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Comorbidities

Nurses have a central role in supporting patients in co-ordinating and managing their comorbidities and treatments1

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MANY PATIENTS WITH ILD MAY ALSO HAVE OTHER HEALTH CONDITIONS2

Comorbidities can pre-exist or develop at any time during the course of ILD.3 If unidentified and untreated, comorbidities may impair your patients’ quality of life and/or lead to early mortality.3

Common diseases that may occur along with fibrotic ILD:
  • Chronic obstructive pulmonary disease (COPD): A lung disease that limits the flow of air into and out of the lungs. This makes it harder to breathe4
  • Gastroesophageal reflux disease (GERD): A stomach condition that causes stomach acid moving up into the food pipe (oesophagus), leading to heartburn3–6
  • Obstructive sleep apnea: A condition where breathing stops and starts during sleep3–5
  • Pulmonary hypertension: High blood pressure in the blood vessels that supply blood to the lungs3–5
  • Heart conditions such as coronary heart disease, where there is a build-up of plaque in the blood vessels in the heart3,5
  • Other conditions: Diabetes, underactive thyroid and hiatal hernia5

As a main point of contact for patient questions and concerns, you have an important role in educating your patients – understanding the potential impact of comorbidities may help your patients identify them early1–3,7

COMORBIDITIES CAN BE CHALLENGING FOR PATIENTS IN TERMS OF MANAGING THEIR TREATMENTS1

Early identification and treatment of comorbidities can potentially improve patients’ quality of life and survival.3 Patients with chronic health conditions are often required to attend multiple medical appointments with different specialists in order to meet the complexities of their needs.1

The potential need for multiple treatments regimens for multiple conditions can be potentially difficult for patients to manage.1 This can be both complicated and confusing for patients and adds to the frustration of already being unwell.1

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You can help your patients manage their complicated treatment regimens by creating a Medication reminder chart with them8
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You can help your patients by creating a Multi-medication chart which could be useful in providing information on both previous and current medications to another healthcare team who may be seeing your patients for the first time about a comorbidity9

It is also important to note that multiple drug use is associated with medication side effects.1

You have a key role in coordinating care and supporting patients in managing their treatments1,2

What other resources can help you support your patients in their journey with fibrotic ILD?

Footnotes
  • COPD, chronic obstructive pulmonary disease; GERD, gastroesophageal reflux disease; ILD, interstitial lung disease.

  1. O’Connor S, Deaton C, Nolan F, Johnston B. Nursing in an age of multimorbidity. BMC Nursing. 2018;17:49.
  2. Russell AM, Olive S, Lines S, et al. Contemporary challenges for specialist nursing in interstitial lung disease. Breathe. 2018;14:36–41.
  3. Margaritopoulos G, Antoniou K, Wells A. Comorbidities in interstitial lung diseases. Eur Respir Rev. 2017;26(143):160027.
  4. Raghu G, Amatto VC, Behr J, Stowasser S. Comorbidities in idiopathic pulmonary fibrosis patients: a systematic literature review. Eur Respir J. 2015;46(4):1113–1130.
  5. Oldham JM, Collard HR. Comorbid conditions in idiopathic pulmonary fibrosis: recognition and management. Front Med (Lausanne). 2017;4:123.
  6. National Health Service. Gastro-oesophageal reflux disease (GORD). Available at: https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/gastro-oesophageal-reflux-disease-gord. [Accessed January 2023].
  7. Grewal JS, Ryerson CJ. A closer look at the multidisciplinary interstitial lung disease clinic: Who, what and how. Respirology. 2021;26:12–13.
  8. Royal Pharmaceutical Society. Managing medication guidance to assist healthcare professional, to assess patients experiencing medication compliance problems. Version 7 September 2012. Available at: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Support/toolkit/managing-medication-guidance.pdf. [Accessed January 2023].
  9. Dietrich MF, Hersberger KE, Arnet I. Benefits of medication charts provided at transitions of care: a narrative systematic review. BMJ Open. 2020;10:e037668.
  10. Barbera T, Davila L, Patel NM. Management and support of patients with fibrosing interstitial lung diseases. Nurse Pract. 2021;46(7):39–44.
  11. Shaw J, Marshall T, Morris H, et al. Idiopathic pulmonary fibrosis: a holistic approach to disease management in the antifibrotic age. J Thorac Dis. 2017;9:4700–4707.
  12. Kreuter M, Bendstrup E, Russell A, et al. Palliative care in interstitial lung disease: living well. Lancet Respir Med. 2017;5(12):968–980.
  13. Denton CP, Laird B, Moros L, Flores JLL. Things left unsaid: important topics that are not discussed between patients with systemic sclerosis, their carers and their healthcare professionals–a discourse analysis. Clin Rheumatol. 2021;40:1399–1407.

Resources for patients