Distributionand Outcomes of a Phenotype-Based Approach to Guide COPD Management: Results from the CHAIN Cohort
Por:
Cosio, BG, Soriano, JB, Lopez-Campos, JL, Calle, M, Soler, JJ, de-Torres, JP, Marin, JM, Martinez, C, de Lucas, P, Mir, I, Peces-Barba, G, Feu-Collado, N, Solanes, I, Alfageme, I
Publicada:
29 sep 2016
Resumen:
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.
Filiaciones:
Cosio, BG:
Hosp Son Espases IdISPa, Dept Resp Med, Palma De Mallorca, Spain
Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain
Soriano, JB:
Univ Autonoma Madrid, Catedra UAM Linde, Inst Invest Hosp Univ Princesa IISP, Madrid, Spain
Lopez-Campos, JL:
Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain
Hosp Univ Virgen Rocio IBiS, Dept Resp Med, Seville, Spain
Calle, M:
Hosp Clin San Carlos, Dept Resp Med, Madrid, Spain
Soler, JJ:
Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain
Hosp Arnau Vilanova, Dept Resp Med, Valencia, Spain
de-Torres, JP:
Clin Univ Navarra, Dept Resp Med, Pamplona, Spain
Marin, JM:
Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain
Hosp Univ Miguel Servet, Dept Resp Med, Zaragoza, Spain
Martinez, C:
Hosp Cent Asturias, Dept Resp Med, Oviedo, Spain
de Lucas, P:
Hosp Gregorio Maranon, Dept Resp Med, Madrid, Spain
Mir, I:
Hosp Son Llatzer, Dept Resp Med, Palma De Mallorca, Spain
Peces-Barba, G:
Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain
Fdn Jimenez Diaz, Dept Resp Med, Madrid, Spain
Feu-Collado, N:
Hosp Univ Reina Sofia, Cordoba IMIBIC UCO, Dept Resp Med, Cordoba, Spain
Solanes, I:
Hosp San Pablo & Santa Cruz, Dept Resp Med, Barcelona, Spain
Alfageme, I:
Hosp Univ Valme, Dept Resp Med, Seville, Spain
Gold, Green Published
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