CAROLINA SMITH - Aspects of multimorbidity in patients with chronic obstructive pulmonary disease (COPD)
participating in the National Research School in General Medicine.
In an aging population, multimorbidity increases and presents new challenges to the health care system. COPD-patients are often multimorbid and it is important to increase knowledge to improve the care.
Chronic obstructive pulmonary disease (COPD) is a common condition with high morbidity and mortality. Other coexisting long-term disorders are common in patients with COPD, including cardiovascular disease, diabetes, depression, and anxiety. Some conditions share pathophysiology such as systemic inflammation, others share risk factors such as smoking, and some just coexist. Previous research has shown that comorbidity leads to increased mortality, impairs COPD-related health status, and increases the risk of exacerbations. Exacerbations lead to deterioration of COPD and are important to prevent.
Even if primary health care has become increasingly accustomed to multimorbidity, it can be complex and difficult to manage, and might lead to reduced attention of COPD management during consultations. There is a need for a better understanding of how multimorbidity affect COPD patients to improve management strategies and person-centred care. The thesis consists of four studies that examine comorbidity in COPD patients and its associations with disease progression, exacerbations and management through record reviews, national registers, and questionnaires.
The aim is to explore various aspects of multimorbidity in COPD patients to increase knowledge about and improve the management of these patients, especially in primary care.
Study 1 examines the number of comorbidities and their associations with exacerbation rates and disease-specific health status in COPD patients in primary care in seven European countries. It is a comparative cross-sectional study, where the Swedish cohort comes from the PRAXIS study. The PRAXIS study is an ongoing study in the Healthcare Region central Sweden (formerly Uppsala Örebro Healthcare Region) about COPD. Two cohorts created in 2005 and 2014 respectively, will be followed up with a new survey in 2022. Also, a new cohort of COPD patients will be created in 2022.
Study 2 examines comorbidity in COPD patients in primary care and how it affects management and prioritisation of COPD. It is an observational study where the study population comes from the PRAXIS study. Data come from record reviews and questionnaires.
Study 3 examines the risk of multimorbidity in the years before and after a COPD diagnosis and compares with people without COPD. A longitudinal population-based cohort study, with data from national registers such as the National Patient Register.
Study 4 investigates the relationship between multimorbidity and the future frequency and severity of exacerbations. It is a longitudinal cohort study with data from the PRAXIS study.
Today, most clinical guidelines on chronic disease management tend to focus on single diseases and are not easily adapted for patients with multimorbidity. The overall aim is to improve management of multimorbid COPD patients which also may be of relevance for a broader patient group with multimorbidity, beyond those with COPD. The studies are “real-world” of an unselected population, from clinical reality.