Abstract
BackgroundThe Spanish chronic obstructive pulmonary disease (COPD) guideline phenotypes patients according to the exacerbation frequency and COPD subtypes. In this study, we compared the patients’ health-related quality of life (HRQoL) according to their COPD phenotypes.MethodsThis was a cross-sectional study of COPD patients who attended the outpatient clinic of the Serian Divisional Hospital and Bau District Hospital from 23th January 2018 to 22th January 2019. The HRQoL was assessed using modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George’s Respiratory Questionnaire for COPD (SGRQ-c).ResultsOf 185 patients, 108 (58.4%) were non-exacerbators (NON-AE), 51 (27.6%) were frequent exacerbators (AE), and the remaining 26 (14.1%) had asthma-COPD overlap (ACO). Of AE patients, 42 (82.4%) had chronic bronchitis and only 9 (17.6%) had emphysema. Of the 185 COPD patients, 65.9% had exposure to biomass fuel and 69.1% were ex- or current smokers.The scores of mMRC, CAT, and SGRQ-c were significantly different between COPD phenotypes (p < 0.001). There were significantly more patients with mMRC 2–4 among AE (68.6%) (p < 0.001), compared to those with ACO (38.5%) and NON-AE (16.7%). AE patients had significantly higher total CAT (p = 0.003; p < 0.001) and SGRQ-c (both p < 0.001) scores than those with ACO and NON-AE. Patients with ACO had significantly higher total CAT and SGRQ-c (both p < 0.001) scores than those with NON-AE.AE patients had significantly higher score in each item of CAT and component of SGRQ-c compared to those with NON-AE (all p < 0.001), and ACO [(p = 0.003–0.016; p = < 0.001–0.005) except CAT 1, 2 and 7. ACO patients had significantly higher score in each item of CAT and component of SGRQ-c (p = < 0.001–0.040; p < 0.001) except CAT 2 and activity components of SGRQ-c.ConclusionsThe HRQoL of COPD patients was significantly different across different COPD phenotypes. HRQoL was worst in AE, followed by ACO and NON-AE. This study supports phenotyping COPD patients based on their exacerbation frequency and COPD subtypes. The treatment of COPD should be personalised according to these two factors.
Highlights
The Spanish chronic obstructive pulmonary disease (COPD) guideline phenotypes patients according to the exacerbation frequency and COPD subtypes
There was no significant difference in ethnicity, smoking status, biomass exposure, and Post-bronchodilator forced expiratory volume in 1 s (PB-FEV1) between the COPD phenotypes
Abbreviation: COPD chronic obstructive pulmonary disease, non-exacerbator phenotype (NON-Exacerbator phenotype (AE)) non-exacerbators, ACO asthma-COPD overlap, AE frequent exacerbators, PB-FEV1 post bronchodilator forced expiratory volume in 1 s, SD standard deviation; 95% CI, 95% confidence interval p-values with bold are significant for AE versus ACO, as well as cough and daily activity limitation for ACO versus NON-AE
Summary
The Spanish chronic obstructive pulmonary disease (COPD) guideline phenotypes patients according to the exacerbation frequency and COPD subtypes. COPD is currently the fourth leading cause of death and is expected to rank number three by 2030 [2]. It ranks second in the disease burden measured by the disability-adjusted life-years, [3] causing substantial socioeconomic burden in many countries [1]. COPD phenotype is defined as a single or combination of disease attributes that describe the differences between individuals with COPD according to their clinically meaningful outcomes, such as exacerbation, symptoms, rate of disease progression, response to therapy, and mortality risk [4]. In 2012, the Spanish Society of Pulmonology and Thoracic Surgery proposed to phenotype COPD based on the exacerbation frequency and existing COPD subtypes [6]
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