Feature Article

COPD is complicated: the story of its comorbidities

Peter Frith



COPD is increasingly being considered a systemic disease because of the over-representation of an extraordinary range of comorbid conditions associated with biomarkers of systemic inflammation.

Key Points

  • COPD is common, costly, and associated with many comorbidities, including heart disease, osteoporosis, mental health disorders, diabetes, renal dysfunction, anaemia, lung cancer and other respiratory conditions.
  • Systemic inflammation is common to most of the observed chronic comorbid conditions, leading to a proposed unifying hypothesis that their association and consequences are due to systemic inflammation.
  • Almost all people with moderate-to-severe COPD aged over 65 years are estimated to have at least one comorbidity.
  • The implications of comorbidities in patients with COPD include diagnostic confusion, inappropriate use of treatment, and increased rates of hospitalisation and mortality.
  • Clinical practice guidelines for COPD do not currently provide evidence-based guidance on how to account for the comorbid conditions.