Distribution and Outcomes of a Phenotype-Based Approach to Guide COPD Management : Results from the CHAIN Cohort
Cosio, Borja G.. (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
Soriano, Joan B.. (Instituto de Investigación Hospital Universitario de la Princesa)
López-Campos, José Luis (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Calle Rubio, Myriam (Hospital Clínico San Carlos (Madrid))
Soler, Juan José (Hospital Arnau de Vilanova (Lleida, Catalunya))
De Torres, Juan Pablo (Clínica Universidad de Navarra)
Marín, Jose Maria (Hospital Universitario Miguel Servet (Saragossa))
Martínez González, Cristina (Hospital Universitario Central de Asturias)
de Lucas, Pilar (Hospital General Universitario Gregorio Marañón)
Mir, Isabel (Hospital Universitari Son Llàtzer (Palma de Mallorca, Balears))
Peces-Barba, Germán (Hospital Universitario Fundación Jiménez Díaz)
Feu-Collado, Nuria (Instituto Maimónides de Investigación Biomédica de Córdoba)
Solanes García, Ingrid (Institut d'Investigació Biomèdica Sant Pau)
Alfageme, Inmaculada (Hospital Universitario Virgen de Valme (Sevilla, Andalusia))
Universitat Autònoma de Barcelona

Fecha:	2016
Resumen:	The Spanish guideline for COPD (GesEPOC) recommends COPD treatment according to four clinical phenotypes: non-exacerbator phenotype with either chronic bronchitis or emphysema (NE), asthma-COPD overlap syndrome (ACOS), frequent exacerbator phenotype with emphysema (FEE) or frequent exacerbator phenotype with chronic bronchitis (FECB). However, little is known on the distribution and outcomes of the four suggested phenotypes. We aimed to determine the distribution of these COPD phenotypes, and their relation with one-year clinical outcomes. We followed a cohort of well-characterized patients with COPD up to one-year. Baseline characteristics, health status (CAT), BODE index, rate of exacerbations and mortality up to one year of follow-up were compared between the four phenotypes. Overall, 831 stable COPD patients were evaluated. They were distributed as NE, 550 (66. 2%); ACOS, 125 (15. 0%); FEE, 38 (4. 6%); and FECB, 99 (11. 9%); additionally 19 (2. 3%) COPD patients with frequent exacerbations did not fulfill the criteria for neither FEE nor FECB. At baseline, there were significant differences in symptoms, FEV and BODE index (all p<0. 05). The FECB phenotype had the highest CAT score (17. 1±8. 2, p<0. 05 compared to the other phenotypes). Frequent exacerbator groups (FEE and FECB) were receiving more pharmacological treatment at baseline, and also experienced more exacerbations the year after (all p<0. 05) with no differences in one-year mortality. Most of NE (93%) and half of exacerbators were stable after one year. There is an uneven distribution of COPD phenotypes in stable COPD patients, with significant differences in demographics, patient-centered outcomes and health care resources use.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Publicado en:	PloS one, Vol. 11 (september 2016) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0160770
PMID: 27684372

15 p, 1.6 MB

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