Co-morbidities in chronic respiratory patients: limitations or opportunities for caring ?

In the population of chronic respiratory patients a new subset with clinical complexity and with multiple coexisting organ failure and diseases is rapidly growing. Mainly due to the aging process, the associated frailty - not strictly related to the patient’s age - consists in a progressive and physiologic decline in multiple body systems leading to a substantial loss of functions and physiologic reserve. It is commonly acquainted that frailty, co-morbidities (several medical conditions associated) and disability (decline in physical functions) overlap each other: both frailty and co-morbidities can predict physical disability, whereas disability per se may exacerbate frailty and co-morbidities. Specific interventions (as rehabilitation) targeting at the physical activity the old population have been shown to improve physical function and have a benefit along the full spectrum of health status. However, there is a substantial need for a multidimensional and personalized care approach: patient’s complexity, in fact, may play a role in determining the patient’s response to treatment. In particular, each disease as a single entity might reduce the response to treatment, depending on its effect on body functions and target therapies. Notwithstanding, the clinical complexity of these patients and the presence of several co-morbidities, does not preclude per se the application and the effectiveness of a comprehensive rehabilitation program targeted to the individual’s needs.