Limits...
Characterisation of COPD heterogeneity in the ECLIPSE cohort.

Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, MacNee W, Miller BE, Rennard S, Silverman EK, Tal-Singer R, Wouters E, Yates JC, Vestbo J, Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) investigato - Respir. Res. (2010)

Bottom Line: Even in subjects with severe airflow obstruction, a substantial proportion did not report symptoms, exacerbations or exercise limitation.The amount of emphysema increased with GOLD severity.Some gender differences were also identified.

View Article: PubMed Central - HTML - PubMed

Affiliation: Thorax Institute, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Spain. alvar.agusti@clinic.ub.es

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE).

Methods: We studied 2164 clinically stable COPD patients, 337 smokers with normal lung function and 245 never smokers. In these individuals, we measured clinical parameters, nutritional status, spirometry, exercise tolerance, and amount of emphysema by computed tomography.

Results: COPD patients were slightly older than controls and had more pack years of smoking than smokers with normal lung function. Co-morbidities were more prevalent in COPD patients than in controls, and occurred to the same extent irrespective of the GOLD stage. The severity of airflow limitation in COPD patients was poorly related to the degree of breathlessness, health status, presence of co-morbidity, exercise capacity and number of exacerbations reported in the year before the study. The distribution of these variables within each GOLD stage was wide. Even in subjects with severe airflow obstruction, a substantial proportion did not report symptoms, exacerbations or exercise limitation. The amount of emphysema increased with GOLD severity. The prevalence of bronchiectasis was low (4%) but also increased with GOLD stage. Some gender differences were also identified.

Conclusions: The clinical manifestations of COPD are highly variable and the degree of airflow limitation does not capture the heterogeneity of the disease.

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Related in: MedlinePlus

Frequency distribution of the breathlessness as assessed by the mMRC questionnaire (panel A), exercise capacity as assessed by the 6MWD (panel B), reported exacerbations in the year before inclusion in the study (panel C), and health status assessed by SGRQ-C (panel D) according to severity of disease. For further explanations see text.
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Figure 4: Frequency distribution of the breathlessness as assessed by the mMRC questionnaire (panel A), exercise capacity as assessed by the 6MWD (panel B), reported exacerbations in the year before inclusion in the study (panel C), and health status assessed by SGRQ-C (panel D) according to severity of disease. For further explanations see text.

Mentions: Age and pack-years of smoking were similar in the different GOLD stages (Table 2) and neither was related to the severity of airflow limitation (Figure 3). Symptoms (mMRC and SGRQ-C) and reported exacerbations during the previous year increased with disease severity, whereas the proportion of current smokers, BMI, FFMI, and the 6MWD decreased (Table 2). The frequency distribution of these variables within each GOLD category was wide and unimodal, so no discrete subgroups could be identified except for the fact that, within each GOLD stage, a substantial proportion of patients did not complain of symptoms, report exacerbations and/or exhibit exercise limitation, even with severe disease (Figure 4). In fact, while airflow limitation was significantly related to breathlessness, health status, 6MWD and number of exacerbations, there was considerable overlap between GOLD stages (Figure 5). FEV1 reversibility decreased in more severe disease. By contrast, co-morbidities appeared to be independent of the degree of airflow limitation (Table 2). The extent of emphysema (and the prevalence of bronchiectasis) increased in proportion to the GOLD stage (Table 2).


Characterisation of COPD heterogeneity in the ECLIPSE cohort.

Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, MacNee W, Miller BE, Rennard S, Silverman EK, Tal-Singer R, Wouters E, Yates JC, Vestbo J, Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) investigato - Respir. Res. (2010)

Frequency distribution of the breathlessness as assessed by the mMRC questionnaire (panel A), exercise capacity as assessed by the 6MWD (panel B), reported exacerbations in the year before inclusion in the study (panel C), and health status assessed by SGRQ-C (panel D) according to severity of disease. For further explanations see text.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2944278&req=5

Figure 4: Frequency distribution of the breathlessness as assessed by the mMRC questionnaire (panel A), exercise capacity as assessed by the 6MWD (panel B), reported exacerbations in the year before inclusion in the study (panel C), and health status assessed by SGRQ-C (panel D) according to severity of disease. For further explanations see text.
Mentions: Age and pack-years of smoking were similar in the different GOLD stages (Table 2) and neither was related to the severity of airflow limitation (Figure 3). Symptoms (mMRC and SGRQ-C) and reported exacerbations during the previous year increased with disease severity, whereas the proportion of current smokers, BMI, FFMI, and the 6MWD decreased (Table 2). The frequency distribution of these variables within each GOLD category was wide and unimodal, so no discrete subgroups could be identified except for the fact that, within each GOLD stage, a substantial proportion of patients did not complain of symptoms, report exacerbations and/or exhibit exercise limitation, even with severe disease (Figure 4). In fact, while airflow limitation was significantly related to breathlessness, health status, 6MWD and number of exacerbations, there was considerable overlap between GOLD stages (Figure 5). FEV1 reversibility decreased in more severe disease. By contrast, co-morbidities appeared to be independent of the degree of airflow limitation (Table 2). The extent of emphysema (and the prevalence of bronchiectasis) increased in proportion to the GOLD stage (Table 2).

Bottom Line: Even in subjects with severe airflow obstruction, a substantial proportion did not report symptoms, exacerbations or exercise limitation.The amount of emphysema increased with GOLD severity.Some gender differences were also identified.

View Article: PubMed Central - HTML - PubMed

Affiliation: Thorax Institute, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Spain. alvar.agusti@clinic.ub.es

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE).

Methods: We studied 2164 clinically stable COPD patients, 337 smokers with normal lung function and 245 never smokers. In these individuals, we measured clinical parameters, nutritional status, spirometry, exercise tolerance, and amount of emphysema by computed tomography.

Results: COPD patients were slightly older than controls and had more pack years of smoking than smokers with normal lung function. Co-morbidities were more prevalent in COPD patients than in controls, and occurred to the same extent irrespective of the GOLD stage. The severity of airflow limitation in COPD patients was poorly related to the degree of breathlessness, health status, presence of co-morbidity, exercise capacity and number of exacerbations reported in the year before the study. The distribution of these variables within each GOLD stage was wide. Even in subjects with severe airflow obstruction, a substantial proportion did not report symptoms, exacerbations or exercise limitation. The amount of emphysema increased with GOLD severity. The prevalence of bronchiectasis was low (4%) but also increased with GOLD stage. Some gender differences were also identified.

Conclusions: The clinical manifestations of COPD are highly variable and the degree of airflow limitation does not capture the heterogeneity of the disease.

Show MeSH
Related in: MedlinePlus