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      Phenotypes of COPD patients with a smoking history in Central and Eastern Europe: the POPE Study

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          Abstract

          Chronic obstructive pulmonary disease (COPD) represents a major health problem in Central and Eastern European (CEE) countries; however, there are no data regarding clinical phenotypes of these patients in this region.

          Participation in the Phenotypes of COPD in Central and Eastern Europe (POPE) study was offered to stable patients with COPD in a real-life setting. The primary aim of this study was to assess the prevalence of phenotypes according to predefined criteria. Secondary aims included analysis of differences in symptom load, comorbidities and pharmacological treatment.

          3362 patients with COPD were recruited in 10 CEE countries. 63% of the population were nonexacerbators, 20.4% frequent exacerbators with chronic bronchitis, 9.5% frequent exacerbators without chronic bronchitis and 6.9% were classified as asthma–COPD overlap. Differences in the distribution of phenotypes between countries were observed, with the highest heterogeneity observed in the nonexacerbator cohort and the lowest heterogeneity observed in the asthma–COPD cohort. There were statistically significant differences in symptom load, lung function, comorbidities and treatment between these phenotypes.

          The majority of patients with stable COPD in CEE are nonexacerbators; however, there are distinct differences in surrogates of disease severity and therapy between predefined COPD phenotypes.

          Abstract

          Distinct phenotypes of COPD in Central and Eastern Europe have differences in symptoms, comorbidities and treatment http://ow.ly/oMZI307ndr5

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          The clinical features of the overlap between COPD and asthma

          Megan Hardin, Edwin K Silverman, R. Barr … (2011)
          Background The coexistence of COPD and asthma is widely recognized but has not been well described. This study characterizes clinical features, spirometry, and chest CT scans of smoking subjects with both COPD and asthma. Methods We performed a cross-sectional study comparing subjects with COPD and asthma to subjects with COPD alone in the COPDGene Study. Results 119 (13%) of 915 subjects with COPD reported a history of physician-diagnosed asthma. These subjects were younger (61.3 vs 64.7 years old, p = 0.0001) with lower lifetime smoking intensity (43.7 vs 55.1 pack years, p = 0.0001). More African-Americans reported a history of asthma (33.6% vs 15.6%, p < 0.0001). Subjects with COPD and asthma demonstrated worse disease-related quality of life, were more likely to have had a severe COPD exacerbation in the past year, and were more likely to experience frequent exacerbations (OR 3.55 [2.19, 5.75], p < 0.0001). Subjects with COPD and asthma demonstrated greater gas-trapping on chest CT. There were no differences in spirometry or CT measurements of emphysema or airway wall thickness. Conclusion Subjects with COPD and asthma represent a relevant clinical population, with worse health-related quality of life. They experience more frequent and severe respiratory exacerbations despite younger age and reduced lifetime smoking history. Trial registration ClinicalTrials.gov: NCT00608764
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            Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease

            Jadwiga Wedzicha, Simon Brill, James Allinson … (2013)
            Exacerbations of chronic obstructive pulmonary disease (COPD) are important events that carry significant consequences for patients. Some patients experience frequent exacerbations, and are now recognized as a distinct clinical subgroup, the ‘frequent exacerbator’ phenotype. This is relatively stable over time, occurs across disease severity, and is associated with poorer health outcomes. These patients are therefore a priority for research and treatment. The pathophysiology underlying the frequent exacerbator phenotype is complex, with increased airway and systemic inflammation, dynamic lung hyperinflation, changes in lower airway bacterial colonization and a possible increased susceptibility to viral infection. Frequent exacerbators are also at increased risk from comorbid extrapulmonary diseases including cardiovascular disease, gastroesophageal reflux, depression, osteoporosis and cognitive impairment. Overall these patients have poorer health status, accelerated forced expiratory volume over 1 s (FEV1) decline, worsened quality of life, and increased hospital admissions and mortality, contributing to increased exacerbation susceptibility and perpetuation of the frequent exacerbator phenotype. This review article sets out the definition and importance of the frequent exacerbator phenotype, with a detailed examination of its pathophysiology, impact and interaction with other comorbidities.
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              Risk factors for chronic obstructive pulmonary disease in a European cohort of young adults.

              Simone Accordini, Nino Kuenzli, Jordi Sunyer … (2011)
              Few studies have investigated the factors associated with the early inception of chronic obstructive pulmonary disease (COPD). We investigated COPD risk factors in an international cohort of young adults using different spirometric definitions of the disease. We studied 4,636 subjects without asthma who had prebronchodilator FEV(1)/FVC measured in the European Community Respiratory Health Survey both in 1991 to 1993 (when they were 20-44 yr old) and in 1999 to 2002. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease fixed cut-off criterion (FEV(1)/FVC < 0.70), and two criteria based on the Quanjer and LuftiBus reference equations (FEV(1)/FVC less than lower limit of normal). COPD determinants were studied using two-level Poisson regression models. COPD incidence ranged from 1.85 (lower limit of normal [Quanjer]) to 2.88 (Global Initiative for Chronic Obstructive Lung Disease) cases/1,000/yr. Although about half of the cases had smoked less than 20 pack-years, smoking was the main risk factor for COPD, and it accounted for 29 to 39% of the new cases during the follow-up. Airway hyperresponsiveness was the second strongest risk factor (15-17% of new cases). Other determinants were respiratory infections in childhood and a family history of asthma, whereas the role of sex, age, and of being underweight largely depended on the definition of COPD used. COPD may start early in life. Smoking prevention should be given the highest priority to reduce COPD occurrence. Airway hyperresponsiveness, a family history of asthma, and respiratory infections in childhood are other important determinants of COPD. We suggest the need for a definition of COPD that is not exclusively based on spirometry.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur Respir J
                Journal ID (iso-abbrev): Eur. Respir. J
                Journal ID (publisher-id): ERJ
                Journal ID (hwp): erj
                Title: The European Respiratory Journal
                Publisher: European Respiratory Society
                ISSN (Print): 0903-1936
                ISSN (Electronic): 1399-3003
                Publication date Collection: May 2017
                Publication date (Electronic): 11 May 2017
                Volume: 49
                Issue: 5
                Electronic Location Identifier: 1601446
                Affiliations
                [1 ]Dept of Pneumology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
                [2 ]Clinic for Pulmonary Diseases, Faculty of Medicine, Clinical Centre of Serbia, Belgrade, Serbia
                [3 ]Dept of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
                [4 ]Dept of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia
                [5 ]Dept of Pulmonology, University of Szeged, Deszk, Hungary
                [6 ]Laboratory of Pulmonology, Moscow State University of Medicine and Dentistry named after A.I.Evdokimov, Moscow, Russia
                [7 ]School of Medicine Zagreb, University Hospital Dubrava, Zagreb, Croatia
                [8 ]Clinic of Pulmonary Diseases, Military Medical Academy, Sofia, Bulgaria
                [9 ]Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
                [10 ]Pulmonary Dept, Topolsica Hospital, Topolsica, Slovenia
                [11 ]Faculty of Medicine, University of Latvia, Riga, Latvia
                [12 ]Pneumology Dept, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
                [13 ]Dept of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Vienna, Austria
                Author notes
                Arschang Valipour, Dept of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Sanatoriumstrasse 2, 1140 Vienna, Austria. E-mail: arschang.valipour@ 123456wienkav.at
                Article
                Publisher ID: ERJ-01446-2016
                DOI: 10.1183/13993003.01446-2016
                PMC ID: 5460642
                PubMed ID: 28495687
                SO-VID: a631f47f-a155-47d9-a7cf-b2b177cf2a0b
                Copyright © Copyright ©ERS 2017
                License:

                This ERJ Open article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                Date received : 20 July 2016
                Date accepted : 10 December 2016
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                Subject: Original Articles
                Subject: COPD
                Subject: 1

                ScienceOpen disciplines: Respiratory medicine
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                ScienceOpen disciplines: Respiratory medicine

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