Phenotypical heterogeneity of severe COPD subjects: Baseline results from the Czech multicentre research database of COPD

Abstract

Background: The COPD has been recognized as a multiple-faced syndrome. Heterogeneity features of severe COPD patients still remains unknown.

Aim: Systematic observation of the variety of symptoms and other clinical characteristics of severe airflow limitation subjects.

Methods: The Czech Multicentre Research Database of COPD (Database) is a multicenter, observational, and prospective study of patients with post bronchodilator FEV₁≤60%(NCT01923051). Every consecutive patient, who fulfils the inclusion criteria, is asked to participate in the study. Baseline data includes parameters used for identification of clinical phenotypes.

Results: We have enrolled 488 patients from Aug13 to Dec14, 343 of them with complete set of parameters for phenotype assessment (250males,67.0 years,FEV₁43.0%,6.7% non-smokers). We found all GOLD categories (A 4.4%,B 14.9%,C 3.8%,D 73.8%) and six COPD phenotypes (bronchitic-b 75.5%,emphysematous-e 77.4%,exacerbators-ex 34.7%,bronchiectatic-be 28.4%,cachectic-ca 16.3%,ACOS-ac 4.2%) in our severe COPD cohort. Clinical assessment of phenotypes (without computer tomography) have high sensitivity (0.69-0.74) in majority of them (except be) and excellent specificity in all (0.71-0.99). Some phenotypes are significantly associated with more symptoms (fatigue in b,ex and dyspnea in ex,ca) greater value of BODE index (e,ex,ca), higher values of specific CAT items (b,ca,ex). Contrary e,ac,be COPD have not any CAT items predominance.

Conclusion: 1^st analysis of baseline data of the Database has confirmed the wide clinical distribution of COPD syndrome. Subjective evaluation by physicians achieves satisfactory sensitivity and specificity.