Abstract
Background and objectivesThe clinical implications of the discordance between the risk of exacerbations and the level of airflow limitation in patients with chronic obstructive pulmonary disease (COPD) are still unknown. This study aimed to clarify the clinical significance of such discordance in the management of COPD by exploring its characteristics and risk factors.MethodsIn this retrospective, cross-sectional study, participating physicians completed a detailed patient record form for each participating outpatient with COPD. The data, collected by the Taiwan Obstructive Lung Disease consortium, were managed and analyzed.ResultsOf the enrolled participants, 316 (41.7%) had an inconsistency between the risk of exacerbations and the severity of airflow limitation. Univariate analysis showed that more severe airflow limitation (p = 0.000), higher COPD assessment test (CAT) scores (p = 0.003) and modified Medical Research Council (mMRC) scales (p = 0.008), and the presence of at least one (p = 0.000) or two (p = 0.003) co-morbidities were significantly associated with such inconsistency. More severe airflow limitation (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 3 and 4 classification; odds ratio (OR) = 27.09, p = 0.000 and OR = 25.15, p = 0.000, respectively) and the presence of at least one co-morbidity (OR = 2.01, p = 0.001) were still associated with the inconsistency in multivariate logistic regression analysis. Furthermore, the presence of wheezing (OR = 3.90, p = 0.000) and at least two co-morbidities (OR = 5.43, p = 0.005) were independent risk factors for an inconsistency of a high risk of exacerbations / GOLD 1 or 2 and the CAT score≧10 (OR = 1.58, p = 0.007), mMRC scale 2–4 (OR = 1.53, p = 0.017), and the presence of at least one co-morbidity (OR = 2.55, p = 0.000) for an inconsistency of a low risk of exacerbations / GOLD 3 or 4.ConclusionsThe patients with COPD and an inconsistency between the risk of exacerbations and level of airflow limitation had unique clinical characteristics and risk factors for this inconsistency. Management of these patients should include more detailed evaluations.
Highlights
As described previously [1], the complexities of chronic obstructive pulmonary disease (COPD) mean that comprehensive assessments are required for its management
Univariate analysis showed that more severe airflow limitation (p = 0.000), higher COPD assessment test (CAT) scores (p = 0.003) and modified Medical Research Council scales (p = 0.008), and the presence of at least one (p = 0.000) or two (p = 0.003) co-morbidities were significantly associated with such inconsistency
This change in definition of the risk of exacerbations in COPD from Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2014 to GOLD 2017 has resulted in inconsistencies between the risk of exacerbations and severity of airflow limitation, in that the patients with COPD with a low risk of exacerbations may have severe to very severe airflow limitation (FEV1 < 50%), whereas those with a high risk of exacerbations may have mild to moderate airflow limitation (FEV1 ! 50%)
Summary
As described previously [1], the complexities of chronic obstructive pulmonary disease (COPD) mean that comprehensive assessments are required for its management. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee provided a two-dimensional assessment tool that takes into account both exacerbation risk and symptom assessment to allow for the appropriate treatment of COPD in 2014 [2]. In this tool, the risk of exacerbations of COPD is determined by both a history of exacerbations in the previous one year and forced expiratory volume in one second (FEV1) % predicted. The clinical implications of the discordance between the risk of exacerbations and the level of airflow limitation in patients with chronic obstructive pulmonary disease (COPD) are still unknown. This study aimed to clarify the clinical significance of such discordance in the management of COPD by exploring its characteristics and risk factors.
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