Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory airway disease punctuated by exacerbations (AECOPD). Subjects with frequent AECOPD, defined by having at least two exacerbations per year, experience accelerated loss of lung function, deterioration in quality of life and increase in mortality. Fibroblast growth factor (FGF)23, a hormone associated with systemic inflammation and altered metabolism is elevated in COPD. However, associations between FGF23 and AECOPD are unknown. In this cross-sectional study, individuals with COPD were enrolled between June 2016 and December 2016. Plasma samples were analyzed for intact FGF23 levels. Logistic regression analyses were used to measure associations between clinical variables, FGF23, and the frequent exacerbator phenotype. Our results showed that FGF23 levels were higher in frequent exacerbators as compared to patients without frequent exacerbations. FGF23 was also independently associated with frequent exacerbations (OR 1.02; 95%CI 1.004–1.04; p = 0.017), after adjusting for age, lung function, smoking, and oxygen use. In summary, FGF23 was associated with the frequent exacerbator phenotype and correlated with number of exacerbations recorded retrospectively and prospectively. Further studies are needed to explore the role of FGF 23 as a possible biomarker for AECOPD to better understand the pathobiology of COPD and to help develop therapeutic targets.
Highlights
Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by chronic airway inflammation and progressive decline in lung function which currently accounts as the third leading cause of death in the United States [1,2]
The natural history of COPD is modified by the presence of acute exacerbations of COPD (AECOPD), which significantly increase airway inflammation and are associated with a more accelerated decline in lung function, negatively impacting quality of life and increasing mortality [3,4,5,6]
Frequent exacerbators, defined based on events before FGF23 measurement, were not significantly different compared to the infrequent exacerbator group in several demographic and clinical features of COPD (Table 2)
Summary
Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by chronic airway inflammation and progressive decline in lung function which currently accounts as the third leading cause of death in the United States [1,2]. Given the variable occurrence of AECOPD among subjects with COPD, recent reports have demonstrated the existence and clinical relevance of a frequent exacerbator subgroup of patients with COPD [7]. Subjects with this particular phenotype do have more airflow limitation, symptoms and health-related quality of life impairment and respiratory disability [7,8,9,10]. Specific therapeutic approaches targeting this phenotype are sparse [14,15] It is still not clear whether the COPD frequent exacerbator group has a stable phenotype or whether the rate of exacerbations can change over time [16]. It is important to better understand the underlying pathophysiology of this phenotype and identify reliable prognostic biomarkers and novel targets for therapy
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