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Background:
COPD is currently recognized as a syndrome associated with a high prevalence of comorbidities and various phenotypes. Exacerbations are very important events in the clinical history of COPD because they drive the decline in lung function. In the present study, we aim to identify whether there are any clinical and functional specific fe...
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Background
Breathlessness is associated with major adverse health outcomes and is twice as common in women as men in the general population. We evaluated whether this is related to their lower absolute lung volumes.
Methods
Cross-sectional analysis of the population-based Swedish CardioPulmonarybioImage Study (SCAPIS) Pilot, including static spiro...
Citations
... A reduction in IC due to an increase in RV causes shortness of breath through hyperinflation independent of hypoxemia. A clinical trial has indicated that the IC percentage predicted is significantly reduced in COPD with frequent exacerbations, and the Motley index (RV/total lung capacity (TLC) percentage) is also significantly increased in these patients with COPD [58]. Therefore, FEV 1 , DLco, IC, and RV/TLC can be predictors for COPD exacerbations. ...
... In exacerbation-prone COPD, major predictors of exacerbations are associated with respiratory disorders such as function, hyperresponsiveness, infection, diseases, inflammation, and prior exacerbations. Illustrated based on Refs.[3,14,[52][53][54][55][56][57][58].Airway Disorders as Predictive Factors of Exacerbations in Asthma and COPD DOI: http://dx.doi.org/10.5772/intechopen.1002669 ...
Asthma and chronic obstructive pulmonary disease (COPD) are heterogenous diseases in the respiratory system. Since wheezing, reduced FEV1, eosinophilic airway inflammation, and airway hyperresponsiveness are observed in some patients with COPD similar to asthma, differential diagnosis is sometimes difficult in subset of these diseases. To advance the management and treatment of asthma and COPD, it is necessary to accurately classify patients with these two diseases according to distinct clinical phenotypes based on clinically meaningful outcomes such as symptoms, exacerbations, response to therapy, and prognosis. However, since several phenotypes are present in individual patients, a search for treatable traits needs to establish precision medicine for asthma and COPD. Since these diseases worsen with each repeated exacerbation, the establishment of treatment to avoid exacerbations is the most important goal of the long-term management of these diseases. Airway physiological and pathological disorders, such as reversibility in FEV1, airway hyperresponsiveness, airway eosinophilic inflammation, and upper respiratory infection, are probably considered as major predictors of exacerbations. This chapter states clinical phenotypes related to acute exacerbation to establish treatable traits for asthma and COPD.
... In recent years, individuals at heightened risk of COPD exacerbations have been said to display a so-called "frequent exacerbator (FE)" phenotype, defined as having two or more exacerbation events (or ≥ 1 exacerbation with a hospitalization) within 1 year (4). Previous studies have identified various risk factors associated with more frequent exacerbations, including chronic respiratory symptoms (i.e., persistent cough and sputum production); older age; COPD severity; emphysematous phenotype; low forced expiratory pressure in 1 second (FEV1), low partial pressure of oxygen in arterial blood (PaO2); high levels of systemic inflammation; bacterial load; comorbid extrapulmonary diseases; anxiety; depression; and the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) category of patients (5)(6)(7). It has been reported that the FE phenotype can be identified in 22 ...
Background:
Acute exacerbation events, which can develop during the natural course of chronic obstructive pulmonary disease (COPD) can lead to worsening quality of life, increased hospital costs, and higher rates of morbidity and mortality. In recent years, individuals at heightened risk of COPD exacerbations have been said to display a so-called "frequent exacerbator (FE)" phenotype, defined as having two or more exacerbation events (or ≥ 1 exacerbation with a hospitalization) within 1 year.
Materials and methods:
We conducted a retrospective study involving 299 patients with COPD. Patients were divided into 2 groups as non-exacerbator phenotype (group-1, n=195) and FE phenotype (group-2, n=104).
Results:
FE phenotype was identified in 35.1% of patients. There were no significant differences between these two phenotypes in terms of gender, smoking status, or leukocyte count. However, FEs were found to be older (p=0.04), with more frequent detection of emphysema (p=0.02) and lower eosinophil levels (p=0.02). FEs also demonstrated worse pulmonary function parameters.
Conclusion:
COPD patients with the FE phenotype likely require a different treatment algorithm due to differing clinical features such as poorer respiratory function, lower eosinophil levels, and more frequent emphysema.
... As a marker of air trapping, the RV/TLC ratio had a J-shaped relationship with the risk of moderate to severe exacerbation, suggesting a positive correlation with the risk of COPD exacerbation. Recently, several papers have been published that the frequent exacerbation history affects the prognosis or mortality of patients with COPD, and the clinicians are interested in a new concept of "frequent exacerbator phenotype" (24)(25)(26). In accordance with a paper describing the frequent exacerbator phenotype (24), multivariable analysis regarding the frequent exacerbation status showed that RV/TLC is the most relevant factor among various variables. ...
... Recently, several papers have been published that the frequent exacerbation history affects the prognosis or mortality of patients with COPD, and the clinicians are interested in a new concept of "frequent exacerbator phenotype" (24)(25)(26). In accordance with a paper describing the frequent exacerbator phenotype (24), multivariable analysis regarding the frequent exacerbation status showed that RV/TLC is the most relevant factor among various variables. Therefore, clinicians should pay attention to measurement of the RV/TLC ratio in patients with COPD at risk of exacerbation. ...
Background and Aims
Air trapping is a predictive index for a decline in lung function and mortality in patients with chronic obstructive pulmonary disease (COPD). However, the role of air trapping in COPD exacerbation has rarely been studied. Therefore, this study aimed to investigate the impact of air trapping as a continuous parameter on COPD exacerbation.
Materials and Methods
To evaluate air trapping, we identified the ratio of residual volume (RV) to total lung capacity (TLC) of patients with COPD from the Korean COPD Subgroup Study (KOCOSS) cohort, which is a multicenter-based, prospective, consecutive cohort in Korea. The primary outcome was a development of COPD exacerbation during 3 years of follow-up.
Results
Of 2,181 participants, 902 patients measured the RV/TLC ratio in the baseline enrollment, and 410 were evaluated for assessing the development of COPD exacerbation. Of 410 patients, the rate of moderate to severe exacerbation and severe exacerbation was 70.7% and 25.9%. A 10% increase of RV/TLC ratio increased the risk of the moderate to severe exacerbation by 35% and severe exacerbation by 36%. In subgroup analysis, an interaction effect between triple inhaled therapy and the RV/TLC ratio for severe exacerbation nullified the association between the RV/TLC ratio and severe exacerbation ( p for interaction = 0.002).
Conclusions
In this prospective cohort study, we found that air trapping (representing RV/TLC ratio as a continuous parameter) showed an association with an increased risk of COPD exacerbation, particularly in patients who have not undergone triple inhaler therapy.
... The panel used the following threshold to define 'frequent lower airway': at least two exacerbations/year or one hospitalization/year. This decision was taken in consideration of the available literature on freqüent exacerbator phenotypes in both COPD and BE [47][48][49][50][51]. The inclusion of smoking or toxic exposures received a high level of consensus since the first round. ...
Introduction
The coexistence of chronic obstructive pulmonary disease (COPD) and bronchiectasis (BE) seems to be common and associated with a worse prognosis than for either disease individually. However, no definition of this association exists to guide researchers and clinicians.
Methods
We conducted a Delphi survey involving expert pulmonologists and radiologists from Europe, Turkey and Israel in order to define the “COPD-BE association”.
A panel of 16 experts from EMBARC selected 35 statements for the survey after reviewing scientific literature. Invited participants, selected on the basis of expertise, geographical and gender distribution, were asked to express agreement on the statements. Consensus was defined as a score of ≥6 points (scale 0 to 9) in ≥70% of answers across two scoring rounds.
Results
A-hundred-and-two (72.3%) out of 141 invited experts participated the first round. Their response rate in the second round was 81%. The final consensus definition of “COPD-BE association” was: “The coexistence of (1) specific radiological findings ( abnormal bronchial dilatation, airways visible within 1 cm of pleura and/or lack of tapering sign in ≥1 pulmonary segment and in >1 lobe) with (2) an obstructive pattern on spirometry (FEV1/FVC<0.7), (3) at least two characteristic symptoms ( cough, expectoration, dyspnoea, fatigue, frequent infections ) and (4) current or past exposure to smoke (≥10 pack-years ) or other toxic agents (bi omass, etc. )”. These criteria form the acronym “ROSE” (Radiology, Obstruction, Symptoms, Exposure).
Conclusions
The Delphi process formulated a European consensus definition of “COPD-BE association”. We hope this definition will have broad applicability across clinical practice and research in the future.
... dyspnea [34], and a reduction of resistance to physical exercise and daily activities [35] having a relevant impact of symptom perception by the patients. In a recent study, hyperinflation was correlated to the frequent exacerbator phenotype in COPD patients [36]. Despite the natural history of COPD leads to a functional decline [37], during the year of observation, patients of the present study showed an improvement of both FEV1 and hyperinflation indexes. ...
Objectives: Chronic obstructive pulmonary disease (COPD) is a complex disease, with few “real-life” studies on the relationship between functional and clinical features. We described the correlation between clinical and functional respiratory parameters in one-year follow-up observational study during stable phase COPD and regular inhalation therapy.
Methods: In 237 patients, the impact of respiratory symptoms was evaluated using the Modified Medical Research Council (mMRC) dyspnoea scale, the COPD assessment test (CAT), and a self-assessment of patient’s perceived COPD severity (Mapel scale) at baseline (T0) and after one year (T1).
Results: Mean CAT and mMRC scores at T0 were 10.55 and 1.2, respectively. The majority of patients pointed out mild symptoms (values between 1 and 2 at Mapel scale). Mean CAT score at T0 did not differ after subdividing our population in the four spirometry GOLD stages. In the year of follow-up, FEV1 and hyperinflation indexes improved. CAT score was significantly associated with mMRC (p<0,001), residual volume (RV) (p=0.023), and RV/total lung capacity % (p= 0.011).
Conclusion: The impact of symptoms in COPD stable patients was related to hyperinflation indexes and mMRC. There was no correlation between significant changes in CAT score and other systems of symptom evaluation after one year.
... 3 At this time, the emphysematous phenotype, physician-diagnosed asthma, presence of gastroesophageal reflux disease, more severe airflow obstruction, use of inhaled corticosteroids, higher mMRC, and higher BODE (BMI, degree of airflow obstruction, dyspnea, and exercise capacity) index are associated with the frequent exacerbator phenotype. [34][35][36][37] Recently, Le Rouzic et al derived a score to predict the frequent exacerbator cluster, called the ESOD (Exacerbation history, chronic sputum production, GOLD stage of obstruction, and mMRC dyspnea stage). 38 In our study, BMI < 25 kg/m 2 , higher mMRC, and any critical error were independent risk factors for frequent exacerbations. ...
Objective
Chronic obstructive pulmonary disease (COPD) acute exacerbations are significant causes of morbidity and mortality. “Frequent exacerbator” phenotypes are considered a distinct subgroup and this phenotype has a negative effect on lung function, quality of life, activity, hospital admission, and mortality. We assess inhaler handling technique and adherence, and evaluate risk factors associated with frequent exacerbations in COPD patients.
Methods
This study was a cross-sectional, case-control study. We prospectively enrolled 189 COPD patients from Yeungnam University Hospital from January 2018 to November 2018. Subjects were tested regarding their inhaler technique in face-to-face interviews with an advanced practice nurse of inhaler upon study entry. Frequency of moderate to severe COPD exacerbations were reviewed via electronic medical records during 12 months prior to study entry. Frequent exacerbations were defined as ≥2 moderate to severe exacerbations in the prior 12 months. Multivariate logistic regression was performed to identify risk factors for frequent exacerbations.
Results
Among 189 COPD patients, 50 (26.5%) were frequent exacerbators. Based on univariate analyses, body mass index (BMI) < 25 kg/m², lower forced expiratory volume in 1 s (FEV1), higher mMRC, lower feeling of satisfaction with the inhaler, and any critical errors were potential risk factors for frequent exacerbations. Multivariate logistic regression analyses revealed that BMI < 25 kg/m² (OR, 2.855, 95% CI, 1.247–6.534; p=0.013), higher mMRC (OR, 1.625, 95% CI, 1.072–2.463; p=0.022), and any critical error (OR, 2.020, 95% CI, 1.021–3.999; p=0.044) were risk factors.
Conclusion
Any critical error, BMI < 25 kg/m² and high mMRC are independent risk factors for frequent exacerbations in COPD patients. Careful monitoring and education around inhaler devices, particularly in frequent exacerbators, are important components of COPD treatment.
... Subjects with this particular phenotype do have more airflow limitation, symptoms and health-related quality of life impairment and respiratory disability [7][8][9][10]. Frequent exacerbators demonstrate persistent systemic and airway inflammation thereby entering a destructive cycle of increased cardiovascular risk, worsened comorbidities, frequent hospitalization and mortality [11][12][13]. So far, specific therapeutic approaches targeting this phenotype are sparse [14,15]. ...
Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory airway disease punctuated by exacerbations (AECOPD). Subjects with frequent AECOPD, defined by having at least two exacerbations per year, experience accelerated loss of lung function, deterioration in quality of life and increase in mortality. Fibroblast growth factor (FGF)23, a hormone associated with systemic inflammation and altered metabolism is elevated in COPD. However, associations between FGF23 and AECOPD are unknown. In this cross-sectional study, individuals with COPD were enrolled between June 2016 and December 2016. Plasma samples were analyzed for intact FGF23 levels. Logistic regression analyses were used to measure associations between clinical variables, FGF23, and the frequent exacerbator phenotype. Our results showed that FGF23 levels were higher in frequent exacerbators as compared to patients without frequent exacerbations. FGF23 was also independently associated with frequent exacerbations (OR 1.02; 95%CI 1.004–1.04; p = 0.017), after adjusting for age, lung function, smoking, and oxygen use. In summary, FGF23 was associated with the frequent exacerbator phenotype and correlated with number of exacerbations recorded retrospectively and prospectively. Further studies are needed to explore the role of FGF 23 as a possible biomarker for AECOPD to better understand the pathobiology of COPD and to help develop therapeutic targets.
... The evaluation of COPD longitudinally to identify predictive surrogate endpoints (ECLIPSE) study first identified frequent exacerbators as the subgroup of COPD patients undergoing 2 or more exacerbation episodes per year (Reinhold et al., 2017). Frequent exacerbator is now being reported in literature as distinct phenotype of COPD patients which can be found in all disease stages (Alexopoulos et al., 2015;Blasi et al., 2017;Capozzolo et al., 2017;McGarvey et al., 2015;Miravitlles et al., 2013;Mirza and Benzo, 2017;Nachef and Mador, 2017;Wedzicha et al., 2013). The frequent exacerbators (FEs) have greater local and systemic inflammation (Del Río et al., 2016), poorer adaptive immunity (Geerdink et al., 2016), worse quality of life, increased mortality, and a greater decline in lung function (Blasi et al., 2017). ...
... Investigators have also identified some clinical features as risk factors for frequent exacerbations. These include higher baseline symptom burden, weakened lung function variables (FEV1 percent predicted, inspiratory capacity percentage predicted/FIVC%, FEF25-75%, residual volume/total lung capacity percentage), comorbid diseases, previous exacerbations and radiological evidence of small airway abnormality (Blasi et al., 2017;Capozzolo et al., 2017;Del Río et al., 2016;Ekström et al., 2016;Han et al., 2017;Le Rouzic et al., 2017;McGarvey et al., 2015;Wan et al., 2011). In agreement with literature we found an inverse association of exacerbation frequency with lung function variables including FEV1, FVC and FEF25-75%. ...
Acute exacerbations are important events in the natural history of chronic obstructive pulmonary disease (COPD). Their frequency is directly related to the prognosis of the disease. The objective of this study was to identify the ‘frequent exacerbator’ phenotype and determine the risk factors for increased frequency of acute exacerbations in local chronic obstructive pulmonary disease (COPD) patients in a cross sectional analytical study design. For this purpose 137 patients were included in the study after obtaining necessary permissions from the ethical board of the hospital. COPD was diagnosed on the basis of clinical symptoms and a post bronchodilator values of FEV1/FVC<0.70 on spirometry. Frequent exacerbator’s were defined as patients experiencing 2 or more exacerbation episodes per year, which merited visited to the hospital. Average number of hospital visits for exacerbations per year, smoking history, family history of smoking related chronic lung disease in first degree relatives and presence of comorbidities were recorded from patient history and medical records. Body mass index was calculated and complete pulmonary function tests were recorded using electronic spirometer. Three multiple linear regression models were created with mid maximal expiratory flow, FEV1, and FVC as surrogate markers for lung function in different models. We found that 28 (20.4%) of our COPD patients were frequent exacerbators. All three multiple linear regression models for identifying risk factors for frequent exacerbations were significant (p< 0.001). The model in which mid maximal expiratory flow was used as a surrogate marker for lung function, accounted for the change in the dependent variable to the greatest degree (Adjusted R2= 0.38, p< 0.001). Overall the three models consistently showed that positive family history, high body mass index, heavy smoking, poor lung function (mid maximal expiratory flow/FEF2575, FEV1 and FVC), older age and requirement of steroid therapy predicted increased frequency of exacerbations. To conclude lung function (FEF2575%, FEV1 % predicted and FVC% predicted), longer smoking history, higher body mass index, succumbing to COPD at a younger age, and a positive family history of chronic lung disease in first degree relatives are important risk factors for frequent exacerbations of COPD
