Chronic Bronchitic Symptoms in Severe COPD Are Associated with Increased Exacerbation Frequency and Less Emphysema.

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by intermittent exacerbations, which leads to substantial morbidity and mortality. Chronic cough and sputum production are significant but variable symptoms in COPD, but their effects on exacerbation frequency have not been well described. Methods: We analyzed 52 stable outpatients in Phase II of the Pennsylvania Study of COPD Exacerbations (PA−SCOPE) with severe airflow obstruction (FEV1 <50%). Patients documented daily symptoms of cough, wheeze, breathlessness, sputum quantity, color, and consistency, and upper respiratory tract infectious symptoms in semiquantitative scales, as well as peak flow for up to 2 years. Exacerbation presence and severity was defined based on a daily index of symptoms. Patients were divided into tertiles based on their average sputum symptom indices. Percent emphysema in a subset of these patients (n=23, 8 in tertile 1, 6 in tertile 2, 9 in tertile 3) was analyzed using 3D Slicer v2.8. Data were analyzed using ANOVA and Chi−square test.

The Chronic Bronchitic Phenotype of COPD

“…Indeed, we have shown that in high-risk patients with severe COPD, chronic sputum production was associated with a lower peak expiratory fl ow when measured daily for up to 2 years as well as with more breathlessness and more frequent exacerbations. 18 Alternatively, it is possible that patients who have complaints of chronic cough and sputum production are simply more likely to describe worse respiratory symptoms to health-care providers without any quantifi able difference in airway infl ammation or disease severity. We also did not collect information on use of intranasal steroids or leukotriene antagonists, so it is possible that the CB 1 group described more upper-respiratory symptoms as a result of underuse of these medications.…”

“…[13][14][15] Several studies have demonstrated an increased risk of COPD exacerbation. [16][17][18][19] Goblet cell hyperplasia also has prognostic value as it has been associated with an increased risk of mortality and a lack of improvement in lung function after lung reduction surgery. 20,21 Despite these clinical and pathologic correlates of chronic bronchitis (CB) to various clinical outcomes, the current literature is limited regarding Background: Chronic bronchitis (CB) in patients with COPD is associated with an accelerated lung function decline and an increased risk of respiratory infections.…”