Comorbidities reduce survival and quality of life in COPD with severe lung hyperinflation

Patients with chronic obstructive pulmonary disease (COPD) often present with a significant number of comorbidities, which are thought to be related to a higher mortality risk. Our aim was to investigate the prevalence and impact of comorbidities on survival and quality of life (QoL), specifically in patients with emphysema characterized by severe lung hyperinflation.Data were prospectively collected from patients, who visited our hospital for evaluating their eligibility for a bronchoscopic lung volume reduction treatment, and were included in the Groningen Severe COPD cohort (NCT04023409). Comorbidities were patient-reported by a questionnaire, and were validated with patients’ medical records. QoL was assessed with the St. Georges Respiratory Questionnaire (SGRQ).We included 830 COPD patients with GOLD stage III and IV. The total number of comorbidities was an independent predictor of survival when adjusting for other factors influencing survival (HR 1.12, 95%CI:1.05–1.20, p<0.001). Of the individual comorbidities, pulmonary arterial hypertension (HR 1.53, 95%CI:1.01–2.32, p=0.045), low body-mass index (HR 1.63, 95%CI:1.16–2.27, p=0.004), and anxiety (HR 1.46, 95%CI:1.11–1.92, p=0.007) were independently associated with worse survival. Moreover, patients having 3, 4 or >5 comorbidities had a significantly (all p<0.05) worse QoL, in comparison to patients without comorbidities.Our results show that comorbidities were associated with lower survival and poor QoL in emphysema patients characterized by severe hyperinflation. Appropriate treatment of treatable traits, including anxiety, low body-mass index, and pulmonary arterial hypertension, could lead to a survival benefit and improvement in QoL in this specific patient population.