Comprehensive Review of Comorbidities in Chronic Obstructive Pulmonary Disease and Preserved Ratio Impaired Spirometry: Insights from 2024.

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder frequently accompanied by multiple comorbidities, which can substantially influence prognosis and clinical management. Systemic inflammation and overlapping risk factors play significant roles in the pathogenesis of these comorbidities. Further, Preserved Ratio Impaired Spirometry (PRISm) has emerged as a condition indicating a high risk for COPD progression; nevertheless, the comorbidity burden of PRISm has not been adequately investigated. This review synthesizes major findings from clinically meaningful studies released in 2024, concentrating on cardiovascular diseases (CVD), pulmonary comorbidities, frailty, and obstructive sleep apnea (OSA) observed in both COPD and PRISm. CVD risk in COPD is modulated by disease phenotype, with severity and frequency of exacerbations being independent predictors of myocardial infarction and pulmonary embolism. Bronchiectasis may be present in as many as 69% of COPD patients and is linked to elevated rates of exacerbation and increased mortality. The newly proposed Radiological bronchiectasis, Obstruction, Symptoms, and Exposure (ROSE) criteria deliver an evidence-based approach to patient characterization in those with concurrent bronchiectasis and COPD. This approach has revealed that individuals fulfilling the ROSE criteria are at a higher risk for COPD exacerbations and exacerbation- related hospitalization. Additionally, recent evidence indicates a robust association between severe OSA and PRISm, with a notably higher prevalence in severe OSA cases (12.9%) versus mild/moderate OSA (6.2%). Both PRISm and COPD are associated with an accelerated progression of frailty, underlining the necessity for prompt recognition and multidisciplinary management of comorbidities. The collective evidence underscores the critical value of adopting a multidimensional assessment in COPD and PRISm, utilizing objective diagnostic criteria and the implementation of early therapeutic measures. It is recommended that future research emphasize longitudinal designs and precision-based interventions to optimize health outcomes within these groups.