Identification and prospective validation of clinically relevant chronic obstructive pulmonary disease (COPD) subtypes
Judith Garcia-Aymerich,Federico P. Gómez,Marta Benet,Eva Farrero,Xavier Basagaña,Angel Gayete,Carles Paré,Xavier Freixa,Jaume Ferrer,Antoni Ferrer,Josep Roca,Juan B. Galdiz,Jaume Sauleda,Eduard Monsó,Joaquim Gea,Joan Albert Barberà,Alvar Agusti,Josep M. Antó +17 more
TLDR
In 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'.Abstract:
Background Chronic obstructive pulmonary disease (COPD) is increasingly considered a heterogeneous condition. It was hypothesised that COPD, as currently defined, includes different clinically relevant subtypes. Methods To 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. Results Three COPD groups were identified: group 1 (n¼126, 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 (n¼125, 69 years) showed milder airflow limitation (FEV1 63% predicted); and group 3 (n¼91, 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, p¼0.018) than the other two groups, whereas group 3 had more admissions due to cardiovascular disease (HR 2.87, p¼0.014). Conclusions In 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’.read more
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Anemia and survival in chronic obstructive pulmonary disease: a dichotomous rather than a continuous predictor.
TL;DR: This is the first study to indicate that anemia (but not the Hb value) is independently associated with survival in stable COPD outpatients and should be treated as a categorical variable in future scoring systems.
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Treatable traits in acute exacerbations of chronic airway diseases
TL;DR: This work reviews the literature relating to treatable traits in airway diseases and proposes this approach as a potentially useful model of care to both prevent and manage acute exacerbations.
Journal ArticleDOI
Comorbidity Distribution, Clinical Expression and Survival in COPD Patients with Different Body Mass Index.
Miguel Divo,Carlos Javier Gutiérrez Cabrera,Ciro Casanova,Jose M. Marin,Victor Pinto-Plata,Juan P. de-Torres,Javier J. Zulueta,Jorge Zagaceta,Pablo Sanchez-Salcedo,Juan Berto,Claudia Cote,Bartolome R. Celli +11 more
TL;DR: Different BMI categories are associated with distinct clinical expressions of COPD and comorbidity patterns, and the relationship between BMI and mortality in patients with COPD remains an unresolved paradox.
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Physical activity patterns and clusters in 1001 patients with COPD
Rafael Mesquita,Gabriele Spina,Fabio Pitta,David Donaire-Gonzalez,Brenda M. Deering,Mehul S. Patel,Katy E. Mitchell,Jennifer A. Alison,Arnoldus J. R. van Gestel,Stefanie Zogg,Philippe Gagnon,Beatriz Abascal-Bolado,Barbara Vagaggini,Judith Garcia-Aymerich,Sue Jenkins,Elisabeth A. P. M. Romme,Samantha S.C. Kon,Paul Albert,Benjamin Waschki,Dinesh Shrikrishna,Sally J Singh,Nicholas S Hopkinson,David Miedinger,Roberto P. Benzo,François Maltais,Pierluigi Paggiaro,Zoe J. McKeough,Michael I. Polkey,Kylie Hill,William D.-C. Man,Christian F. Clarenbach,Nidia A. Hernandes,Daniela Savi,Sally L. Wootton,Karina Couto Furlanetto,Li W. Cindy Ng,Anouk W. Vaes,Christine Jenkins,Peter R. Eastwood,Diana Jarreta,Anne Kirsten,Dina Brooks,David R. Hillman,Thais Sant'Anna,Kenneth Meijer,Selina Dürr,Erica P.A. Rutten,Malcolm Kohler,Vanessa S. Probst,Ruth Tal-Singer,Esther Garcia Gil,Albertus C. den Brinker,Jörg D. Leuppi,Peter M.A. Calverley,Frank W.J.M. Smeenk,Richard W. Costello,Marco Gramm,Roger S. Goldstein,Miriam T.J. Groenen,Helgo Magnussen,Emiel F.M. Wouters,Richard ZuWallack,Oliver Amft,Henrik Watz,Martijn A. Spruit +64 more
TL;DR: Physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) are heterogeneous and couch potatoes were characterised by higher BMI, lower FEV1, worse dyspnoea and higher ADO index compared to other clusters.
Journal ArticleDOI
Treatment responsiveness of phenotypes of symptomatic airways obstruction in adults
James Fingleton,Justin Travers,Mathew Williams,Thomas Charles,Darren Bowles,Rianne Strik,Philippa Shirtcliffe,Mark Weatherall,Richard Beasley +8 more
TL;DR: Cluster analysis of adults with symptomatic airflow obstruction identifies 5 disease phenotypes, including asthma-COPD overlap and obese-comorbid phenotype, and provides evidence that patients with the asthma and COPD overlap syndrome might benefit from inhaled corticosteroid therapy.
References
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Jørgen Vestbo,Suzanne S. Hurd,Alvar Agusti,Paul W. Jones,Claus Vogelmeier,Antonio Anzueto,Peter J. Barnes,Leonardo M. Fabbri,Fernando J. Martinez,Masaharu Nishimura,Robert A. Stockley,Don D. Sin,Roberto Rodriguez-Roisin +12 more
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Inference and missing data
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Bartolome R. Celli,William MacNee,Alvar Agusti,Antonio Anzueto,B. Berg,A. S. Buist,Peter M.A. Calverley,Niels H. Chavannes,T. Dillard,Bonnie F. Fahy,Alan M. Fein,John E. Heffner,Suzanne C. Lareau,Paula Meek,Fernando J. Martinez,Walter T. McNicholas,Jean W M Muris,E. Austegard,Romain Pauwels,S. I. Rennard,Adriano G. Rossi,NM Siafakas,B. Tiep,Jørgen Vestbo,E. F. M. Wouters,Richard ZuWallack +25 more
TL;DR: The main goals of the updated document are to improve the quality of care provided to patients with COPD and to develop the project using a disease-oriented approach.
Journal ArticleDOI
The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease
Bartolome R. Celli,Claudia Cote,Jose M. Marin,Ciro Casanova,Maria Montes de Oca,Reina A. Mendez,Victor Pinto Plata,Howard Cabral +7 more
TL;DR: The BODE index, a simple multidimensional grading system, is better than the FEV1 at predicting the risk of death from any cause and from respiratory causes among patients with COPD.
Book
Users' Guides to the Medical Literature
Gordon H. Guyatt,Drummond Rennie +1 more
TL;DR: Without a way of critically appraising the information they receive, clinicians are relatively helpless in deciding what new information to learn and decide how to modify their practice.