The changing co-morbidities of COPD

It seems that people suffering from chronic obstructive pulmonary disease (COPD) who are on long-term oxygen therapy (LTOT) have more to worry about than breathing difficulties.

According to a new study from Sweden, COPD patients on LTOT face an increased risk of death from cardiovascular disease and other non-respiratory ailments. The findings were published in the online version of the American Journal of Respiratory and Critical Care Medicine.

In recent decades the demography of patients starting LTOT for COPD has changed markedly,” said principal researcher Magnus P. Ekström.

The mean age of patients starting LTOT increased from approximately 66 to 73 years between 1987 and 2000.  In parallel there has also been a significant increase in the proportion of women receiving LTOT for COPD.

The researchers enrolled 7,628 adult patients who started LTOT for COPD between January 1987 and December 2004. Patients remained in the study until LTOT was suspended or until death. Study participants were followed for a median of 1.7 years.

5,497 patients died during the course of the study. Although the risk of death decreased annually for both respiratory disease (2.7%) and lung cancer (3.4%), it increased for circulatory disease (2.8%) and digestive organ disease (7.8%). The overall risk of death increased by 1.6% per year during the study period.

In total, the risk of death for cardiovascular disease increased by 61.5% between 1987 and 2004, the authors noted.  According to the authors, the shift in mortality is partly attributable to an increase in the age of patients starting LTOT, which in turn may be related to decreases in tobacco use.

In our view, the mechanism that underlies the increases in both overall mortality and mortality due to non-respiratory causes is that the patients have a progressively higher burden of coexisting diseases and conditions, and become more vulnerable with increasing age,” Dr. Ekström said. “Physicians who treat COPD with LTOT need to be aware of these shifts and to monitor for other conditions that may influence the risk of death in these patients.”

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