Chest
Volume 140, Issue 3, September 2011, Pages 626-633
Journal home page for Chest

Original Research
COPD
The Chronic Bronchitic Phenotype of COPD: An Analysis of the COPDGene Study

https://doi.org/10.1378/chest.10-2948Get rights and content

Background

Chronic bronchitis (CB) in patients with COPD is associated with an accelerated lung function decline and an increased risk of respiratory infections. Despite its clinical significance, the chronic bronchitic phenotype in COPD remains poorly defined.

Methods

We analyzed data from subjects enrolled in the Genetic Epidemiology of COPD (COPDGene) Study. A total of 1,061 subjects with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage II to IV were divided into two groups: CB (CB+) if subjects noted chronic cough and phlegm production for ≥ 3 mo/y for 2 consecutive years, and no CB (CB−) if they did not.

Results

There were 290 and 771 subjects in the CB+ and CB− groups, respectively. Despite similar lung function, the CB+ group was younger (62.8 ± 8.4 vs 64.6 ± 8.4 years, P = .002), smoked more (57 ± 30 vs 52 ± 25 pack-years, P = .006), and had more current smokers (48% vs 27%, P < .0001). A greater percentage of the CB+ group reported nasal and ocular symptoms, wheezing, and nocturnal awakenings secondary to cough and dyspnea. History of exacerbations was higher in the CB+ group (1.21 ± 1.62 vs 0.63 ± 1.12 per patient, P < .027), and more patients in the CB+ group reported a history of severe exacerbations (26.6% vs 20.0%, P = .024). There was no difference in percent emphysema or percent gas trapping, but the CB+ group had a higher mean percent segmental airway wall area (63.2% ± 2.9% vs 62.6% ± 3.1%, P = .013).

Conclusions

CB in patients with COPD is associated with worse respiratory symptoms and higher risk of exacerbations. This group may need more directed therapy targeting chronic mucus production and smoking cessation not only to improve symptoms but also to reduce risk, improve quality of life, and improve outcomes.

Trial registry

ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov

Section snippets

Patient Selection

The COPDGene Study is a multicenter observational study to analyze genetic susceptibility for the development of COPD. This study met all criteria for institutional review board approval (Temple IRB #11369). Inclusion and exclusion criteria and protocol have been described previously.22 Briefly, enrollees are blacks or non-Hispanic whites aged 45 to 80 years with at least a 10-pack-year smoking history. Exclusion criteria include pregnancy, history of other lung disease except asthma, prior

Results

Participant demographics and medications are summarized in Table 1. Of the 1,061 subjects with COPD analyzed, CB was reported in 27.3% (CB+ group, n = 290; CB− group, n = 771). The percentage of subjects with CB in each GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage was similar (GOLD stage II, 27.3%; GOLD stage III, 28.7%; GOLD stage IV, 25.0%; P = .650). In the entire cohort, the CB+ group was younger (62.8 ± 8.4 vs 64.6 ± 8.4 years, P = .002) and had a greater percentage

Discussion

In this large, cross-sectional, multicenter study, we describe with great precision the clinical phenotype of patients with COPD and CB. With similar lung function, we found subjects with CB to be younger, have a greater smoking history, and have a greater likelihood of current smoking history than subjects without CB. Moreover, those with CB had higher SGRQ scores, a greater degree of breathlessness, and more upper-airway symptoms. These differences in health-related quality of life and

Acknowledgments

Author contributions: Dr Kim had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Kim: contributed to the study design, data collection and analysis, and writing of the manuscript.

Dr Han: contributed to the study design, data collection and analysis, and writing of the manuscript.

Ms Vance: contributed to the study design, data collection and analysis, and writing of the manuscript.

Dr Make: contributed to

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    Funding/Support: This study was supported by the National Heart, Lung, and Blood Institute [Grants U01 HL089856 and U01 HL08989].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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