Looking Beyond the Lungs: Why Screening for Comorbidities Matters

This post was written by Arnelle Konde, MPH, CHES.

It is no secret that COPD rarely occurs alone. People living with COPD often face other comorbidities such as heart disease or diabetes, which can affect their symptoms and increase mortality risk.^1-2 Although comorbid conditions are common, many go undiagnosed or are identified too late.1 This can lead to treatment challenges and poor coordination between providers. To improve outcomes, health care providers should incorporate routine screening for these conditions into standard COPD care.

Common Comorbidities Associated with COPD

Cardiovascular Disease

Cardiovascular disease (CVD) is highly prevalent in people living with COPD. Shared inflammatory pathways and overlapping symptoms, such as shortness of breath, fatigue, and chest tightness contribute to higher rates of heart failure, arrhythmias, and coronary heart disease in the COPD population.⁴ The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report identifies CVD as a leading cause of hospitalization and death among people with COPD.⁴ Because of this elevated risk, providers should conduct routine screenings to detect CVD earlier and begin treatment before complications develop.

Mental Health Conditions

Metal health conditions are also common in people with COPD. A cohort study showed that more than half of patients report symptoms of depression and anxiety.^2,5 Anxiety has been linked to lower treatment adherence, more frequent exacerbations, and reduced quality of life.^3,5 Depression and anxiety are also associated with hospital readmission for acute exacerbation of COPD.⁷ Routine mental health screenings can help reduce stigma and support timely intervention.

Metabolic and Systemic Conditions

Several other health conditions are commonly linked to COPD, including diabetes mellitus, osteoporosis, and sleep disorders. Diabetes may worsen COPD outcomes due to increased inflammation and frequent corticosteroid use.^1,3 COPD and osteoporosis share common risk factors, including smoking history and reduced physical activity.⁷ Sleep disorders like obstructive sleep apnea can significantly affect daily functioning and overall quality of life.²

Why Routine Comorbidity Screening is Critical in COPD Care

Comorbidities are major drivers of COPD outcomes. Failure to identify and manage these conditions can negatively affect both respiratory and overall health.

Impact on Clinical Outcomes

Research shows that COPD-related comorbidities are associated with increased hospitalization rates, higher exacerbation frequency, and higher mortality risk.^1-4 Early identification allows clinicians to intervene before complications worsen.

Influence on Treatment Decisions

Comorbid conditions can directly affect treatment strategies. For example, depression and anxiety can affect patient engagement in self-management and pulmonary rehabilitation, while cardiovascular disease can influence medication selection. Additionally, osteoporosis should be considered when prescribing certain COPD therapies.¹ Routine screening enables clinicians to create personalized treatment plans.

Supporting Patient-centered Care

Early detection of comorbidities supports individualized care planning and encourages collaboration among care teams. Comprehensive care models that address both pulmonary and systemic diseases components are associated with improved symptom control and quality of life.³

Practical Strategies for Comorbidity Screening in Clinical Practice

Clinicians may consider integrating the following screening strategies into routine COPD care:

• Cardiovascular risk assessment, including blood pressure monitoring and cardiovascular history evaluation
• Mental health screening using questionnaires such as the Patient Health Questionnaire (PHQ-9) for depression or the Generalized Anxiety Disorder scale (GAD-7)⁸
• Bone health evaluation for patients at risk of osteoporosis
• Measure hemoglobin A1C and fasting blood glucose every 3 to 5 years⁸
• Assessment and evaluation of sleep quality through the STOP-BANG or Epworth sleepiness scale⁸
• Coordination with multidisciplinary care teams

Clinicians may also consider screening for COPD in patients who already have chronic conditions. Identifying COPD early can help guide treatment options and better management of both COPD and existing comorbidities.

COPD is more than a lung disease and often affects many parts of a patient's health. Routine screening helps clinicians identify these risks early, tailor treatment plans, and coordinate care across specialties. Strengthening screening practices is critical to improving COPD care and long-term patient outcomes.