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Association of respiratory symptom profiles with future exacerbations and lung function decline in mild-to-moderate
Huajing Yang1, Shiying Fang1, Yuqiong Yang1
1State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Background:
The prognostic value of respiratory symptom profiles for predicting exacerbation risk and lung function decline remains unclear in mild-to-moderate chronic obstructive pulmonary disease (COPD).
Research Question:
Are respiratory symptom profiles associated with both exacerbation risk and lung function decline in mild-to-moderate COPD?
Study Design And Methods:
This was a posthoc analysis of data from participants with mild-to-moderate COPD from the SubPopulations and InteRmediate Outcome Measures in COPD Study. Respiratory symptom profiles were identified through latent class analysis. Outcomes included exacerbation rates evaluated by zero-inflated negative binomial regressions, time-to-first exacerbation evaluated by Cox regression and longitudinal forced expiratory volume in 1 second (FEV1) decline evaluated by linear mixed-effects models.
Results:
Among the 954 participants with mild-to-moderate COPD, five distinct respiratory symptom profiles were identified. Compared with the 'minimal respiratory' profile, the 'productive cough' profile was associated with a higher rate of any respiratory exacerbations (relative ratio [RR] 1.84; 95% confidence interval [CI] 1.29 to 2.64) and severe respiratory exacerbations (RR 2.05; 95% CI 1.12 to 3.74). Similarly, the 'Wheeze' profile was associated with higher rates of any (RR 1.55; 95% CI 1.12 to 2.15) and severe exacerbations (RR 1.73; 95% CI 1.00 to 2.98). The 'nearly all respiratory symptoms' profile was associated with a higher rate of exacerbations (any exacerbation: RR 2.12; 95% CI 1.56 to 2.89; severe exacerbations: RR 2.07; 1.23 to 3.47) and an accelerated annual FEV1 decline (-15.41 mL/year; 95% CI -30.33 to -0.51 mL/year). The 'dry cough' profile exhibited the lowest FEV1 trajectory despite a non-significant annual decline.
Interpretation:
Respiratory symptom profiles identifies distinct prognostic outcomes in mild-to-moderate COPD. The productive cough is associated with increased exacerbation risk, while the dry cough is associated with a lower lung function trajectory.
Trial Registration Number:
NCT0196934.
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