The distribution of phenotypes in a population of severe COPD

Abstract

Background: COPD is a heterogeneous syndrome. Detailed information on the incidence of COPD phenotypes in the population is currently unavailable.

Aim: The analysis of the COPD population with severe bronchial obstruction in relation to clinically apparent phenotypes.

Methods: Non-interventional observational prospective Czech Multicentre Research Database of COPD focusing on the collection and data analysis of COPD population with post-BD FEV₁ ≤ 60%. More at ClinicalTrials.gov, NCT01923051.

Results: In the first six months we enrolled 190 consecutive patients (67,0 years, 77,4% males, 8,4% non-smokers) with post-BD FEV₁ 42%. All categories were included (A 5,8%, B 20%, C 11%, D 63,2%). Clinically apparent phenotypes were present in all patients (more than one phenotype in 44,2% subjects). In addition to the bronchitic and emphysematic phenotypes, the database identified frequent exacerbators in 23,2%, asthma+COPD overlap in 11,1%, bronchiectasis+COPD overlap in 2,1% and pulmonary cachexia in 8,9% of severe COPD subjects. Some phenotypes were significantly associated with the presence of particular comorbidities (more cardiac comorbidities and upper airway impairment in the bronchitic phenotype, more osteoporosis in the emphysematous phenotype) and clinical parameters (lower KCO and higher oxygen desaturation during 6-minute walking test in emphysematous phenotype). Mucus predominance in CAT was significantly associated with bronchitic phenotype.

Conclusion: Preliminary analysis of baseline data demonstrates the variability of clinical parameters in patients with severe COPD. The effectiveness of a phenotype oriented approach to patients with COPD will be assessed by prospective follow-up of our patients.