The role of comorbidities and inflammation in COPD

Chronic obstructive pulmonary disease (COPD) is now being increasingly recognized as a heterogeneous multidimensional disease associated with comorbid conditions that significantly influence disease expression, survival and cost of care. Nevertheless, a number of clinically relevant components of the disease still remain unaddressed by existing disease management approaches. Clinical phenotyping is an alternative disease management approach recently proposed to address this gap by advancing personalized and evidence-based management of the disease. The Comorbidity, Airway, and Risk factors (CARe) framework is one of the strategies forwarded for the ‘real world’ implementation of the phenotyping approach. CARe is based on three phenotypic characteristics of obstructive airways diseases that respond to targeted therapies, namely, comorbidities, airway pathophysiology and risk factors. In this thesis, I addressed elements from the three components of the CARe framework as applied to COPD. These included (i) the global management of COPD-associated comorbidities in obese COPD patients, (ii) the potential utility of peripheral blood eosinophil counts for the detection of airway eosinophilia in stable COPD and (iii) the relationships of medication regimen complexity with clinical outcomes, comorbidities and multidimensional prognostic indices in COPD. Briefly, the findings of this thesis have shown that (i) a short-term weight loss intervention in obese COPD patients can improve multiple comorbidity markers, (ii) peripheral blood eosinophil counts can be used for predicting sputum eosinophilia in clinically stable COPD patients with a reasonable degree of accuracy and (iii) complex pharmacotherapy in COPD patients is strongly associated with disease severity and the presence of certain comorbidities. Overall, the observations and findings of this thesis lend strong support to the CARe model as an effective approach for the management of COPD.