Distribution and Outcomes of a Phenotype-Based Approach to Guide COPD Management: Results from the CHAIN Cohort.
BACKGROUND
The Spanish guideline for COPD (GesEPOC) recommends COPD treatment according to four clinical phenotypes: non-exacerbator phenotype with either chronic bronchitis or emphysema (NE), asthma-COPD overlap syndrome (ACOS), frequent exacerbator phenotype with emphysema (FEE) or frequent exacerbator phenotype with chronic bronchitis (FECB). However, little is known on the distribution and outcomes of the four suggested phenotypes.


OBJECTIVE
We aimed to determine the distribution of these COPD phenotypes, and their relation with one-year clinical outcomes.


METHODS
We followed a cohort of well-characterized patients with COPD up to one-year. Baseline characteristics, health status (CAT), BODE index, rate of exacerbations and mortality up to one year of follow-up were compared between the four phenotypes.


RESULTS
Overall, 831 stable COPD patients were evaluated. They were distributed as NE, 550 (66.2%); ACOS, 125 (15.0%); FEE, 38 (4.6%); and FECB, 99 (11.9%); additionally 19 (2.3%) COPD patients with frequent exacerbations did not fulfill the criteria for neither FEE nor FECB. At baseline, there were significant differences in symptoms, FEV1 and BODE index (all p<0.05). The FECB phenotype had the highest CAT score (17.1±8.2, p<0.05 compared to the other phenotypes). Frequent exacerbator groups (FEE and FECB) were receiving more pharmacological treatment at baseline, and also experienced more exacerbations the year after (all p<0.05) with no differences in one-year mortality. Most of NE (93%) and half of exacerbators were stable after one year.


CONCLUSIONS
There is an uneven distribution of COPD phenotypes in stable COPD patients, with significant differences in demographics, patient-centered outcomes and health care resources use.
Department of Respiratory Medicine, Hospital Son Espases-IdISPa, Palma de Mallorca, Spain.|CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Borja G
BG
Cosio
Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain.
Joan B
JB
Soriano
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.|Department of Respiratory Medicine, Hospital Universitario Virgen del Rocío- IBiS, Sevilla, Spain.
Jose Luis
JL
López-Campos
Department of Respiratory Medicine, Hospital Clinico San Carlos, Madrid, Spain.
Myriam
M
Calle
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.|Department of Respiratory Medicine, Hospital Arnau de Vilanova, Valencia, Spain.
Juan José
JJ
Soler
Department of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain.
Juan Pablo
JP
de-Torres
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.|Department of Respiratory Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Jose Maria
JM
Marín
Department of Respiratory Medicine Hospital Central de Asturias, Oviedo, Spain.
Cristina
C
Martínez
Department of Respiratory Medicine, Hospital Gregorio Marañon, Madrid, Spain.
Pilar
P
de Lucas
Department of Respiratory Medicine, Hospital Son Llátzer, Palma de Mallorca, Spain.
Isabel
I
Mir
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.|Department of Respiratory Medicine, Fundación Jimenez Diaz, Madrid, Spain.
Germán
G
Peces-Barba
Department of Respiratory Medicine, Hospital Universitario Reina Sofía, Cordoba-IMIBIC.UCO, Spain.
Nuria
N
Feu-Collado
Department of Respiratory Medicine, Hospital San Pablo y la Santa Cruz, Barcelona, Spain.
Ingrid
I
Solanes
Department of Respiratory Medicine, Hospital Universitario de Valme, Sevilla, Spain.
Inmaculada
I
Alfageme
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