COPD exacerbations and patient-reported outcomes according to post-bronchodilator FEV1 – a post-hoc analysis of pooled data

Background Management strategies of chronic obstructive pulmonary disease (COPD) need to be tailored to the forced expiratory volume in one second (FEV1), exacerbations, and patient-reported outcomes (PROs) of individual patients. In this study, we analyzed the association and correlation between the FEV1, exacerbations, and PROs of patients with stable COPD. Methods This was a post-hoc analysis of pooled data from two cross-sectional studies that were previously conducted in Malaysia from 2017 to 2019, the results of which had been published separately. The parameters measured included post-bronchodilator FEV1 (PB-FEV1), exacerbations, and scores of modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George’s Respiratory Questionnaire for COPD (SGRQ-c). Descriptive, association, and correlation statistics were used. Results Three hundred seventy-four patients were included in the analysis. The PB-FEV1 predicted was < 30% in 85 (22.7%), 30–49% in 142 (38.0%), 50–79% in 111 (29.7%), and ≥ 80% in 36 (9.6%) patients. Patients with PB-FEV1 < 30% predicted had significantly more COPD exacerbations than those with PB-FEV1 30–49% predicted (p < 0.001), 50–79% predicted (p < 0.001), and ≥ 80% predicted (p = 0.002). The scores of mMRC, CAT, and SGRQ-c were not significantly higher in patients with more severe airflow limitation based on PB-FEV1 (p = 0.121–0.271). The PB-FEV1 predicted had significant weak negative correlations with exacerbations (r = − 0.182, p < 0.001), mMRC (r = − 0.121, p = 0.020), and SGRQ-c scores (r = − 0.114, p = 0.028). There was a moderate positive correlation between COPD exacerbations and scores of mMRC, CAT, and SGRQ-c (r = 0.407–0.482, all p < 0.001). There were significant strong positive correlations between mMRC score with CAT (r = 0.727) and SGRQ-c scores (r = 0.847), and CAT score with SGRQ-c score (r = 0.851) (all p < 0.001). Conclusions In COPD patients, different severity of airflow limitation was not associated with significant differences in the mMRC, CAT, and SGRQ-c scores. Exacerbations were significantly more frequent in patients with very severe airflow limitation only. The correlation between airflow limitation with exacerbations, mMRC, and SGRQ-c was wea

Impact of Different Chronic Obstructive Pulmonary Disease Clinical Phenotypes on Quality of Life

Chronic obstructive pulmonary disease (COPD) phenotype refers to a sole or mixture of disease features that explain the distinctions separating each individual with COPD based on clinically relevant criteria. The Spanish Society of Pulmonology and Thoracic Surgery phenotypes COPD predicated on the exacerbation frequency and dominant symptoms. In this study, the assessment on the effects of various COPD clinical phenotypes on patients’ health-related quality of life (HRQoL) was conducted. A cross-sectional study looking into COPD patients was carried out at the attending ambulatory clinics Serian Divisional and Bau District Hospitals from 23rd January 2018 to 22nd January 2019. Patients’ HRQoL were appraised utilising validated questionnaires such as the COPD Assessment Test (CAT), and St. George’s Respiratory Questionnaire for COPD (SGRQ-c). From 185 eligible respondents, n=108 (58.4%) were non-exacerbators (NON-AE), n=51 (27.6%) were frequent exacerbators (AE), and the remaining n=26 (14.1%) had asthma-COPD overlapped (ACO). Respondents with AE were found with chronic bronchitis with total of n=42 (82.4%), while remaining n=9 (17.6%) had emphysema. The total CAT and SGRQ-c scores were remarkably distinct between the COPD clinical phenotypes (all p < 0.001). The total CAT was crucially elevated in AE patients compared to ACO (17.3 ± 9.5 against 11.7 ± 8.6, p = 0.003) and NON-AE (17.3 ± 9.5 against 5.5 ± 4.7, p < 0.001). While for ACO, the CAT scores were markedly elevated against those with NON-AE (11.7 ± 8.6 against 5.5 ± 4.7, p < 0.001). The total SGRQ-c scores were crucially elevated in AE patients compared to ACO ((53.5 ± 22.7% against 34.4 ± 19.5%, p < 0.001) and NON-AE (53.5 ± 22.7% against 16.4 ± 14.8%, p < 0.001). ACO patients’ SGRQ-c scores were also markedly elevated against those with NON-AE (34.4 ± 19.5% against 16.4 ± 14.8%, p < 0.001). In subgroup analysis, the score for CAT item 3, 4, 5, 6 and 8 were remarkably higher for AE when compared with NON-AE (all p < 0.001), and ACO (p = 0.003 – 0.016). As for ACO against NON-AE, all iv the CAT items were prominently higher except CAT item 2 (p = < 0.001 – 0.040). All SGRQ-c components were also crucially higher for AE patients when compared with NON-AE (all p < 0.001), and ACO (p = < 0.001 – 0.005). Excluding Activity component in SGRQ-c, patients with ACO’s markedly higher in the rest of SGRQ-c’s component (p < 0.001) against NON-AE. To sum up, COPD patients’ HRQoL were indeed impoverished than the normal subjects irrespective of the clinical phenotypes. The poorest HRQoL is AE patients, then ACO and NON-AE . This study supports the recommendation to phenotype COPD patients based on the exacerbation frequency and COPD subtypes, therefore enabling personalisation and prioritisation of COPD management to achieve a better outcome and leading to an improve quality of life

COPD exacerbations and patient-reported outcomes according to post-bronchodilator FEV1 – a post-hoc analysis of pooled data

Abstract Background Management strategies of chronic obstructive pulmonary disease (COPD) need to be tailored to the forced expiratory volume in one second (FEV1), exacerbations, and patient-reported outcomes (PROs) of individual patients. In this study, we analyzed the association and correlation between the FEV1, exacerbations, and PROs of patients with stable COPD. Methods This was a post-hoc analysis of pooled data from two cross-sectional studies that were previously conducted in Malaysia from 2017 to 2019, the results of which had been published separately. The parameters measured included post-bronchodilator FEV1 (PB-FEV1), exacerbations, and scores of modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George’s Respiratory Questionnaire for COPD (SGRQ-c). Descriptive, association, and correlation statistics were used. Results Three hundred seventy-four patients were included in the analysis. The PB-FEV1 predicted was < 30% in 85 (22.7%), 30–49% in 142 (38.0%), 50–79% in 111 (29.7%), and ≥ 80% in 36 (9.6%) patients. Patients with PB-FEV1 < 30% predicted had significantly more COPD exacerbations than those with PB-FEV1 30–49% predicted (p < 0.001), 50–79% predicted (p < 0.001), and ≥ 80% predicted (p = 0.002). The scores of mMRC, CAT, and SGRQ-c were not significantly higher in patients with more severe airflow limitation based on PB-FEV1 (p = 0.121–0.271). The PB-FEV1 predicted had significant weak negative correlations with exacerbations (r = − 0.182, p < 0.001), mMRC (r = − 0.121, p = 0.020), and SGRQ-c scores (r = − 0.114, p = 0.028). There was a moderate positive correlation between COPD exacerbations and scores of mMRC, CAT, and SGRQ-c (r = 0.407–0.482, all p < 0.001). There were significant strong positive correlations between mMRC score with CAT (r = 0.727) and SGRQ-c scores (r = 0.847), and CAT score with SGRQ-c score (r = 0.851) (all p < 0.001). Conclusions In COPD patients, different severity of airflow limitation was not associated with significant differences in the mMRC, CAT, and SGRQ-c scores. Exacerbations were significantly more frequent in patients with very severe airflow limitation only. The correlation between airflow limitation with exacerbations, mMRC, and SGRQ-c was weak

Additional file 1 of COPD exacerbations and patient-reported outcomes according to post-bronchodilator FEV1 – a post-hoc analysis of pooled data

Supplementary Material

Clinical phenotypes and heath-related quality of life of COPD patients in a rural setting in Malaysia – a cross-sectional study

Background: The Spanish chronic obstructive pulmonary disease (COPD) guideline phenotypes patients according to the exacerbation frequency and COPD subtypes. In this study, we compared the patients’ health-related quality of life (HRQoL) according to their COPD phenotypes. Methods: This was a cross-sectional study of COPD patients who attended the outpatient clinic of the Serian Divisional Hospital and Bau District Hospital from 23th January 2018 to 22th January 2019. The HRQoL was assessed using modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George’s Respiratory Questionnaire for COPD (SGRQ-c). Results: Of 185 patients, 108 (58.4%) were non-exacerbators (NON-AE), 51 (27.6%) were frequent exacerbators (AE), and the remaining 26 (14.1%) had asthma-COPD overlap (ACO). Of AE patients, 42 (82.4%) had chronic bronchitis and only 9 (17.6%) had emphysema. Of the 185 COPD patients, 65.9% had exposure to biomass fuel and 69.1% were ex- or current smokers. The scores of mMRC, CAT, and SGRQ-c were significantly different between COPD phenotypes (p < 0.001). There were significantly more patients with mMRC 2–4 among AE (68.6%) (p < 0.001), compared to those with ACO (38.5%) and NON-AE (16.7%). AE patients had significantly higher total CAT (p=0.003; p < 0.001) and SGRQ-c (both p < 0.001) scores than those with ACO and NON-AE. Patients with ACO had significantly higher total CAT and SGRQ-c (both p< 0.001) scores thanthose with NON-AE. AE patients had significantly higher score in each item of CAT and component of SGRQ-c compared to those with NON-AE (all p < 0.001), and ACO [(p = 0.003–0.016; p=<0.001–0.005) except CAT 1, 2 and 7. ACO patients had significantly higher score in each item of CAT and component of SGRQ-c (p=<0.001–0.040; p < 0.001) except CAT 2 and activity components of SGRQ-c. Conclusions: The HRQoL of COPD patients was significantly different across different COPD phenotypes. HRQoL was worst in AE, followed by ACO and NON-AE. This study supports phenotyping COPD patients based on their exacerbation frequency and COPD subtypes. The treatment of COPD should be personalised according to these two factors