Phenotype and management of chronic obstructive pulmonary disease patients in general population in China: a nationally cross-sectional study

Heling Bao,Jeffrey L Curtis,Guohua Jia,Liwen Fang,Yajing Feng,Ning Wang,Wanlu Sun,Linhong Wang,Jing Fan,Shu Cong,Baohua Wang,Yahong Chen

doi:10.1038/s41533-021-00243-x

Abstract

This study aims to investigate the characteristics of the phenotype and management of chronic obstructive pulmonary disease (COPD) patients in the general population in China. We analyzed spirometry-confirmed COPD patients who were identified from a population-based, nationally representative sample in China. All participants were measured with airflow limitation severity based on post-bronchodilator FEV1 percent predicted, bronchodilator responsiveness, exacerbation history, and respiratory symptoms. Among a total of 9134 COPD patients, 90.3% were non-exacerbators, 2.9% were frequent exacerbators without chronic bronchitis, 2.0% were frequent exacerbators with chronic bronchitis, and 4.8% were asthma-COPD overlap. Less than 5% of non-exacerbators ever had pulmonary function testing performed. The utilization rate of inhaled medication in non-exacerbators, exacerbators without chronic bronchitis, exacerbators with chronic bronchitis, and asthma-COPD overlap was 1.4, 23.5, 29.5, and 19.4%, respectively. A comprehensive strategy for the management of COPD patients based on phenotype in primary care is urgently needed.

Highlights

Chronic obstructive pulmonary disease (COPD) is a globally publichealth problem, with an estimation of 299.4 million prevalent cases and 3.2 million deaths per year worldwide[1,2]
The estimated COPD phenotype prevalence among COPD patients according to predefined definition were, NON-as frequent exacerbators (AE), 90.3%, AE NON-Chronic bronchitis (CB), 2.9% (2.4–3.4%), AE-CB, 2.0% (1.7–2.3%), and asthma-COPD overlap (ACO), 4.8% (4.2–5.4%), while the pattern according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) was GOLD A, 54.1%, GOLD B 39.5% (34.8–44.1%), GOLD C, 1.7% (1.2–2.1%), and GOLD D, 4.8% (4.1–5.6%) (Fig. 2)
All NON-AE patients were in GOLDA through B group, and AE with or without CB were in GOLD C through D group

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a globally publichealth problem, with an estimation of 299.4 million prevalent cases and 3.2 million deaths per year worldwide[1,2]. In China, the COPD prevalence is 8.6% among adults with a projected 99.9 million patients[3,4]. COPD management greatly challenge the health-care systems, especially in low- and middle-income countries. Diagnosis and appropriate management of COPD patients in primary care play an important role in reducing the risk of adverse outcomes and improving quality of life, but this issue is paid not enough attention previously[5]. Individualized management protocol based on specific COPD phenotype has been advocated instead of a “one size fits all” pattern[6,7]. Phenotypic strategies based on symptoms, response to therapy, and risk of disease progression are essential to direct the identification and management of COPD patients in routine practice[8]. COPD phenotype distribution associated with clinically meaningful outcomes have been identified in clinical-based studies[9,10,11], the issue is less known for COPD patients in general population in China

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