The characteristics of the frequent exacerbators with chronic bronchitis phenotype and the asthma-chronic obstructive pulmonary disease overlap syndrome phenotype in chronic obstructive pulmonary disease patients

Abstract

To investigate the difference of clinical characteristics between chronic obstructive pulmonary disease (COPD) patients with the frequent exacerbators with chronic bronchitis (FE-CB) phenotype and those with the asthma-COPD overlap syndrome (ACO) phenotype. We searched CNKI, Wan Fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE databases for studies published as of April 30, 2019. All studies that investigated COPD patients with the FE-CB and ACO phenotypes and which qualified the inclusion criteria were included. Cross-sectional/prevalence study quality recommendations were used to measure methodological quality. RevMan5.3 software was used for meta-analysis. Ten studies (combined n = 4568) qualified the inclusion criteria. The FE-CB phenotype of COPD was associated with significantly lower forced vital capacity percent predicted (mean difference [MD] −9.05, 95% confidence interval [CI] [−12.00, −6.10], P < .001, I 2 = 66%), forced expiratory volume in 1 second (FEV1) (MD −407.18, 95% CI [−438.63, −375.72], P < .001, I 2 = 33%), forced expiratory volume in 1 second percent predicted (MD −9.71, 95% CI [−12.79, −6.63], P < .001, I 2 = 87%), FEV1/forced vital capacity (MD −5.4, 95% CI [−6.49, −4.30], P < .001, I 2 = 0%), and body mass index (BMI) (MD −0.81, 95% CI [−1.18, −0.45], P < .001, I 2 = 44%) as compared to the ACO phenotype. However, FE-CB phenotype was associated with higher quantity of cigarettes smoked (pack-years) (MD 6.45, 95% CI [1.82, 11.09], P < .001, I 2 = 73%), COPD assessment test score (CAT) (MD 4.04, 95% CI [3.46, 4.61], P < .001, I 2 = 0%), mMRC score (MD 0.54, 95% CI [0.46, 0.62], P < .001, I 2 = 34%), exacerbations in previous year (1.34, 95% CI [0.98, 1.71], P < .001, I 2 = 68%), and BMI, obstruction, dyspnea, exacerbations (BODEx) (MD 1.59, 95% CI [1.00, 2.18], P < .001, I 2 = 86%) as compared to the ACO phenotype. Compared with the ACO phenotype, COPD patients with the FE-CB phenotype had poorer pulmonary function, lower BMI, and higher CAT score, quantity of cigarettes smoked (pack-years), exacerbations in previous year, mMRC score, and BODEx. This study is an analysis of published literature, which belongs to the second study. Therefore, this study does not require the approval of the ethics committee. The findings will be disseminated through a peer-reviewed journal publication or conference presentation.

The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

“…The language was restricted to English or Chinese. Referring to our previous research [5], the research was obtained using the following keywords or combinations: "Chronic Obstructive Pulmonary Disease" or "COPD"; merging "Non-exacerbators" or "Nonexacerbators" or "nonexacerbator" or "non-frequent exacerbators with chronic bronchitis or emphysema" or "non-exacerbator phenotype with either chronic bronchitis or emphysema" or "NE" or "NONEX" or "NE-CB/E" or "NON-AE", merging "frequent exacerbator(s) with chronic bronchitis" or "exacerbator(s) with chronic bronchitis" or "exacerbator phenotype with chronic bronchitis" or "FE-CB". In order to avoid omissions, the references of relevant reviews and meta-analyses were manually screened.…”

“…GesEPOC identifies four phenotypes: non-exacerbator (NE), asthma-COPD overlap (ACO), exacerbator with emphysema (FE-E), and frequent exacerbator with chronic bronchitis (FE-CB) [4,5].…”

“…In our previous studies, we had explored the characteristics of the FE-CB phenotype and the ACO phenotype in COPD patients. However, the characteristics of the FE-CB phenotype and the NE phenotype in patients with COPD is still controversial [5].…”

The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

“…Previous studies had explored the characteristic of BMI in COPD patients with the emphysema phenotype and the bronchitis phenotype. Studies had shown that the emphysema phenotype had a lower BMI than those with the bronchitis phenotype [5]. However, the characteristic of BMI in the FE-CB and NE phenotypes is still controversial.…”

The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

“…The language was restricted to English or Chinese. Referring to our previous research [5] , the research was obtained using the following keywords or combinations: "Chronic Obstructive Pulmonary Disease" or "COPD";…”