Abstract
Objectives
The current management of chronic obstructive pulmonary disease (COPD) largely ignores
its heterogeneous pulmonary and extrapulmonary manifestations in the individual patient.
This study aimed to identify clusters of patients with COPD based on a thorough traits
assessment.
Design
An observational, prospective, single-center study.
Setting and Participants
Patients with COPD referred by chest physicians for a comprehensive pulmonary rehabilitation
program to CIRO (Horn, the Netherlands) were eligible to participate. CIRO is a specialized
pulmonary rehabilitation center in the southern part of the Netherlands for patients
with complex underlying respiratory diseases.
Methods
Clinically stable patients with COPD underwent a comprehensive assessment, including
pulmonary traits (airflow limitation, static hyperinflation, gas transfer, respiratory
pressures, and arterial blood gases), extrapulmonary functional traits, and health
status (quadriceps muscle strength, physical functioning, body composition, comorbidities,
symptoms perception, and social and emotional functioning). Clusters were generated
using the SOM-Ward Cluster algorithm, a hybrid algorithm that applies the classical
hierarchical method of Ward on top of the self-organizing map topology.
Results
Based on the abovementioned attributes of 518 patients with mild to very severe COPD
(44% women, age 64.1 ± 9.1 years, forced expiratory volume in the first second 48.6% ± 20.0%
of predicted), 7 clusters were identified. Clusters had unique patterns differing
in demographics, pulmonary, extrapulmonary functional, and behavioral traits and/or
health status.
Conclusion and Implications
The tremendous heterogeneity in pulmonary, extrapulmonary functional and behavioral
traits, and health status in patients with COPD supports the need for an individual
comprehensive assessment and a goal-directed personalized management strategy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The natural history of chronic airflow obstruction revisited: An analysis of the Framingham offspring cohort.Am J Respir Crit Care Med. 2009; 180: 3-10
- Various mechanistic pathways representing the aging process are altered in COPD.Chest. 2016; 149: 53-61
- Accelerated ageing of the lung in COPD: New concepts.Thorax. 2015; 70: 482-489
- Role of accelerated aging in limb muscle wasting of patients with COPD.Int J Chron Obstruct Pulmon Dis. 2018; 13: 1987-1998
- The many “small COPDs”: COPD should be an orphan disease.Chest. 2008; 134: 623-627
- Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2019 report).(Available at:)https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdfDate: 2020Date accessed: May 14, 2020
- Burden of COPD in patients treated in different care settings in the Netherlands.Respir Med. 2016; 118: 76-83
- Treatable traits: Toward precision medicine of chronic airway diseases.Eur Respir J. 2016; 47: 410-419
- An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation.Am J Respir Crit Care Med. 2013; 188: e13-e64
- Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases.Respirology. 2019; 24: 838-843
- Differential response to pulmonary rehabilitation in COPD: Multidimensional profiling.Eur Respir J. 2015; 46: 1625-1635
- Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2013; 187: 728-735
- Cluster analysis in severe emphysema subjects using phenotype and genotype data: An exploratory investigation.Respir Res. 2010; 11: 30
- Identification of clinical phenotypes using cluster analyses in COPD patients with multiple comorbidities.Biomed Res Int. 2014; 2014: 420134
- The respiratory physiome: Clustering based on a comprehensive lung function assessment in patients with COPD.PLoS One. 2018; 13: e0201593
- Impact of cardiovascular comorbidities on COPD Assessment Test (CAT) and its responsiveness to pulmonary rehabilitation in patients with moderate to very severe COPD: Protocol of the Chance study.BMJ Open. 2015; 5: e007536
- Treatable traits of chronic airways disease.Curr Opin Pulm Med. 2018; 24: 24-31
- Isometric and isokinetic knee extension and flexion torque in men and women aged 20-70.Scand J Rehabil Med. 1989; 21: 45-53
- Test-retest reliability of lower limb isokinetic endurance in COPD: A comparison of angular velocities.Int J Chron Obstruct Pulmon Dis. 2015; 10: 1163-1172
- An official European Respiratory Society/American Thoracic Society technical standard: Field walking tests in chronic respiratory disease.Eur Respir J. 2014; 44: 1428-1446
- ATS/ACCP Statement on cardiopulmonary exercise testing.Am J Respir Crit Care Med. 2003; 167: 211-277
- Constant-load cycle endurance performance: Test-retest reliability and validity in patients with COPD.J Cardiopulm Rehabil. 2003; 23: 143-150
- Nutritional assessment and therapy in COPD: A European Respiratory Society statement.Eur Respir J. 2014; 44: 1504-1520
- Whole-body versus local DXA-scan for the diagnosis of osteoporosis in COPD patients.J Osteoporos. 2010; 2010: 640878
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.J Chronic Dis. 1987; 40: 373-383
- Further psychometric testing of the Dutch Care Dependency Scale on two different patient groups.Int J Nurs Pract. 2002; 8: 305-314
- Problematic activities of daily life are weakly associated with clinical characteristics in COPD.J Am Med Dir Assoc. 2012; 13: 284-290
- Within-day test-retest reliability of the Timed Up & Go test in patients with advanced chronic organ failure.Arch Phys Med Rehabil. 2013; 94: 2131-2138
- The Hospital Anxiety and Depression Scale.Acta Psychiatr Scand. 1983; 67: 361-370
- Evaluation of clinical methods for rating dyspnea.Chest. 1988; 93: 580-586
- Development and first validation of the COPD Assessment Test.Eur Respir J. 2009; 34: 648-654
- The St George's Respiratory Questionnaire.Respir Med. 1991; 85 (discussion 33-37): 25-31
- Development, validity and responsiveness of the Clinical COPD Questionnaire.Health Qual Life Outcomes. 2003; 1: 13
- Treatable Traits: A new paradigm for 21(st) century management of chronic airway diseases.Eur Respir J. 2019; 53: 1802058
- American Thoracic Society. Medical Section of the American Lung Association. Pulmonary rehabilitation.Am Rev Respir Dis. 1981; 124: 663-666
- Comprehensive lung function assessment does not allow to infer response to pulmonary rehabilitation in patients with COPD.J Clin Med. 2018; 8: 27
- Influence of anxiety on health outcomes in COPD.Thorax. 2010; 65: 229-234
- Depression and anxiety in patients with COPD.Eur Respir Rev. 2014; 23: 345-349
- Disease-specific comorbidity clusters in COPD and accelerated aging.J Clin Med. 2019; 8: 511
- Association of anxiety and depression with pulmonary-specific symptoms in chronic obstructive pulmonary disease.Int J Psychiatry Med. 2013; 45: 189-202
- The epidemiology and economics of chronic obstructive pulmonary disease.Proc Am Thorac Soc. 2007; 4: 502-506
- Anxiety and depression-Important psychological comorbidities of COPD.J Thorac Dis. 2014; 6: 1615-1631
- Strategies to improve anxiety and depression in patients with COPD: A mental health perspective.Neuropsychiatr Dis Treat. 2016; 12: 297-328
- Differences in content and organisational aspects of pulmonary rehabilitation programmes.Eur Respir J. 2014; 43: 1326-1337
- Gender and COPD in patients attending a pulmonary clinic.Chest. 2005; 128: 2012-2016
- COPD and gender differences: An update.Transl Res. 2013; 162: 208-218
- Management of chronic obstructive pulmonary disease beyond the lungs.Lancet Respir Med. 2016; 4: 911-924
Article info
Publication history
Published online: July 25, 2020
Footnotes
The CHANCE study was supported by the Lung Foundation Netherlands (3.4.10.015) and GlaxoSmithKline (SCO115406). These funding organizations provided only financial support, not playing a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
