open access

Vol 89, No 4 (2021)
Research paper
Submitted: 2020-11-06
Accepted: 2021-07-19
Published online: 2021-09-02
Get Citation

Clinical outcomes of chronic obstructive pulmonary disease phenotypes. One center prospective study

Azza Said1, Mernal Esmail1, Emad Abdel Naiem2, Zaki Zaki2, Rasha Raouf1
DOI: 10.5603/ARM.a2021.0086
·
Pubmed: 34494240
·
Adv Respir Med 2021;89(4):369-377.
Affiliations
  1. Faculty of Medicine, Pulmonary Medicine Department, Minia University, Minia, Egypt
  2. Faculty of Medicine, Clinical Pathology Department, Minia University, Minia, Egypt

open access

Vol 89, No 4 (2021)
ORIGINAL PAPERS
Submitted: 2020-11-06
Accepted: 2021-07-19
Published online: 2021-09-02

Abstract

Introduction: The clinical outcome of different chronic obstructive pulmonary disease (COPD) phenotypes is still unclear. Objectives: This study was designed to detect the effect of different COPD phenotypes on disease outcomes.
Material and methods: One hundred stable COPD patients were included. They were divided into 3 phenotypes; 45 patients in exacerbator phenotype, 37 patients in non-exacerbator, and 18 patients in asthma COPD overlap (ACO) phenotype. Patient demo-graphics, respiratory symptoms, grading of COPD, co-morbidities, spirometry, six minute walk test, and systemic inflammatory markers were measured. Also, exacerbation frequency and severity were assessed throughout the study period.
Results: COPD Assessment Test (CAT) score was significantly higher in exacerbator phenotype versus the other phenotypes(14.7 ± 1.5; p = 0.04).In addition, about 60% and 42% of exacerbator phenotype were in Global Initiative for Chronic Obstructive Lung Disease (GOLD) class D and C respectively which were significantly higher than the other phenotypes(p = 0.001), while 58% and 50% of non-exacerbator and ACO patients respectively were in class B of GOLD. Twenty eight percent of patients of ACO had no comorbidity and this was significantly higher versus the other phenotypes (p = 0.03), while 40% of non-exacerbator had one comorbidity (p = 0.003) and 86% of exacerbator had ≥ 2 comorbidities (p = 0.002). COPD comorbidity index was significantly higher in exacerbator phenotype (2.5 ± 0.8; p = 0.01). Although patients of exacerbator phenotype had more and severe form of exacerbations than the other phenotypes, no significant difference in in-hospital outcome was found (p = 0.3). Conclusions: Exacerbator phenotype has worse disease outcome than those of non-exacerbator and ACO phenotypes. These results support the need for more treatment options to alleviate the morbidity of COPD especially among exacerbator phenotype.

Abstract

Introduction: The clinical outcome of different chronic obstructive pulmonary disease (COPD) phenotypes is still unclear. Objectives: This study was designed to detect the effect of different COPD phenotypes on disease outcomes.
Material and methods: One hundred stable COPD patients were included. They were divided into 3 phenotypes; 45 patients in exacerbator phenotype, 37 patients in non-exacerbator, and 18 patients in asthma COPD overlap (ACO) phenotype. Patient demo-graphics, respiratory symptoms, grading of COPD, co-morbidities, spirometry, six minute walk test, and systemic inflammatory markers were measured. Also, exacerbation frequency and severity were assessed throughout the study period.
Results: COPD Assessment Test (CAT) score was significantly higher in exacerbator phenotype versus the other phenotypes(14.7 ± 1.5; p = 0.04).In addition, about 60% and 42% of exacerbator phenotype were in Global Initiative for Chronic Obstructive Lung Disease (GOLD) class D and C respectively which were significantly higher than the other phenotypes(p = 0.001), while 58% and 50% of non-exacerbator and ACO patients respectively were in class B of GOLD. Twenty eight percent of patients of ACO had no comorbidity and this was significantly higher versus the other phenotypes (p = 0.03), while 40% of non-exacerbator had one comorbidity (p = 0.003) and 86% of exacerbator had ≥ 2 comorbidities (p = 0.002). COPD comorbidity index was significantly higher in exacerbator phenotype (2.5 ± 0.8; p = 0.01). Although patients of exacerbator phenotype had more and severe form of exacerbations than the other phenotypes, no significant difference in in-hospital outcome was found (p = 0.3). Conclusions: Exacerbator phenotype has worse disease outcome than those of non-exacerbator and ACO phenotypes. These results support the need for more treatment options to alleviate the morbidity of COPD especially among exacerbator phenotype.

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Keywords

COPD severity, co-morbidity, exacerbation

About this article
Title

Clinical outcomes of chronic obstructive pulmonary disease phenotypes. One center prospective study

Journal

Advances in Respiratory Medicine

Issue

Vol 89, No 4 (2021)

Article type

Research paper

Pages

369-377

Published online

2021-09-02

DOI

10.5603/ARM.a2021.0086

Pubmed

34494240

Bibliographic record

Adv Respir Med 2021;89(4):369-377.

Keywords

COPD severity
co-morbidity
exacerbation

Authors

Azza Said
Mernal Esmail
Emad Abdel Naiem
Zaki Zaki
Rasha Raouf

References (30)
  1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of COPD. Eur Respir J. 2019; 53(5): 1900164.
  2. Salzman SH. Which pulmonary function tests best differentiate between COPD phenotypes? Respir Care. 2012; 57(1): 50–60.
  3. Fragoso E, André S, Boleo-Tomé JP, et al. GI COPD — Interest Group on Chronic Obstructive Pulmonary Disease. Understanding COPD: a vision on phenotypes, comorbidities and treatment approach. Rev Port Pneumol (2006). 2016; 22(2): 101–111.
  4. Kania A, Krenke R, Kuziemski K, et al. Distribution and characteristics of COPD phenotypes — results from the Polish sub-cohort of the POPE study. Int J Chron Obstruct Pulmon Dis. 2018; 13: 1613–1621.
  5. Cosio BG, Soriano JB, López-Campos JL, et al. PLOS ONE Staff, CHAIN study. Distribution and outcomes of a phenotype-based approach to guide COPD management: results from the CHAIN cohort. PLoS One. 2016; 11(9): e0160770.
  6. Arkhipov V, Arkhipova D, Miravitlles M, et al. Characteristics of COPD patients according to GOLD classification and clinical phenotypes in the Russian Federation: the SUPPORT trial. Int J Chron Obstruct Pulmon Dis. 2017; 12: 3255–3262.
  7. Fletcher CM. Standardized questionnaire on respiratory symptoms: a statement prepared and approved by the MRC Committee on the Aetiology of Chronic Bronchitis (MRC breathlessness score). BMJ. 1960; 2: 1662.
  8. Jones PW, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009; 34(3): 648–654.
  9. Shear MK, Vander Bilt J, Rucci P, et al. Reliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale (SIGH-A). Depress Anxiety. 2001; 13(4): 166–178.
  10. Kroenke K, Spitzer R. The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals. 2002; 32(9): 509–515.
  11. Divo M, Cote C, de Torres JP, et al. BODE Collaborative Group. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012; 186(2): 155–161.
  12. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004; 350(10): 1005–1012.
  13. Roberts W, Sedrick R, Moulton L, et al. Evaluation of four automated high-sensitivity C-reactive protein methods: implications for clinical and epidemiological applications. Clinical Chemistry. 2000; 46(4): 461–468.
  14. Mackie IJ, Kitchen S, Machin SJ, et al. Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology. Guidelines on fibrinogen assays. Br J Haematol. 2003; 121(3): 396–404.
  15. Miravitlles M, Calle M, Soler-Cataluña J. Clinical phenotypes of COPD: identification, definition and implications for guidelines. Archivos de Bronconeumología (English Edition). 2012; 48(3): 86–98.
  16. Charlson M, Pompei P, Ales K, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases. 1987; 40(5): 373–383.
  17. Chai CS, Liam CK, Pang YK, et al. Assessment test (CAT) score of patients with chronic obstructive pulmonary disease based on clinical phenotypes. Respirology. 2018; 23(S2): 246.
  18. Wu JJ, Xu HR, Zhang YX, et al. The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review. BMC Pulm Med. 2020; 20(1): 103.
  19. Corlateanu A, Botnaru V, Scutaru E, et al. Bode index in different phenotypes of COPD. Eur Resp J. 2017; 50(Suppl 61): PA 3621.
  20. Dahl M, Tybjaerg-Hansen A, Vestbo J, et al. Elevated plasma fibrinogen associated with reduced pulmonary function and increased risk of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001; 164(6): 1008–1011.
  21. Broekhuizen R, Grimble RF, Howell WM, et al. Pulmonary cachexia, systemic inflammatory profile, and the interleukin 1beta -511 single nucleotide polymorphism. Am J Clin Nutr. 2005; 82(5): 1059–1064.
  22. Kim TH, Oh DK, Oh YM, et al. Fibrinogen as a potential biomarker for clinical phenotype in patients with chronic obstructive pulmonary disease. J Thorac Dis. 2018; 10(9): 5260–5268.
  23. Miravitlles M, Soler-Cataluña JJ, Calle M, et al. Treatment of COPD by clinical phenotypes: putting old evidence into clinical practice. Eur Respir J. 2013; 41(6): 1252–1256.
  24. Chubachi S, Nakamura H, Sasaki M, et al. Keio COPD Comorbidity Research (K-CCR) Group. Polymorphism of LRP5 gene and emphysema severity are associated with osteoporosis in Japanese patients with or at risk for COPD. Respirology. 2015; 20(2): 286–295.
  25. Donaldson GC, Seemungal TAR, Bhowmik A, et al. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002; 57(10): 847–852.
  26. Beeh KM, Glaab T, Stowasser S, et al. Characterisation of exacerbation risk and exacerbator phenotypes in the POET-COPD trial. Respir Res. 2013; 14(1): 116.
  27. Izquierdo-Alonso JL, Rodriguez-Gonzálezmoro JM, de Lucas-Ramos P, et al. Prevalence and characteristics of three clinical phenotypes of chronic obstructive pulmonary disease (COPD). Respir Med. 2013; 107(5): 724–731.
  28. Dewan N, Rafique S, Kanwar B, et al. Acute exacerbation of COPD. Chest. 2000; 117(3): 662–671.
  29. Ong KC, Earnest A, Lu SJ. A multidimensional grading system (BODE index) as predictor of hospitalization for COPD. Chest. 2005; 128(6): 3810–3816.
  30. Marin JM, Carrizo SJ, Gascon M, et al. Inspiratory capacity, dynamic hyperinflation, breathlessness, and exercise performance during the 6-minute-walk test in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001; 163(6): 1395–1399.

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