RATIONALE
Based on the long tradition of single organ classification of diseases, the identification of the cause of death or the burden of these diseases in the world is presented in silos, assuming that one single diagnosis is the responsible cause of the outcome.
This epidemiological information was very useful when infectious diseases were the primary cause of illness across the globe, when one agent, one cause, one disease was the rule.
However, the world population has aged, has been exposed to the environment for longer periods of time and as a result, non-communicable diseases are the most important causes of poor health and death globally.
Actually, multimorbidity is now considered the next “pandemic” to affect the inhabitants of the planet in which we live, and that the medical community should be prepared to face this challenge.
The multimorbid state is particularly relevant to patients with COPD caused by cigarette smoking, who on average suffer from 5 other identified morbidities that independently affect their health and increase their risk of death.
The morbidities seen in patients with COPD, can be evaluated by measuring their frequency as has been done in several studies.
However, these associations assume that the patients with a diagnosis of COPD constitute a homogenous group, a fact that is far from real.
Indeed, unbiased hypothesis free analysis of several cohorts of COPD patients including clinical and laboratory characteristics have demonstrated the grouping of clusters with similar expressions of disease within each group and with significant differences amongst the clusters, including differences in the type of morbidities present in each cluster.
In 2006, the concept of Syndemics was first used by Singer and coworkers to define the aggregation of two or more diseases or other health conditions in a population in which there is some level of deleterious biological
or behavior interface that exacerbatesthe negative health effects of any or all of the diseases involved.
Primarily used in the field of epidemiology it can be useful in the context of mutimorbidity whereby syndemics refers to the occurrence of disease clusters which have biological interactions that exacerbate the overall prognosis and burden of disease.
With the support of the Menarini Foundation, we have built this closed forum, to review the state of the art of the most important morbidities associated with COPD and explore how to best approach this reality.
We look forward to an important exchange of constructive ideas, so we can look ahead with optimism.
A change in paradigm is needed, if we are to help our COPD patients live a longer and healthier life.
Bartolome Celli