<p>Clinical phenotypes of COPD and health-related quality of life: a cross-sectional study</p>

Abstract

Introduction The Spanish COPD guideline (GesEPOC) classifies COPD into four clinical phenotypes based on the exacerbation frequency and dominant clinical manifestations. In this study, we compared the disease-specific health-related quality of life (HRQoL) of patients with different clinical phenotypes. Methods This was a cross-sectional study of patients with COPD attending the respiratory medicine clinic of University of Malaya Medical Centre from 1 June 2017 to 31 May 2018. Disease-specific HRQoL was assessed by using the COPD Assessment Test (CAT) and St George’s Respiratory Questionnaire for COPD (SGRQ-c). Results Of 189 patients, 28.6% were of non-exacerbator phenotype (NON-AE), 18.5% were of exacerbator with emphysema phenotype (AE NON-CB), 39.7% were of exacerbator with chronic bronchitis phenotype (AE CB), and 13.2% had asthma-COPD overlap syndrome phenotype (ACOS). The total CAT and SGRQ-c scores were significantly different between the clinical phenotypes ( P <0.001). Patients who were AE CB had significantly higher total CAT score than those with ACOS ( P =0.033), AE NON-CB ( P =0.001), and NON-AE ( P <0.001). Concerning SGRQ-c, patients who were AE CB also had a significantly higher total score than those with AE NON-CB ( P =0.001) and NON-AE ( P <0.001). However, the total SGRQ-c score of AE CB patients was only marginally higher than those who had ACOS ( P =0.187). There was a significant difference in the score of each CAT item (except CAT 7) and SGRQ-c components between clinical phenotypes, with AE CB patients recording the highest score in each of them. Conclusion Patients who were AE CB had significantly poorer HRQoL than other clinical phenotypes and recorded the worst score in each of the CAT items and SGRQ-c components. Therefore, AE CB patients may warrant a different treatment approach that focuses on the exacerbation and chronic bronchitis components.

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

“…8849 patients from ten studies [9][10][11][12][13][14][15][16][17][18] were included, of which 2699 patients with the FE-CB phenotype and 6150 patients with the NE phenotype. Study characteristics are summarized in Table 1.…”

“…Ten studies [9][10][11][12][13][14][15][16][17][18] reported FEV 1 %pred of COPD patients with the FE-CB and NE phenotypes. In nine studies [9][10][11][12][13][14][15][16][17] , the FEV 1 %pred of the FE-CB phenotype was significantly lower than that of the NE phenotype, while one other study [18] found no significant between-group difference in this respect. Owing to significant heterogeneity among the studies, the random-effects model was used for analysis.…”

“…However, among non-smokers, there is no strong evidence that maternal smoking affects adult lung health [26] . In this study, six studies [9,11,[14][15][16]18] had reported the quantity of cigarettes smoked (pack-years). One study [14] found that the number of the quantity of cigarettes smoked (pack-years) of the FE-CB phenotype was significantly higher than that of the NE phenotype (P<0.05), while five studies [9,11,15,16,18] found no significant betweengroup difference in this respect.…”

“…). Four studies [13,14,16,18] reported mMRC scores. In all 4 studies, the mMRC score of COPD patients with the FE-CB phenotype was significantly higher than that of the NE phenotype.…”

“…Among all phenotypes, FE-CB was associated with more than three complications [8] . In some studies, patients with the FE-CB phenotype showed lower forced vital capacity percent predicted (FVC%pred) [9][10][11][12][13][14] , forced expiratory volume in one second percent predicted (FEV 1 %pred) [9][10][11][12][13][14][15][16][17] , forced expiratory volume in one second/ forced vital capacity (FEV 1 /FVC) [10][11][12]14] , and forced expiratory volume in one second (FEV 1 ) [14,17] as compared to those with the NE phenotype;…”