Clinical phenotypes and heath-related quality of life of COPD patients in a rural setting in Malaysia – a cross-sectional study

Abstract

Background The Spanish chronic obstructive pulmonary disease (COPD) guideline phenotypes patients according to the exacerbation frequency and COPD subtypes. In this study, we compared the patients’ health-related quality of life (HRQoL) according to their COPD phenotypes. Methods This was a cross-sectional study of COPD patients who attended the outpatient clinic of the Serian Divisional Hospital and Bau District Hospital from 23th January 2018 to 22th January 2019. The HRQoL was assessed using modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George’s Respiratory Questionnaire for COPD (SGRQ-c). Results Of 185 patients, 108 (58.4%) were non-exacerbators (NON-AE), 51 (27.6%) were frequent exacerbators (AE), and the remaining 26 (14.1%) had asthma-COPD overlap (ACO). Of AE patients, 42 (82.4%) had chronic bronchitis and only 9 (17.6%) had emphysema. Of the 185 COPD patients, 65.9% had exposure to biomass fuel and 69.1% were ex- or current smokers. The scores of mMRC, CAT, and SGRQ-c were significantly different between COPD phenotypes (p < 0.001). There were significantly more patients with mMRC 2–4 among AE (68.6%) (p < 0.001), compared to those with ACO (38.5%) and NON-AE (16.7%). AE patients had significantly higher total CAT (p = 0.003; p < 0.001) and SGRQ-c (both p < 0.001) scores than those with ACO and NON-AE. Patients with ACO had significantly higher total CAT and SGRQ-c (both p < 0.001) scores than those with NON-AE. AE patients had significantly higher score in each item of CAT and component of SGRQ-c compared to those with NON-AE (all p < 0.001), and ACO [(p = 0.003–0.016; p = < 0.001–0.005) except CAT 1, 2 and 7. ACO patients had significantly higher score in each item of CAT and component of SGRQ-c (p = < 0.001–0.040; p < 0.001) except CAT 2 and activity components of SGRQ-c. Conclusions The HRQoL of COPD patients was significantly different across different COPD phenotypes. HRQoL was worst in AE, followed by ACO and NON-AE. This study supports phenotyping COPD patients based on their exacerbation frequency and COPD subtypes. The treatment of COPD should be personalised according to these two factors.

Chronic Obstructive Pulmonary Disease in Can Tho: Clinical Characteristics and Features of Treatment by Clinical Phenotypes

“…The study of C. S. Chai in 2019 showed that patients with AE phenotype had a mean CAT score and a significantly higher proportion of patients with mMRC scores from 2-4, compared with ACO and NON-AE groups. The frequency of exacerbations in the ACO group in this study was also significantly smaller than that in the AE group [4]. The results in our study were also similar, specifically, the frequency of exacerbations of the ACO phenotype is significantly lower than that of the AE group.…”

“…The symptom severity based on mMRC and CAT scores of the NON-AE group in our study was lower than that in AE group, however, this difference was not statistically significant. Many studies on COPD phenotypes have shown significant differences in mMRC and CAT scores in the NON-AE group compared with the remaining phenotypes as studied by the authors H. Bao, C. S. Chai, and G. Reiger [1], [4], [11]. This could be explained by the small sample size of our study, which has not yet highlighted this difference.…”

“…Not only prominent in the degree of airway limitation, the symptom burden of patients with multiple exacerbations, especially AE-CB was also quite prominent, this has been shown in many studies. A study in Malaysia in 2019 by C. S. Chai et al showed that patients with AE phenotype had CAT scores and the rate of symptoms of cough, sputum production was significantly higher than patients with ACO or NON-AE phenotype [4]. H. Bao et al, in a study in China, showed that the group of AE-CB patients had mean scores of mMRC and CAT significantly higher than other groups [1].…”

Burden of Disease in Patients with Mild or Mild-to-Moderate Chronic Obstructive Pulmonary Disease (Global Initiative for Chronic Obstructive Lung Disease Group A or B): A Systematic Literature Review

“…The baseline characteristics of the patients described in the included publications are presented in Supplementary Table 14 . Across the various GOLD group categorizations, the mean patient age at baseline ranged from 57.6 14 to 74.7 15 years (GOLD A), 59.1 14 to 77.9 15 years (GOLD B), 64.3 16 to 67.8 17 years (combined GOLD A/B), and 60.5 18 to 74.1 19 years (indirectly mapped combined GOLD A/B). The proportion of males ranged from 10.0% 20 to 98.3% 21 (GOLD A), 15.8% 22 to 96.5% 23 (GOLD B), 51.1% 16 to 61.1% 17 (combined GOLD A/B), and 52.1% 24 to 94.4% 25 (indirectly mapped combined GOLD A/B).…”

“…Forced expiratory volume in 1 second (FEV 1 ) % predicted ranged from 54.3% 32 to 83% 30 (GOLD A), 40% 33 to 72.8% 15 (GOLD B), and 43.6% 18 to 75.4% 25 (indirectly mapped combined GOLD A/B). One publication reported an FEV 1 % predicted of 57% among GOLD A/B patients 17 ( Figure 3 ).…”