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Title: Identification and prospective validation of clinically relevant chronic obstructive pulmonary disease (COPD) subtypes
Author: García Aymerich, Judith
Gomez, Federico P.
Benet Mora, Marta
Farrero, Eva
Basagaña, Xavier
Gayete, Àngel
Pare i Bardera, J. Carles
Freixa, Xavier
Ferrer, Jaume
Ferrer Monreal, Antonio
Roca Elias, Josep
Galdiz, Juan B.
Sauleda, Jaume
Monsó, Eduard
Gea Guiral, Joaquim
Barberà i Mir, Joan Albert
Agustí García-Navarro, Àlvar
Antó i Boqué, Josep Maria
Keywords: Malalties de l'aparell respiratori
Malalties pulmonars obstructives cròniques
Assaigs clínics
Respiratory organs diseases
Chronic obstructive pulmonary diseases
Clinical trials
Issue Date: 21-Dec-2010
Publisher: BMJ Publishing Group
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 (n ¼ 126, 67 years) was characterised by severe airflow limitation (postbronchodilator forced expiratory volume in 1 s (FEV 1 ) 38% predicted) and worse performance in most of the respiratory domains of the disease; group 2 (n ¼ 125, 69 years) showed milder airflow limitation (FEV 1 63% predicted); and group 3 (n ¼ 91, 67 years) combined a similarly milder airflow limitation (FEV 1 58% predicted) with a high proportion of obesity, cardiovascular disorders, iabetes 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, p ¼ 0.018) than the other two groups, whereas group 3 had more admissions due to cardiovascular disease (HR 2.87, p ¼ 0.014). 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'
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It is part of: Thorax, 2010, vol. 66, p. 430-437
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ISSN: 0040-6376
Appears in Collections:Articles publicats en revistes (Medicina)

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