Clinical outcomes of chronic obstructive pulmonary disease phenotypes. One center prospective study

Introduction: The clinical outcome of different chronic obstructive pulmonary disease (COPD) phenotypes is still unclear. Objectives: This study was designed to detect the effect of different COPD phenotypes on disease outcomes. Material and methods: One hundred stable COPD patients were included. They were divided into 3 phenotypes; 45 patients in exacerbator phenotype, 37 patients in non- exacerbator, and 18 patients in asthma COPD overlap (ACO) phenotype. Patient demographics, respiratory symptoms, grading of COPD, co-morbidities, spirometry, six minute walk test, and systemic inflammatory markers were measured. Also, exacerbation frequency and severity were assessed throughout the study period. Results: COPD Assessment Test (CAT) score was significantly higher in exacerbator phenotype versus the other phenotypes(14.7 +/- 1.5; p = 0.04).In addition, about 60% and 42% of exacerbator phenotype were in Global Initiative for Chronic Obstructive Lung Disease (GOLD) class D and C respectively which were significantly higher than the other phenotypes(p = 0.001), while 58% and 50% of non-exacerbator and ACO patients respectively were in class B of GOLD. Twenty eight percent of patients of ACO had no comorbidity and this was significantly higher versus the other phenotypes (p = 0.03), while 40% of non-exacerbator had one comorbidity (p = 0.003) and 86% of exacerbator had >= 2 comorbidities (p = 0.002). COPD comorbidity index was significantly higher in exacerbator phenotype (2.5 +/- 0.8; p = 0.01). Although patients of exacerbator phenotype had more and severe form of exacerbations than the other phenotypes, no significant difference in in-hospital outcome was found (p = 0.3). Conclusions: Exacerbator phenotype has worse disease outcome than those of non-exacerbator and ACO phenotypes. These results support the need for more treatment options to alleviate the morbidity of COPD especially among exacerbator phenotype.