Distributionand Outcomes of a Phenotype-Based Approach to Guide COPD Management: Results from the CHAIN Cohort
Por:
Cosio BG, Soriano JB, López-Campos JL, Calle M, Soler JJ, de-Torres JP, Marín JM, Martínez C, de Lucas P, Mir I, Peces-Barba G, Feu-Collado N, Solanes I, Alfageme I and CHAIN study
Publicada:
29 sep 2016
Resumen:
Rationale 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.
Objective
We aimed to determine the distribution of these COPD phenotypes, and
their relation with one-year clinical outcomes.
Methods
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.
Results
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, FEV1 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.
Conclusions
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.
Filiaciones:
Cosio BG:
Department of Respiratory Medicine, Hospital Son Espases-IdISPa, Palma de Mallorca, Spain
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
Soriano JB:
Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain
López-Campos JL:
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
Department of Respiratory Medicine, Hospital Universitario Virgen del Rocío- IBiS, Sevilla, Spain
Calle M:
Department of Respiratory Medicine, Hospital Clinico San Carlos, Madrid, Spain
:
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
Department of Respiratory Medicine, Hospital Arnau de Vilanova, Valencia, Spain
de-Torres JP:
Department of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain
Marín JM:
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
Department of Respiratory Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
Martínez C:
Department of Respiratory Medicine Hospital Central de Asturias, Oviedo, Spain
de Lucas P:
Department of Respiratory Medicine, Hospital Gregorio Marañon, Madrid, Spain
Mir I:
Department of Respiratory Medicine, Hospital Son Llátzer, Palma de Mallorca, Spain
Peces-Barba G:
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
Department of Respiratory Medicine, Fundación Jimenez Diaz, Madrid, Spain
Feu-Collado N:
Department of Respiratory Medicine, Hospital Universitario Reina Sofía, Cordoba-IMIBIC.UCO, Spain
Solanes I:
Department of Respiratory Medicine, Hospital San Pablo y la Santa Cruz, Barcelona, Spain
Alfageme I:
Department of Respiratory Medicine, Hospital Universitario de Valme, Sevilla, Spain
Open Access
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