persistent airflow limitation that is usually
progressive and associated with an
enhanced chronic inflammatory response
in the airways and the lung to noxious
particles or gases.
Exacerbations and comorbidities contribute
to the overall severity in individual patients.

3. Risk factors
Genes
Infections
Socio-economic
status
Aging Populations

4. Mechanisms Underlying
Airflow Limitation in COPD
Small Airways Disease Parenchymal Destruction
• Airway inflammation • Loss of alveolar attachments
• Airway fibrosis, luminal plugs • Decrease of elastic recoil
• Increased airway resistance
AIRFLOW LIMITATION

5. Diagnosis
EXPOSURE TO RISK
SYMPTOMS FACTORS
shortness of breath tobacco
chronic cough occupation
sputum indoor/outdoor pollution
SPIROMETRY: Required to establish
diagnosis

6. Spirometry: Obstructive Disease
5 Normal
4
Volume, liters
3
FEV1 = 1.8L
2 FVC = 3.2L
Obstructive
FEV1/FVC = 0.56
1
1 2 3 4 5 6
Time, seconds

7. Classification
In patients with FEV1/FVC < 0.70:
• Stage I: Mild - FEV1 > 80% predicted
with or without symptoms
• Stage II: Moderate - 50% < FEV1 < 80% predicted
usually with symptoms
• Stage III: Severe - 30% < FEV1 < 50% predicted
with cough, sputum, dyspnea
• Stage IV: Very Severe - FEV1 < 30% predicted
with clinical signs of respiratory failure and
right-sided heart failure

8. Background
• COPD represents one of the most important
health issues, assessed to become the 3rd
leading cause of morbidity by 2030, due to
continued exposure to risk factors and the
aging of the world’s population;
• associated with several comorbidities
(cardiovascular disease, lung cancer,
diabetes, chronic respiratory diseases, etc.);
• Multi-systemic disease;
• significant economic expenses.

9. Aim
to establish how the disease's
evolution is affected by different
comorbidities found in every patient of
the studied group.

10. Material and method
• 40 patients that were diagnosed with COPD
according to the Global initiative for chronic
obstructive lung disease (GOLD) definition
have been analyzed.
• The analysis has been done retrospectively,
by making use of the patients' individual
treatment files, the spirometry results and
other investigations specific for the
associated comorbidities.

11. Results
• 38 male patients, 2 female
• Age – between 40 and 80 years
• 38 smokers, ex-smokers
87.5% of the studied patients presented two or
more comorbidities.

12. The most frequently encountered comorbidities were:
• cardiovascular diseases - 65%
• tuberculosis - 42.5%
• lung cancer - 10%
• digestive conditions - 10%
• diabetes - 5%
• renal failure - 2%
• sleep apnea - 2%

13. • At the time of the initial diagnosis of COPD:
1 patient - stage I
13 patients - stage II
19 patients - stage III
7 patients - stage IV

14. Treatment
Stage I patient
- no medications, helped to quit smoking, received
annual flu vaccine and the pneumococcal vaccine in
every 5 years;
- Evolution - good, no exacerbations
Stage II patients
- 11 - treated with Tiotropium (Spiriva);
- 2 - Salbutamol (Ventolin) +/- Theophylline - retard;
- Evolution: 1-2 exacerbation/ year, 4 patients went to
stage III of disease, one died of heart attack.

15. Stage III patients
Treated with Seretide or Symbicort
Evolution: ~2 exacerbations/ year, mostly on pacients
with diabetes, TB sequelae and autoimmune
conditions. 3 died - 1 of age, 2 of heart attack.
Stage IV patients
1 pacient treated with Ventolin – because of low
income, the proper scheme could not be applied.
Evolution: 4 exacerbations in one year.
3 pacients – Seretide/ Symbicort +/ - Spiriva,
theophylline – retard, Ventolin
3 patients – + oxygen
Evolution: no exacerbations.

16. The average cost of care for these
patients goes up to 200 euros/ month, or even
more, in case of associated comorbidities.
Every new exacerbation multiplies this
cost up to 8 times.
Number of premature deaths and number
of missed days of work are also very important
facts to be considered when calculating
COPD’s costs.

17. Conclusions
• COPD and associated comorbidities are
consequences of smoking, and treatment for these
patients is highly expensive, because it involves not
only the COPD treatment, but also the treatment of
associated illnesses.
• When a new case of COPD is found, one should
always consider the presence of associated
diseases; these should be properly treated because
they have a great influence on the COPD evolution.

18. Thank you!