Comprehensive Review of Comorbidities in Chronic Obstructive Pulmonary Disease and Preserved Ratio Impaired Spirometry: Insights from 2024.

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease commonly associated with multiple comorbidities, significantly affecting prognosis and clinical management. Systemic inflammation and shared risk factors contribute to the development of these comorbidities. Additionally, Preserved Ratio Impaired Spirometry (PRISm) has been recognized as a high-risk condition for COPD progression; however, its comorbid burden remains insufficiently studied. This review summarizes key findings from clinically relevant studies published in 2024, focusing on cardiovascular diseases (CVD), pulmonary conditions, frailty, and obstructive sleep apnea (OSA) in both COPD and PRISm. CVD risk in COPD varies according to disease phenotype, with exacerbation severity and frequency serving as independent risk factors for myocardial infarction and pulmonary embolism. Bronchiectasis affects up to 69% of COPD patients, leading to higher exacerbation rates and mortality. The recently proposed ROSE criteria (Radiological bronchiectasis, Obstruction, Symptoms, and Exposure) provide an objective framework for characterizing patients with both bronchiectasis and COPD. This classification has shown that patients meeting the ROSE criteria are at increased risk of COPD exacerbations and hospitalization due to exacerbation. Furthermore, recent studies demonstrate a strong association between severe OSA and PRISm, with a significantly higher prevalence in severe OSA cases (12.9%) compared to mild/moderate OSA (6.2%). PRISm and COPD are also linked to accelerated frailty progression, emphasizing the need for early identification and management of comorbidities. These findings highlight the importance of a multidimensional approach to COPD and PRISm, incorporating objective diagnostic criteria and early interventions. Future research should prioritize longitudinal studies and targeted strategies to improve clinical outcomes in these populations.