A Narrative Review of the Correlation Between Comorbidity and Acute Exacerbation of COPD Patients

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. Most COPD patients have one or more additional chronic diseases (comorbidities), which significantly increase the risk of acute exacerbations-sudden worsening of symptoms that often lead to hospitalization and death.

A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP, CBM, Web of Science, and Scopus databases until January 2026. Cohort studies, randomized controlled trials, real-world studies, and high-quality reviews were included for narrative synthesis and descriptive comprehensive analysis. No PROSPERO registration was performed as this is a narrative review, not a systematic review.

Over 70% of COPD patients worldwide have two or more comorbidities, with heart disease, diabetes, and high blood pressure being most common. These comorbidities increase acute exacerbation risk through multiple pathways: direct organ stress (heart failure increases risk 2.3-fold), immune dysfunction (diabetes raises hospitalization 1.8-fold), behavioral changes (depression/anxiety increase risk 1.5-2.1-fold), and self-management breakdown (cognitive impairment affects 32% of patients and drives medication non-adherence). Body-wide inflammation serves as a central biological mechanism linking lung disease to multi-organ damage. New prediction tools using artificial intelligence and dynamic risk scores improve forecasting of exacerbations. Additional about 30 papers were identified through the Snowball Method (citation tracking of included articles and reference list screening), ensuring comprehensive coverage of relevant evidence.

Comorbidities are not merely accompaniments to COPD but active drivers of acute exacerbations through interconnected biological and behavioral pathways. Effective COPD management requires integrated care that addresses heart disease, metabolic disorders, mental health conditions, and cognitive function alongside lung disease, using team-based approaches and locally adapted strategies.