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COPD Comorbid Conditions: Heart Disease, Osteoporosis, and More

Why are Comorbidities so Common in COPD?

No one really knows the answer to that question.

Some of it may have to do with ageing. As we get older we are all more likely to develop medical problems. Folks with significant COPD tend to be a bit older. Cigarette smoking remains the most common risk factor for COPD in the United States. We know that cigarette smoking can contribute to many other medical problems. These include coronary heart disease, peripheral vascular disease, strokes, osteoporosis, cataracts, erectile dysfunction, peptic ulcer disease, poor wound healing and a long list of cancers. But nonsmokers with COPD have many comorbid conditions as well. So, the increase in comorbid conditions in COPD patients cannot be just about smoking. For smokers with COPD, the risks are increased compared to smokers without COPD.

Whatever the reasons, having COPD increases the risk of these comorbid conditions. Medicines all have potential risks. Inhaled bronchodilators can lead to rapid heart rates. Inhaled steroids may lead to cataracts, easy bruising and in high doses possibly to osteoporosis. Inhaled anticholinergics may raise eye pressure, affect bladder function or even have some cardiac effects. Steroids given in pill form or by IV have major potential risks. These include osteoporosis, diabetes, high blood pressure and muscle weakness. So some of the comorbid conditions we see with COPD could be caused by the medicines we use to treat the disease. You and your doctor must balance the benefits of using medicine in treating your disease with the relative risks of medicine side effects. In almost all cases the benefits of treatment are much greater than the relatively small but real risks.

One of the more interesting new concepts in COPD relates to the issue of lung inflammation. Inflammation is common in COPD both in early and later stages of the disease. However, COPD patients have not only increased lung inflammation, they also tend to have signs of "systemic" inflammation. "Systemic" inflammation means evidence of markers of inflammation in the blood. Many experts now believe that in COPD, ongoing lung inflammation somehow leads to an increase in "systemic" inflammation.  This can contribute to other organ damage such as to the heart, muscles or bones.11

This theory has led to the concept that COPD is not just a disease of the lungs, but a "systemic" disease. It involves many parts of the body. If this is correct, future treatment aimed at breaking this "inflammatory cycle" could have dramatic benefits for COPD patients.

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