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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Esacerbazioni delle broncopneumopatie croniche ostruttive
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TL;DR: In this article, a data-driven recursive partitioning algorithm was employed using baseline data from two pooled one-year randomized exacerbation trials (n=3,255) of fluticasone furoate/vilanterol or vilanterol alone to identify distinct patient groups at greatest risk of pneumonia or serious pneumonia.
References
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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.