Distribution and Outcomes of a Phenotype-Based Approach to Guide COPD Management: Results from the CHAIN Cohort
Cosio BG (1,2), Soriano JB (3), López-Campos JL (2,4), Calle M (5), Soler JJ (2,6), de-Torres JP (7), Marín JM (2,8), Martínez C (9), de Lucas P (10), Mir I (11), Peces-Barba G (2,12), Feu-Collado N (13), Solanes I (14), Alfageme I (15); CHAIN study.
(1) Department of Respiratory Medicine, Hospital Son Espases-IdISPa, Palma de Mallorca, Spain.
(2) CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
(3) Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain.
(4) Department of Respiratory Medicine, Hospital Universitario Virgen del Rocío- IBiS, Sevilla, Spain.
(5) Department of Respiratory Medicine, Hospital Clinico San Carlos, Madrid, Spain.
(6) Department of Respiratory Medicine, Hospital Arnau de Vilanova, Valencia, Spain.
(7) Department of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain.
(8) Department of Respiratory Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain.
(9) Department of Respiratory Medicine Hospital Central de Asturias, Oviedo, Spain.
(10) Department of Respiratory Medicine, Hospital Gregorio Marañon, Madrid, Spain.
(11) Department of Respiratory Medicine, Hospital Son Llátzer, Palma de Mallorca, Spain.
(12) Department of Respiratory Medicine, Fundación Jimenez Diaz, Madrid, Spain.
(13) Department of Respiratory Medicine, Hospital Universitario Reina Sofía, Cordoba-IMIBIC.UCO, Spain.
(14) Department of Respiratory Medicine, Hospital San Pablo y la Santa Cruz, Barcelona, Spain.
(15) Department of Respiratory Medicine, Hospital Universitario de Valme, Sevilla, Spain.
The Spanish guideline for COPD (GesEPOC) recommends COPD treatment according to four clinical phenotypes: non-exacerbator phenotype with either chronic bronchitis or emphysema (NE), asthma-COPD overlap syndrome (ACOS), frequent exacerbator phenotype with emphysema (FEE) or frequent exacerbator phenotype with chronic bronchitis (FECB). However, little is known on the distribution and outcomes of the four suggested phenotypes.
We aimed to determine the distribution of these COPD phenotypes, and their relation with one-year clinical outcomes.
We followed a cohort of well-characterized patients with COPD up to one-year. Baseline characteristics, health status (CAT), BODE index, rate of exacerbations and mortality up to one year of follow-up were compared between the four phenotypes.
Overall, 831 stable COPD patients were evaluated. They were distributed as NE, 550 (66.2%); ACOS, 125 (15.0%); FEE, 38 (4.6%); and FECB, 99 (11.9%); additionally 19 (2.3%) COPD patients with frequent exacerbations did not fulfill the criteria for neither FEE nor FECB.
At baseline, there were significant differences in symptoms, FEV1 and BODE index (all p<0.05). The FECB phenotype had the highest CAT score (17.1±8.2, p<0.05 compared to the other phenotypes). Frequent exacerbator groups (FEE and FECB) were receiving more pharmacological treatment at baseline, and also experienced more exacerbations the year after (all p<0.05) with no differences in one-year mortality. Most of NE (93%) and half of exacerbators were stable after one year.
There is an uneven distribution of COPD phenotypes in stable COPD patients, with significant differences in demographics, patient-centered outcomes and health care resources use.
CITATION PLoS One. 2016 Sep 29;11(9):e0160770. doi: 10.1371/journal.pone.0160770.