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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Multimorbidity clusters in patients with chronic obstructive airway diseases in the EpiChron Cohort
Jonás Carmona-Pírez,Beatriz Poblador-Plou,Ignatios Ioakeim-Skoufa,Francisca González-Rubio,Luis Andrés Gimeno-Feliu,Jesús Díez-Manglano,Jesús Díez-Manglano,Clara Laguna-Berna,Jose M. Marin,Antonio Gimeno-Miguel,Alexandra Prados-Torres +10 more
TL;DR: In this article, the authors conducted an observational retrospective study in the EpiChron Cohort (Aragon, Spain), selecting all patients with a diagnosis of allergic rhinitis, asthma, COPD, and/or OSA.
Chronic Obstructive Pulmonary Disease and Cerebral Microbleeds
Lies Lahousse,Meike W. Vernooij,Sirwan K.L. Darweesh,Saloua Akoudad,Daan W. Loth,Guy Joos,Albert Hofman,Bruno H. Stricker,M. Arfan Ikram,Guy Brusselle +9 more
TL;DR: Subjects with COPD had a significantly higher prevalence of microbleeds in deep or infratentorial locations, which increased with severity of airflow limitation and are suggestive of hypertensive or arteriolosclerotic microangiopathy.
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The excessive use of inhaled corticosteroids in chronic obstructive pulmonary disease.
TL;DR: A re-evaluation of their safety, the consistency of the data on their efficacy showing similar results with moderate doses and a better patient selection require the use of this treatment in COPD patients to be reconsidered.
Journal ArticleDOI
Phenotypes of symptomatic airways disease in China and New Zealand
James Fingleton,Kewu Huang,Mark Weatherall,Mark Weatherall,Yanfei Guo,Stefan Ivanov,Piet L.B. Bruijnzeel,Hong Zhang,Wei Wang,Richard Beasley,Chen Wang +10 more
TL;DR: Cluster analysis of adults with symptomatic airways disease suggests the presence of similar asthma/COPD overlap phenotypes within populations with different genetic and environmental characteristics, and an obese/comorbid phenotype in a Western population.
Journal ArticleDOI
Moving Towards a New Focus on COPD. The Spanish COPD Guidelines (GESEPOC)
TL;DR: La Estrategia en EPOC fue el impulso a desarrollar una guía clínica interdisciplinar de tratamiento de la EPOC, en la which participaran todos los agentes integrantes of the Estrategy.
References
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Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.
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
TL;DR: It is recommended that spirometry is required for the clinical diagnosis of COPD to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation.
Journal ArticleDOI
Inference and missing data
TL;DR: In this article, it was shown that ignoring the process that causes missing data when making sampling distribution inferences about the parameter of the data, θ, is generally appropriate if and only if the missing data are missing at random and the observed data are observed at random, and then such inferences are generally conditional on the observed pattern of missing data.
Journal ArticleDOI
Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper
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.