Chronic Obstructive Pulmonary Disease (COPD) Co-Morbidities

You might have to manage other illnesses in addition to your COPD

Verywell / Brianna Gilmartin

Chronic obstructive pulmonary disease (COPD) is an irreversible and incurable lung disease that can have a major impact on an affected person’s quality of life. The condition is associated with a number of comorbidities, which are illnesses that affect people with COPD at a higher rate than people who don’t have COPD. 

Experts aren’t sure why each of these comorbidities tend to occur with COPD, but some of them develop due to causes that overlap with the causes of COPD. 

If you have COPD, it helps to be aware of the common comorbidities and their symptoms so that you can let your medical team know if you begin to experience the early effects of these conditions. Getting prompt treatment can help control your comorbid illness (or illnesses) and may even completely reverse it. 

Gastroesophageal Reflux Disease (GERD)

According to some sources, GERD is among the most common COPD comorbidity. This condition results in symptoms such as indigestion and heartburn. You can develop GERD when the muscle that prevents stomach contents from backing up into the esophagus weakens.

Some risk factors associated with GERD overlap with COPD risk factors—including obesity, smoking, and a lack of physical activity. 


Generally, osteoporosis does not cause symptoms at the early stages. But since the condition causes bones to be weak and fragile, it can predispose you to bone fractures. Depending on your risk of osteoporosis, your medical team may screen you with imaging tests for this condition before it becomes symptomatic. 

Risk factors for osteoporosis include malnutrition, low calcium and/or vitamin D, and a decline in estrogen levels, such as during menopause, which are not common risk factors of COPD. 

Cardiovascular Disease and Hypertension 

A number of cardiovascular conditions occur along with COPD, including hypertension, arrhythmias (irregular heart rhythm), heart valve disease, and congestive heart failure (CHF). These conditions might not cause symptoms at early stages—as they advance, symptoms can include light-headedness, dizziness, palpitations, and low energy.

While smoking is among the causes of cardiovascular disease, experts aren’t sure if there is another reason for the increased risk of heart disease with COPD.

Additionally, cor pulmonale, a type of right-sided heart failure, occurs as complication of COPD, so it isn’t necessarily considered to be one of the comorbidities.

Treatment of cardiovascular disease, such as hypertension, can be complicated when you have COPD because some anti-hypertensive medications can cause breathing problems.

Metabolic Syndrome and Diabetes 

Metabolic syndrome is considered a risk factor for type 2 diabetes. Features of metabolic syndrome include hypertension, high body mass index (BMI), and high fat and cholesterol levels.

BMI is a dated, flawed measure. It does not take into account factors such as body composition, ethnicity, sex, race, and age. 
Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.

This condition might not produce symptoms in the early stages. If you have any symptoms, they may include excessive thirst and frequent urination, especially at night. 

Smoking can increase the risk of metabolic syndrome and type 2 diabetes, and experts suggest that inflammation may also play a role COPD as well as these metabolic conditions, increasing the chance of their coexistence. 


While high lipid levels are associated with cardiovascular disease and metabolic syndrome, hyperlipidemia is also independently associated with COPD. An elevated lipid level does not produce symptoms, but it can contribute to cardiovascular disease. Hyperlipidemia is often associated with diet, but it also has a strong genetic component. 

The reason for the link between COPD and hyperlipidemia is not completely clear.


Anemia (low red blood cell function) has many causes, including malnutrition, which is a complication of COPD. You may feel tired, pale, cold, and irritable if you have anemia. It isn’t clear whether anemia and COPD are also associated with each other for other reasons besides malnutrition. 

Allergic Disease and Asthma 

Asthma is a lung disease that, like COPD, is characterized by inflammation, bronchospasm, and a reaction to airborne triggers such as dust and pollen. Some people have a type of asthma described as allergic asthma because it is significantly worsened by exposure to triggers.

Asthma, like COPD, causes shortness of breath. Asthma may make you feel extremely short of breath when you have an asthma attack, and you can have almost normal breathing in between your asthma attacks.

It can be difficult to recognize either asthma or COPD when you have the other because many of the symptoms overlap.

Several other allergic conditions are also associated with COPD. These can manifest with symptoms such as stomach upset, skin rash, nasal congestion, or sneezing. Experts believe that COPD is mediated by an excessive inflammatory reaction to inhalants such as cigarette smoke, and that this tendency to experience excessive inflammation carries over to other inflammatory conditions, including allergic diseases.

Sleep Apnea 

A respiratory condition characterized by interrupted breathing during sleep, obstructive sleep apnea (OSA) results in snoring, frequently waking up at night, and a sense of feeling unrested even after a full night of sleep.

For reasons that are not completely clear, sleep apnea and COPD frequently coexist and the combined condition, called COPD-OSA overlap syndrome can cause fatigue, lack of energy, and generalized weakness. 


While malnutrition and weight loss can occur as complications of COPD, there is also an increased risk of obesity, especially in the early stages. This association may be partially related to a lack of physical exercise and physical activity. 

Obesity is also one of the risk factors for OSA.

Cognitive Impairment 

With COPD, there is an increased risk of issues such as confusion and difficulty concentrating. This can occur due to multiple factors, including hypoxemia (low blood oxygen levels) and neurological disease such as strokes. Malnutrition may contribute to cognitive impairment as well.

Symptoms may progress slowly due to low oxygen levels and nutritional issues, but can occur suddenly and abruptly when caused by a stroke. 

Renal Failure 

Kidney failure can occur with COPD. Typically, kidney failure does not cause symptoms at the early stages, but advanced disease can cause severe illness, dizziness, and confusion. 

There are many contributors to kidney failure, including hypertension and smoking.

Lung Cancer 

Lung cancer and COPD can coexist primarily because smoking is a major risk factor for both conditions. Smoking causes inflammation and damage to the lung tissue, which can cause thickening and stiffness of the lungs in COPD, as well as damage and genetic mutations that lead to lung cancer. 


Some comorbidities of COPD may occur because they have causes that overlap with COPD, and some occur without a clear reason for the association. COPD complications on the other hand, occur as a direct result of COPD. 

Common complications of COPD include: 

  • Respiratory infections such as sinusitis, acute bronchitis, or pneumonia. 
  • Depression 
  • Pulmonary hypertension and right heart failure 
  • Malnutrition
  • Pneumothorax (collapsed lung)

A Word From Verywell

There are a number of diseases that commonly co-exist with COPD. Having more than one disease can have a major impact on your health. As you navigate your COPD care plan, you can achieve a better health outcome. Be sure to stay on top of managing your co-morbid conditions as well, because this will improve your quality of life and long term survival.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2014;9:871-88.doi:10.2147/COPD.S49621

  2. Hillas G, Perlikos F, Tsiligianni I, Tzanakis N. Managing comorbidities in COPD. Int J Chron Obstruct Pulmon Dis. 2015;10:95-109.doi:10.2147/COPD.S54473

  3. Putcha N, Drummond MB, Wise RA, Hansel NN. Comorbidities and chronic obstructive pulmonary disease: Prevalence, influence on outcomes, and management. Semin Respir Crit Care Med. 2015;36(4):575-91.doi:10.1055/s-0035-1556063

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.