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Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease
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  1. Hironi Makita,
  2. Yasuyuki Nasuhara,
  3. Katsura Nagai,
  4. Yoko Ito,
  5. Masaru Hasegawa,
  6. Tomoko Betsuyaku,
  7. Yuya Onodera,
  8. Nobuyuki Hizawa,
  9. Masaharu Nishimura
  1. First Department of Medicine and Department of Radiology, Hokkaido University School of Medicine, Sapporo, Japan
  1. Dr Masaharu Nishimura, First Department of Medicine, Hokkaido University School of Medicine, N-15 W-7, Kita-Ku, Sapporo 060-8638, Japan; ma-nishi{at}med.hokudai.ac.jp

Abstract

Background: Airflow limitation in chronic obstructive pulmonary disease (COPD) is caused by a mixture of small airway disease and emphysema, the relative contributions of which may vary among patients. Phenotypes of COPD classified purely based on severity of emphysema are not well defined and may be different from the classic phenotypes of “pink puffers” and “blue bloaters”.

Methods: To characterise clinical phenotypes based on severity of emphysema, 274 subjects with COPD were recruited, excluding those with physician-diagnosed bronchial asthma. For all subjects a detailed interview of disease history and symptoms, quality of life (QOL) measurement, blood sampling, pulmonary function tests before and after inhalation of salbutamol (0.4 mg) and high-resolution CT scanning were performed.

Results: Severity of emphysema visually evaluated varied widely even among subjects with the same stage of disease. No significant differences were noted among three groups of subjects classified by severity of emphysema in age, smoking history, chronic bronchitis symptoms, blood eosinophil count, serum IgE level or bronchodilator response. However, subjects with severe emphysema had significantly lower body mass index (BMI) and poorer QOL scores, evaluated using St George’s Respiratory Questionnaire (SGRQ), than those with no/mild emphysema (mean (SD) BMI 21.2 (0.5) vs 23.5 (0.3) kg/m2, respectively; SGRQ total score 40 (3) vs 28 (2), respectively; p<0.001 for both). These characteristics held true even if subjects with the same degree of airflow limitation were chosen.

Conclusions: The severity of emphysema varies widely even in patients with the same stage of COPD, and chronic bronchitis symptoms are equally distributed irrespective of emphysema severity. Patients with the phenotype in which emphysema predominates have lower BMI and poorer health-related QOL.

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Footnotes

  • This study was supported by a scientific research grant from the Ministry of Education, Science, Culture and Sports of Japan (17390239 to MN), a grant to the Respiratory Failure Research Group from the Ministry of Health, Labor and Welfare, Japan and a research grant from Nippon Boehringer Ingelheim Co Ltd and Pfizer Japan Inc.

  • Competing interests: None.

  • Contributors: KKR Sapporo Medical Center: Yoshikazu Kawakami, Youichi Nishiura, Hiroshi Saito, Tetsuya Kojima, Kazuhiko Sakai, Yoriko Demura, Yukihiro Tsuchida, Motoko Tsubono, Kazuhiro Tsuboya, Shinichi Kakimoto; Iwamizawa Rosai Hospital: Takeshi Igarashi, Kiyonobu Kimura, Ikuo Nakano, Kouichi Itabashi, Kiyoshi Morikawa, Seiichi Tagami, Rika Sato, Junichiro Kojima, Shinji Nigawara, Shiro Fujii, Kazuyoshi Kanehira, Ryota Funakoshi, Yui Takashima, Masahiro Awaka, Hitoshi Ishii, Makoto Nakayama, Hiroki Honda, Ryo Kaneda, Masahisa Takagi; Sapporo City General Hospital: Hiroshi Yamamoto, Shigeaki Ogura, Kenji Akie, Kensuke Baba, Hiroki Goya, Kihoko Kitamura, Shiho Mineta, Takayo Takeda, Kiyoshi Kubo, Hiroshi Nara; Otaru City Hospital: Tsuyoshi Nakano, Kimihiro Takeyabu, Chihiro Naka, Hiroko Sato, Teiji Yamamoto, Toshio Abe; Hokkaido Social Insurance Hospital: Yasushi Akiyama, Fujiya Kishi, Akihide Ito, Masashi Ooe, Michihiro Fujino, Yasuko Noda, Teruyo Takahashi, Keiko Abe, Mayumi Souma, Emiko Sato, Sumiyo Miyakawa, Tomokazu Indo, Shizuko Taguchi, Azusa Nakajima, Tomonori Fujii, Hironari Mori, Hideo Taguchi, Takashi Kojima, Ryouji Minami, Shigeki Murakami, Yuzuri Oono, Osamu Ishigamori, Satoru Akimoto, Takashi Emoto; Iwamizawa City General Hospital: Akira Kamimura, Toshiyuki Harada, Nobuyuki Hakuma, Eriko Anada, Tamaki Numata, Teiko Itakura, Tomoko Iizawa, Yoshihiro Honoki; Sapporo Social Insurance General Hospital: Kazuo Takaoka, Isamu Doi, Miki Suzuki, Sachiko Komuro, Yoshiko Yoshida, Hitoshi Seki; Kinikyo Chuo Hospital: Atsushi Ishimine, Ryouji Nakano, Masako Ishihara, Fumiyo Itagaki, Naoya Matsuzaka, Takae Kosukegawa, Eriko Miyajima, Kimitsugu Nakamura, Wako Funayama, Katsumigi Tsuchiya, Ryouji Kaihatsu; Tenshi Hospital: Kaoru Kamishima, Yasushi Hasegawa; Hokkaido University Hospital/Hokkaido University School of Medicine; First Department of Medicine: Motoko Kobayashi, Takeshi Hosokawa, Satoshi Fuke, Nao Odajima, Kunio Hamada, Eiji Shibuya, Yoshiko Obata, Kotomi Hosono, Kana Yoshikuni, Tomoko Akiyama; The Division of Pulmonary Function, the Department of Laboratory Medicine: Katsuaki Nitta, Masashi Yamamoto; Department of Health Science: Kenji Miyamoto.

  • * See end of article for all contributors to the Hokkaido COPD Cohort Study

  • Abbreviations:
    BDR
    bronchodilator response
    BMI
    body mass index
    COPD
    chronic obstructive pulmonary disease
    FEV1
    forced expiratory volume in 1 s
    FVC
    forced vital capacity
    HRCT
    high-resolution computed tomography
    LAA
    low attenuation area
    QOL
    quality of life
    SGRQ
    St George’s Respiratory Questionnaire
    Tlco
    carbon monoxide transfer factor
    Va
    alveolar volume

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