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Unravelling the mechanisms driving multimorbidity in COPD to develop holistic approaches to patient-centred care
H Burke1,2, T M A Wilkinson3,2,4
1School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK H.Burke@soton.ac.uk.
Insights
Chronic obstructive pulmonary disease (COPD) patients often have multiple conditions. Integrative approaches help understand COPD multimorbidity, guiding holistic, patient-centered management strategies for better outcomes.
Area of Science:
- Pulmonary Medicine
- Systems Biology
- Genetics
Background:
- Chronic obstructive pulmonary disease (COPD) is a leading cause of death globally.
- Multimorbidity is prevalent in COPD patients, significantly impacting prognosis and requiring integrated management.
- Understanding the interplay between COPD and comorbid conditions is crucial for improving patient care.
Purpose of the Study:
- To explore integrative approaches for understanding COPD multimorbidity.
- To identify pathobiological mechanisms driving COPD and co-occurring diseases.
- To inform novel, holistic management strategies for COPD patients with multimorbidity.
Main Methods:
- Utilizing cluster analysis and network-based theory to analyze complex disease relationships.
- Reviewing current understanding of mechanistic drivers of multimorbidity in COPD.
- Examining links between pulmonary inflammation, immune responses, and systemic effects.
Main Results:
- Integrative approaches offer insights into shared and novel mechanisms of COPD multimorbidity.
- Hypotheses include shared environmental exposures and disease-induced systemic effects.
- Pulmonary inflammation, immune priming, and extracellular vesicles are implicated in driving comorbid conditions.
Conclusions:
- Holistic, patient-centered management targeting underlying mechanisms is essential for COPD multimorbidity.
- Novel strategies should move beyond single-disease treatment paradigms.
- Further research into integrative approaches can optimize care for complex COPD patients.
Abstract:
COPD is a major cause of morbidity and mortality worldwide. Multimorbidity is common in COPD patients and a key modifiable factor, which requires timely identification and targeted holistic management strategies to improve outcomes and reduce the burden of disease.We discuss the use of integrative approaches, such as cluster analysis and network-based theory, to understand the common and novel pathobiological mechanisms underlying COPD and comorbid disease, which are likely to be key to informing new management strategies.Furthermore, we discuss the current understanding of mechanistic drivers to multimorbidity in COPD, including hypotheses such as multimorbidity as a result of shared common exposure to noxious stimuli (e.g. tobacco smoke), or as a consequence of loss of function following the development of pulmonary disease. In addition, we explore the links to pulmonary disease processes such as systemic overspill of pulmonary inflammation, immune cell priming within the inflamed COPD lung and targeted messengers such as extracellular vesicles as a result of local damage as a cause for multimorbidity in COPD.Finally, we focus on current and new management strategies which may target these underlying mechanisms, with the aim of holistic, patient-centred treatment rather than single disease management.
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