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Bidirectional Clinical Interactions among Exacerbations and Comorbidities in COPD: A Narrative Review
Daphne E M Peerlings1,2, Sarah Houben-Wilke1, Sami O Simons2,3
1Department of Research and Development, Ciro, Horn, the Netherlands.
Seminars in Respiratory and Critical Care Medicine
|April 10, 2026
Summary
Acute deteriorations in chronic obstructive pulmonary disease (COPD), known as exacerbations, are complex. Managing comorbidities is crucial for better COPD outcomes and reducing exacerbation risks.
Area of Science:
- Pulmonary Medicine
- Internal Medicine
- Clinical Research
Background:
- Acute deteriorations of respiratory symptoms in chronic obstructive pulmonary disease (COPD), termed exacerbations, significantly worsen disease severity and increase mortality.
- Exacerbations are challenging to manage due to their heterogeneous nature, high prevalence of comorbidities, and poorly understood mechanisms.
- Bidirectional relationships exist between COPD exacerbations and comorbidities, impacting each other adversely.
Purpose of the Study:
- To provide an overview of the complex clinical associations of comorbidities in COPD, focusing on exacerbations.
- To highlight differences in comorbidity prevalence among patients experiencing exacerbations.
- To underscore the importance of multimorbidity-oriented management in COPD.
Main Methods:
- This study is a narrative review.
- It synthesizes existing literature on COPD exacerbations and comorbidities.
- Focuses on clinical interrelationships and management strategies.
Main Results:
- Comorbidities are prevalent in COPD exacerbations, with varying prevalence rates among exacerbators.
- Clinical interrelationships between COPD exacerbations and comorbidities are complex and bidirectional.
- Current clinical frameworks inadequately incorporate multimorbidity.
Conclusions:
- Effective COPD management requires addressing multimorbidity.
- Identifying and managing comorbidities are pivotal for mitigating exacerbation impact.
- A multimorbidity-oriented approach is essential for improving patient outcomes in COPD.
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