COPD is a major cause of morbidity and mortality worldwide. Multimorbidity is common in COPD patients and a key modifiable factor, which requires timely identification and targeted holistic management strategies to improve outcomes and reduce the burden of disease.

We discuss the use of integrative approaches, such as cluster analysis and network-based theory, to understand the common and novel pathobiological mechanisms underlying COPD and comorbid disease, which are likely to be key to informing new management strategies.

Furthermore, we discuss the current understanding of mechanistic drivers to multimorbidity in COPD, including hypotheses such as multimorbidity as a result of shared common exposure to noxious stimuli (e.g. tobacco smoke), or as a consequence of loss of function following the development of pulmonary disease. In addition, we explore the links to pulmonary disease processes such as systemic overspill of pulmonary inflammation, immune cell priming within the inflamed COPD lung and targeted messengers such as extracellular vesicles as a result of local damage as a cause for multimorbidity in COPD.

Finally, we focus on current and new management strategies which may target these underlying mechanisms, with the aim of holistic, patient-centred treatment rather than single disease management.

COPD 是全世界发病率和死亡率的主要原因。共病在 COPD 患者中很常见，也是一个关键的可改变因素，需要及时识别和有针对性的整体管理策略，以改善结果并减轻疾病负担。

我们讨论了使用综合方法（例如聚类分析和基于网络的理论）来了解 COPD 和合并症背后常见和新颖的病理生物学机制，这可能是告知新管理策略的关键。

此外，我们讨论了目前对慢性阻塞性肺病多发病机制驱动因素的理解，包括多种假设，例如由于共同暴露于有害刺激（例如烟草烟雾）或肺部疾病发展后功能丧失的结果. 此外，我们探索了与肺部疾病过程的联系，例如肺部炎症的全身溢出、发炎的 COPD 肺内的免疫细胞启动和靶向信使（例如由于局部损伤导致 COPD 合并症的细胞外囊泡）。

最后，我们关注可能针对这些潜在机制的当前和新的管理策略，目的是整体的、以患者为中心的治疗而不是单一的疾病管理。