Rationale The Spanish guideline for COPD (GesEPOC) recommends COPD treatment according to
four clinical phenotypes: non-exacerbator phenotype with either chronic bronchitis or emphy-
sema (NE), asthma-COPD overlap syndrome (ACOS), frequent exacerbator phenotype with
emphysema (FEE) or frequent exacerbator phenotype with chronic bronchitis (FECB). How-
ever, 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, FEV 1 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 exacer-
bations 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 signifi-
cant differences in demographics, patient-centered outcomes and health care resources
use
