Identification and distribution of COPD phenotypes in clinical practice according to Spanish COPD Guidelines: the FENEPOC study

Abstract

BackgroundThe Spanish Guidelines for COPD (GesEPOC) describe four clinical phenotypes: non-exacerbator (NE), asthma-COPD overlap syndrome (ACO), frequent exacerbator with emphysema (EE), and exacerbator with chronic bronchitis (ECB). The objective of this study was to determine the frequency of COPD phenotypes, their clinical characteristics, and the availability of diagnostic tools to classify COPD phenotypes in clinical practice.Materials and methodsThis study was an epidemiological, cross-sectional, and multi-centered study. Patients ≥40 years old with a post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio of <0.7 and who were smokers or former smokers (with at least 10 pack-years) were included. The availability of diagnostic tools to classify COPD phenotypes was assessed by an ad hoc questionnaire.ResultsA total of 647 patients (294 primary care [PC], 353 pulmonology centers) were included. Most patients were male (80.8%), with a mean age (SD) of 68.2 (9.2) years, mean post-bronchodilator FEV1 was 53.2% (18.9%) and they suffered a mean of 2.2 (2.1) exacerbations in the last year. NE was the most frequent phenotype (47.5%) found, followed by ECB (29.1%), EE (17.0%), and ACO (6.5%). Significant differences between the four phenotypes were found regarding age; sex; body mass index; FEV1; body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE)/body mass index, airflow obstruction, dyspnea and exacerbations (BODEx) index; modified Medical Research Council dyspnea scale; respiratory symptoms; comorbidi-ties; hospitalizations; and exacerbations in the last year. Physicians considered that >80% of the diagnostic tools needed to classify COPD phenotypes were available, with the exception of computed tomography (26.9%) and carbon monoxide transfer test (13.5%) in PC, and sputum eosinophilia count in PC and pulmonology centers (40.4% and 49.4%, respectively).ConclusionIn Spanish clinical practice, almost half of the patients with COPD presented with NE phenotype. The prevalence of ACO according to the Spanish consensus definition was very low. In general, physicians indicated that they had the necessary tools for diagnosing COPD phenotypes.

Geographic variations of the prevalence and distribution of COPD phenotypes in Spain: &ldquo;the ESPIRAL-ES study&rdquo;

“…In our study, the non-exacerbator phenotype was the most common with a prevalence of 46.7% followed by exacerbator with chronic bronchitis (22.4%), exacerbator with emphysema (16.4%), and ACOS (14.5%). These percentages are similar to 47.5%, 29.1%, 17.0%, and 6.5%, respectively, found in a cross-sectional sample of 647 patients with COPD reported in the study of Calle Rubio et al, 20 in which the same GesEPOC guidelines for the definition of the four phenotypes were used. Also, our results are consistent with the distribution of phenotypes found in 4,508 audited clinical records of patients diagnosed with COPD reported in the EPOCONSUL study.…”

“… 19 The lower percentage of exacerbators with chronic bronchitis among patients recruited at pulmonology services than in primary care centers (15.3% vs 32%) might be explained in part by a more intense therapy in patients followed by pulmonology specialists. 20 …”

Severity of chronic obstructive pulmonary disease with ‘exacerbator with emphysema phenotype’ is associated with potential biomarkers

“…The Spanish Guidelines for COPD (GesEPOC) describe four clinical phenotypes. The ‘exacerbator with emphysema phenotype’ is an important one of the four clinical phenotypes 17. The objective of this study was to evaluate the relationship between serum biomarkers level and severity of COPD patients.…”

“…COPD is a heterogeneous disease and it is currently believed that the same phenotype may have similar clinical outcomes and therapeutic responses. According to the Spanish COPD phenotype classification,17 the ‘exacerbator with emphysema phenotype’ is a phenotype of the common phenotype of COPD with poor prognosis and poor treatment response. Therefore, the aim of this paper was to investigate the biomarkers levels of FKN, NE andMMP-12 in COPD ‘exacerbator with emphysema phenotype’ and to evaluate the associations between biomarkers levels and the severity of disease by spirometric measurements.…”

Comparing biologicals and small molecule drug therapies for chronic respiratory diseases: An EAACI Taskforce on Immunopharmacology position paper

“…In contrast to asthma, pathogenic mechanisms in COPD are associated with a greater extent with Th1, Th17, ILC1, and ILC3 cells as well as with neutrophils; similarly, clustering on clinical features for COPD that may help to specify management and provide a prognostic outcome is lacking, as no universal consensus regarding their definition and prevalence exists. Clinically, many COPD phenotypes and subtypes of COPD exacerbations have been described; however, clustering across COPD cohorts revealed that the COPD heterogeneity is better characterized by continuous disease traits coexisting in varying degrees within the same individual, rather than by mutually exclusive COPD subtypes …”