COPD phenotypes: differences in survival

• Published in: International journal of chronic obstructive pulmonary disease Vol. 13; pp. 2245 - 2251
• Main Authors: Hernández Vázquez, Julio, Ali García, Ismael, Jiménez-García, Rodrigo, Álvaro Meca, Alejandro, López de Andrés, Ana, Matesanz Ruiz, Carmen, Buendía García, María Jesús, de Miguel Díez, Javier
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2018; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Age; Age Factors; Aged; Analysis; Body mass index; Bronchitis; Bronchitis, Chronic - complications; Bronchitis, Chronic - mortality; Bronchodilator Agents - therapeutic use; Carbon monoxide; Cardiac arrhythmia; Cardiovascular disease; chronic bronchitis; Chronic obstructive pulmonary disease; COPD; Development and progression; Diabetes; Disease Progression; Emphysema; exacerbator; Female; Forced Expiratory Volume; Genetic aspects; Genotype & phenotype; Health aspects; Humans; Hypertension; Male; Medical prognosis; Medical research; Mortality; Original Research; Oxygen therapy; Patients; Phenotype; Phenotypes; Pneumonia; positive bronchodilator response; Pulmonary Disease, Chronic Obstructive - classification; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Emphysema - complications; Respiratory diseases; Risk factors; Spirometry; Statistical analysis; Teachers; phenotypes; positive bronchodilator response; mortality; chronic bronchitis; exacerbator; COPD; emphysema
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S166163

The aim of the study was to analyze the characteristics and survival of a group of patients with COPD according to their clinical phenotype.
The study population was selected from patients undergoing scheduled spirometry between January 1, 2011 and June 30, 2011 at the respiratory function laboratory of a teaching hospital and comprised those with a previous and confirmed diagnosis of COPD and forced expiratory volume in the first second (FEV
) of <70%. The patients selected were classified into 4 groups: positive bronchodilator response, non-exacerbator, exacerbator with emphysema, and exacerbator with chronic bronchitis. Patients were followed up until April 2017.
We recruited 273 patients, of whom 89% were men. The distribution by phenotype was as follows: non-exacerbator, 47.2%; positive bronchodilator response, 25.8%; exacerbator with chronic bronchitis, 13.8%; and exacerbator with emphysema, 13.0%. A total of 90 patients died during follow-up (32.9%). Taking patients with a positive bronchodilator response as the reference category, the risk factors that were independently associated with death were older age (HR, 1.06; 95% CI, 1.03-1.09), lower FEV
(HR, 0.98; 95% CI, 0.96-0.99), and exacerbator with chronic bronchitis phenotype (HR, 3.28; 95% CI, 1.53-7.03).
Classification of COPD patients by phenotype makes it possible to identify subgroups with different prognoses. Thus, mortality was greater in exacerbators with chronic bronchitis and lower in those with a positive bronchodilator response.