A Comparative Analysis of CVD and MSK Comorbidities in Usual COPD and AATD-COPD

Abstract

Background: Chronic obstructive pulmonary disease (COPD) and alpha-1 antitrypsin deficiency-related COPD (AATD-COPD) are complex conditions associated with cardiovascular (CVD) and musculoskeletal (MSK) comorbidities, which exacerbate the severity of the disease and impact patient outcomes. Despite their clinical relevance, the prevalence and impact of these comorbidities in AATD-COPD compared to usual COPD have not been thoroughly investigated. This study aims to address this gap by comparing the prevalence of CVD and MSK comorbidities in these two COPD populations to improve treatment approaches and patient care.

Methods: This retrospective cohort analysis utilised data from the INTEGR-COPD trial and the Birmingham Alpha-1 cohort to compare the prevalence of CVD and MSK comorbidities in patients with usual COPD and AATD-COPD. Baseline characteristics, comorbidities, and pulmonary exacerbations were analysed. Non-parametric tests, including chi-square and Mann-Whitney U tests, were employed to compare categorical and continuous variables across the cohorts, respectively.

Results: The study analysed 1,663 usual COPD and 754 AATD-COPD patients. CVD comorbidities were more prevalent in usual COPD (52.50%) than AATD-COPD (30.11%) (p < 0.001). Similarly, MSK comorbidities were more prevalent in usual COPD (30.07%) compared to AATD-COPD (11.41%) (p < 0.001). AATD-COPD patients were younger, had better lung function, and reported higher dyspnoea scores. Smoking status varied significantly, with higher current smokers in the usual COPD cohort. Pulmonary exacerbations were significantly more frequent in usual COPD patients with CVD than in AATD-COPD patients (p = 0.0011).

Conclusion: This study highlights that usual COPD patients exhibit a higher prevalence of CVD and MSK comorbidities. Additionally, they tend to be older and have worse pulmonary outcomes compared to patients with AATD-COPD, who experience more severe dyspnoea. These findings emphasise the need for tailored clinical management approaches for both populations. Further research should explore the mechanisms and interventions to mitigate these comorbidities and improve patient outcomes.