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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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
Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype.
Alvar Agusti,Lisa D. Edwards,Stephen I. Rennard,William MacNee,Ruth Tal-Singer,Bruce E. Miller,Jørgen Vestbo,Jørgen Vestbo,David A. Lomas,Peter M.A. Calverley,Emiel F.M. Wouters,Courtney Crim,Julie C. Yates,Edwin K. Silverman,Harvey O. Coxson,Per Bakke,Ruth J. Mayer,Bartolome R. Celli +17 more
TL;DR: Overall, the results identify a novel systemic inflammatory COPD phenotype that may be the target of specific research and treatment and show associations but do not prove causality.
Journal ArticleDOI
Clusters of Comorbidities Based on Validated Objective Measurements and Systemic Inflammation in Patients with Chronic Obstructive Pulmonary Disease
Lowie E.G.W. Vanfleteren,Martijn A. Spruit,Miriam T.J. Groenen,Swetlana Gaffron,Vanessa P. M. van Empel,Piet L.B. Bruijnzeel,Erica P.A. Rutten,Jos op 't Roodt,Emiel F.M. Wouters,Frits M.E. Franssen +9 more
TL;DR: Multimorbidity is common in patients with COPD, and different comorbidite clusters can be identified, and low-grade systemic inflammation is mostly comparable among comor bidities.
Journal ArticleDOI
Chronic obstructive pulmonary disease.
Peter J. Barnes,Peter Burney,Edwin K. Silverman,Bartolome R. Celli,Jørgen Vestbo,Jadwiga A. Wedzicha,Emiel F.M. Wouters +6 more
TL;DR: In this paper, the authors investigated the mechanisms underlying chronic obstructive pulmonary disease (COPD), which is associated with chronic inflammation that is usually corticosteroid resistant, and accelerated ageing of the lungs and an abnormal repair mechanism driven by oxidative stress.
Journal ArticleDOI
Antibiotics for exacerbations of chronic obstructive pulmonary disease
Daniela Vollenweider,Harish Jarrett,Claudia Steurer-Stey,Judith Garcia-Aymerich,Milo A. Puhan +4 more
TL;DR: In this article, the effects of antibiotics in the management of acute COPD exacerbations on treatment failure and other patient-important outcomes (mortality, adverse events, length of hospital stay) were assessed.
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