Abstract
BackgroundChronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE).MethodsWe studied 2164 clinically stable COPD patients, 337 smokers with normal lung function and 245 never smokers. In these individuals, we measured clinical parameters, nutritional status, spirometry, exercise tolerance, and amount of emphysema by computed tomography.ResultsCOPD patients were slightly older than controls and had more pack years of smoking than smokers with normal lung function. Co-morbidities were more prevalent in COPD patients than in controls, and occurred to the same extent irrespective of the GOLD stage. The severity of airflow limitation in COPD patients was poorly related to the degree of breathlessness, health status, presence of co-morbidity, exercise capacity and number of exacerbations reported in the year before the study. The distribution of these variables within each GOLD stage was wide. Even in subjects with severe airflow obstruction, a substantial proportion did not report symptoms, exacerbations or exercise limitation. The amount of emphysema increased with GOLD severity. The prevalence of bronchiectasis was low (4%) but also increased with GOLD stage. Some gender differences were also identified.ConclusionsThe clinical manifestations of COPD are highly variable and the degree of airflow limitation does not capture the heterogeneity of the disease.
Highlights
Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extrapulmonary manifestations
A Steering Committee and a Scientific Committee comprising in total ten academics and six representatives of the COPD patients compared with controls COPD patients were older than controls and had more pack years of smoking than smokers with normal lung function (Table 1)
Co-morbidities were more prevalent in COPD; 38% of patients with COPD had more than one co-morbidity (23% in smokers with normal lung function and 16% in non-smokers; p < 0.001)
Summary
Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extrapulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE). Chronic obstructive pulmonary disease (COPD) is defined by the presence of poorly reversible airflow limitation [1]. COPD is a complex, multi-component, heterogeneous disease, whose clinical, functional and radiological presentation varies greatly from patient to patient despite having a similar degree of airflow limitation [1,2,3]. The prevalence, distribution and inter-relationships of the main clinical, functional and radiological manifestations of the disease in a large, well-characterised and controlled population of patients are lacking
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