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Distribution and Outcomes of a Phenotype-Based Approach to Guide COPD Management: Results from the CHAIN Cohort
Borja G Cosio1,2, Joan B Soriano3, Jose Luis López-Campos2,4
1Department of Respiratory Medicine, Hospital Son Espases-IdISPa, Palma de Mallorca, Spain.
Insights
This study analyzed the distribution and outcomes of four chronic obstructive pulmonary disease (COPD) phenotypes. Frequent exacerbator phenotypes experienced more events, but mortality was similar across groups.
Area of Science:
- Pulmonology
- Clinical Medicine
- Respiratory Research
Background:
- The GesEPOC guideline categorizes COPD into four phenotypes: non-exacerbator (NE), asthma-COPD overlap syndrome (ACOS), frequent exacerbator with emphysema (FEE), and frequent exacerbator with chronic bronchitis (FECB).
- Limited data exist on the distribution and clinical outcomes associated with these specific COPD phenotypes.
Purpose of the Study:
- To determine the distribution of the four GesEPOC-defined COPD phenotypes in a stable COPD patient cohort.
- To investigate the relationship between these phenotypes and one-year clinical outcomes, including exacerbations and mortality.
Main Methods:
- A cohort of 831 well-characterized stable COPD patients was followed for one year.
- Baseline characteristics, COPD Assessment Test (CAT) scores, BODE index, exacerbation rates, and mortality were compared across the four phenotypes (NE, ACOS, FEE, FECB).
Main Results:
- The distribution was uneven: NE (66.2%), ACOS (15.0%), FECB (11.9%), and FEE (4.6%).
- Significant differences were observed in baseline symptoms, FEV1, and BODE index. FECB phenotype showed the highest CAT score.
- Frequent exacerbator phenotypes (FEE, FECB) had higher baseline pharmacological treatment and more exacerbations in the following year, with no significant difference in one-year mortality.
Conclusions:
- COPD phenotypes exhibit an uneven distribution in stable patients.
- Significant variations exist in demographics, patient-reported outcomes (CAT score), and healthcare resource utilization among the phenotypes.
- Frequent exacerbator phenotypes are associated with increased exacerbation events but not increased mortality within one year.
Rationale:
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.
Objective:
We aimed to determine the distribution of these COPD phenotypes, and their relation with one-year clinical outcomes.
Methods:
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.
Results:
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.
Conclusions:
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.
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