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Comorbidity as a contributor to frequent severe acute exacerbation in COPD patients

Resource Type: Research Papers

This retrospective observational study examined the relationship between several COPD comorbidities and frequency of COPD exacerbation at follow up. The comorbid conditions studied included hypertension, ischemic heart disease, congestive heart failure, cerebrovascular disease, cor pulmonale, diabetes mellitus, malignancy, asthma, tuberculosis-destroyed lung, chronic liver disease and chronic kidney disease. The authors distinguish this work from prior research in that it did not rely on the aggregate Charlson comorbidity index, but instead sought to gauge the influence of the individual disease states on future exacerbations.

Patients with comorbid asthma were four times more likely to have frequent exacerbations within one year of a previous exacerbation. Those with frequent exacerbations both at 30-day and one-year were more likely to 1) have lower FEV1 values, 2) be on home oxygen therapy and 2) take long-term oral steroids. Higher levels of the inflammatory biomarker CRP were also associated with increased subsequent exacerbations within one year.

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Jeong SH, Lee H, Carriere KC, et al. Comorbidity as a contributor to frequent severe acute exacerbation in COPD patients. Int. J. Chron. Obstruct. Pulmon. Dis. Aug 2016; 11(1): 1857—1865. DOI Accessed March 12, 2020.



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  • By oral steroids, does that include Symbicort, or things like predinose {sp}?


    • Good question -- the researchers defined long-term oral steroid use as "the long-term use of systemic steroids at a dose ≥5 mg prednisolone for >3 months."
  • Didn't read the article, just your summary. I'm surprised GERD (gastric reflux) and also swallowing/aspiration didn't get listed as comorbid conditions that cause exacerbations. After 16 years, we have decided that these are contributing to my frequent exacerbations and we are aggressively treating both.

    ORAL steroids are those that are swallowed in pill form. INHALED steroids are those that are in inhalers and tend to have fewer systemic effects on the rest of our bodies, particularly when taken at low to moderate doses rather than high doses.
    • Agreed -- GERD was the one that surprised me the most. I have noticed that GERD does not make its way into all comorbidities conversations, however. Not nearly to the extent that some of the more common cardiovascular or other conditions do. Glad you pointed these out.
    • GERD is mostly associated with chronic pharyngitis rather than COPD.The chronic bronchitic form of COPD is the problem of bronchial system and the emphsymatous form is the problem of alveolar tissue.At clinic practice I have diagnosed a lot of chronic pharngitis related to GERD.
  • I did have some issues with my GERD and COPD on several occasions and never really received straight answers on aspiration and COPD or it's relationships.