O7. Comorbidities

Optimal management of any individual patient with COPD should include identification and management of comorbidities and anticipation of increased risks associated with those comorbidities in the presence of COPD (Gershon 2016). An American population based, nationally representative survey of almost 15,000 people demonstrated that patients with self reported COPD have significantly higher prevalence of important medical co-morbidities (Schnell 2012). Higher prevalence of cardiac disease, stroke, diabetes, depression, poly-pharmacy and mobility problems were reported. The concept of multimorbidity has been increasingly discussed in primary care. Multimorbidity refers to co-occurrence of two or more chronic medical conditions that may or may not directly interact with each other within the same individual. Multimorbidity is the norm rather than the exception in older primary care patients (Mercer 2009). Managing patients with multimorbidity effectively involves taking a patient-centred approach to balancing multiple, and at times competing, priorities. Some of the common comorbidities experienced by people with COPD (e.g. obesity, anxiety, depression, osteoporosis and metabolic disease) are associated with poorer physical performance as measured by the distance walked on the 6MWT (Li 2014). Both comorbid chronic respiratory conditions and comorbid psychiatric disorders have been found to be associated with a higher risk of frequent (≥ 2 per year) exacerbations (Westerik 2017).