COPD und Begleiterkrankungen

Einleitung

„Outcomes we did not anticipate” – Mit dieser Bewertung fassten Calverley und Rennard 2007 die unerwarteten Resultate umfangreicher neuerer Studien zur COPD zusammen [1]. Zu diesen unerwarteten Resultaten gehörten nicht nur die begrenzte Nützlichkeit von Reversibilitätstests, die Häufigkeit von Pneumonien unter inhalativen Glukokortikosteroiden und die Erkenntnis, dass Studienteilnehmer nicht unbedingt repräsentativ für das Krankheitsbild der COPD sind. Patienten mit erheblichen Komorbiditäten, wie der koronaren Herzkrankheit, der Linksherzinsuffizienz oder Krebsleiden, werden meistens aus klinischen COPD-Studien ausgeschlossen. Diese Erkrankungen sind bei COPD jedoch für die Prognose mitentscheidend [2]. Auch in Studien, in denen Komorbiditäten nicht ausgeschlossen wurden, weil bei diesen keine rasche Mortalität angenommen wurde [3] [4], verstarben mehr als 25 % der Studienteilnehmer an kardiovaskulären Ursachen und 20 % an Tumoren, davon die Hälfte an Lungenkrebs. Obwohl die gemeinsame Noxe, das Zigarettenrauchen, eine naheliegende Erklärung dieser Assoziationen ist, stellt die COPD offenbar ein zusätzliches Risiko dar.

Für zukünftige COPD-Studien ist daher der Parameter „Tod durch alle Ursachen” (all-cause mortality) als primärer Endpunkt besonders geeignet. Die COPD muss in Studien als Erkrankung mit gewichtigen Komorbiditäten betrachtet werden, die für den Verlauf und die Prognose mitentscheidend sind. Es ist die besonders bedeutsame Erkenntnis der Datenlage, dass Studien ohne den Einschluss von Patienten mit Komorbiditäten als Studien bei nicht-repräsentativen Subgruppen zu bewerten sind.

Das Thema COPD und Begleiterkrankungen wurde daher von einer Expertengruppe am 28. und 29.11.2008 erörtert, mit dem Ziel, die Bedeutung der komplexen gesundheitlichen Situation von Patienten mit COPD zu analysieren. Dieser Beitrag stellt die Zusammenfassung der wesentlichen Ergebnisse dar.

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