A person-centred clinical approach to the multimorbid patient with COPD

Abstract

Most patients with a chronic disease are multimorbid. This is particularly important in patients with chronic obstructive pulmonary disease (COPD), who on average have five other identified comorbidities that independently impact their health and increase their mortality risk. Using a modified Delphi method, we selected the 20 most important diseases associated with COPD and clustered them into five domains: mental, respiratory, cardiovascular, metabolic and multiple organs loss of tissue. We then developed a systematic approach to characterise the impact and clinical presentation of individual diseases within each cluster, and to define the priority and timing of measurement of the potential markers of disease presence and severity. Given the absence of integrated guidelines to treat multimorbid patients, we reviewed and selected individual disease guidelines or recommendations that can be accessed for specific information related to the management of each disease. In addition, we built a multimorbidity ‘Health Dashboard’ that, completed by the patient or health practitioner, can help identify the presence and severity of comorbid diseases. By using a practical comprehensive approach, it is possible to identify and characterise important comorbid diseases in patients with COPD, and to implement management tools that should help improve their outcome. This expert consensus commentary summarises patient-centred recommendations to manage comorbidities in COPD patients, aiming to improve quality-of-life and reduce disease burden through a holistic approach. Prospective pragmatic trials comparing such an approach with usual care for multimorbid patients with COPD including long-term follow-up are urgently needed.