Details

Autor(en) / Beteiligte

• Garcia-Aymerich, Judith
• Gómez, Federico P
• Benet, Marta
• Farrero, Eva
• Basagaña, Xavier
• Gayete, Àngel
• Paré, Carles
• Freixa, Xavier
• Ferrer, Jaume
• Ferrer, Antoni
• Roca, Josep
• Gáldiz, Juan B
• Sauleda, Jaume
• Monsó, Eduard
• Gea, Joaquim
• Barberà, Joan A
• Agustí, Àlvar
• Antó, Josep M

Titel

Identification and prospective validation of clinically relevant chronic obstructive pulmonary disease (COPD) subtypes

Ist Teil von

• Thorax, 2011-05, Vol.66 (5), p.430-437

Ort / Verlag

England: BMJ Publishing Group Ltd and British Thoracic Society

Erscheinungsjahr

2011

Link zum Volltext

Quelle

BMJ Journals Archiv - DFG Nationallizenzen

Beschreibungen/Notizen

• BackgroundChronic obstructive pulmonary disease (COPD) is increasingly considered a heterogeneous condition. It was hypothesised that COPD, as currently defined, includes different clinically relevant subtypes.MethodsTo identify and validate COPD subtypes, 342 subjects hospitalised for the first time because of a COPD exacerbation were recruited. Three months after discharge, when clinically stable, symptoms and quality of life, lung function, exercise capacity, nutritional status, biomarkers of systemic and bronchial inflammation, sputum microbiology, CT of the thorax and echocardiography were assessed. COPD groups were identified by partitioning cluster analysis and validated prospectively against cause-specific hospitalisations and all-cause mortality during a 4 year follow-up.ResultsThree COPD groups were identified: group 1 (n=126, 67 years) was characterised by severe airflow limitation (postbronchodilator forced expiratory volume in 1 s (FEV1) 38% predicted) and worse performance in most of the respiratory domains of the disease; group 2 (n=125, 69 years) showed milder airflow limitation (FEV1 63% predicted); and group 3 (n=91, 67 years) combined a similarly milder airflow limitation (FEV1 58% predicted) with a high proportion of obesity, cardiovascular disorders, diabetes and systemic inflammation. During follow-up, group 1 had more frequent hospitalisations due to COPD (HR 3.28, p<0.001) and higher all-cause mortality (HR 2.36, p=0.018) than the other two groups, whereas group 3 had more admissions due to cardiovascular disease (HR 2.87, p=0.014).ConclusionsIn patients with COPD recruited at their first hospitalisation, three different COPD subtypes were identified and prospectively validated: ‘severe respiratory COPD’, ‘moderate respiratory COPD’, and ‘systemic COPD’.