The respiratory physiome: clustering based on a comprehensive lung function assessment in patients with COPD

Abstract

BackgroundWhile spirometry and particularly airflow limitation is still considered as an important tool in therapeutic decision making, it poorly reflects the heterogeneity of respiratory impairment in chronic obstructive pulmonary disease (COPD). The aims of this study were to identify pathophysiological clusters in COPD based on an integrated set of standard lung function attributes and to investigate whether these clusters can predict patient-related outcomes and differ in clinical characteristics. MethodsClinically stable COPD patients referred for pulmonary rehabilitation underwent an integrated assessment including clinical characteristics, dyspnea score, exercise performance, mood and health status, and lung function measurements (post-bronchodilator spirometry, body plethysmography, diffusing capacity, mouth pressures and arterial blood gases). Selforganizing maps were used to generate lung function based clusters. ResultsClustering of lung function attributes of 518 patients with mild to very severe COPD identified seven different lung function clusters. Cluster 1 includes patients with better lung function attributes compared to the other clusters. Airflow limitation is attenuated in clusters 1 to 4 but more pronounced in clusters 5 to 7. Static hyperinflation is more dominant in clusters 5 to 7. A different pattern occurs for carbon monoxide diffusing capacity, mouth pressures and for arterial blood gases. Related to the different lung function profiles, clusters 1 and 4 demonstrate the best functional performance and health status while this is worst for clusters 6 and 7. All clusters show differences in dyspnea score, proportion of men/women, age, number of exacerbations and hospitalizations, proportion of patients using long-term oxygen and number of comorbidities.

Profiling of Patients with COPD for Adequate Referral to Exercise-Based Care: The Dutch Model

“…These abnormalities can co-occur in different combinations, regardless of the degree of airflow limitation. Similar findings have been reported in patients with COPD who were under the care of Dutch pulmonologists [4,5].…”

Add‐on interventions during pulmonary rehabilitation

“…Patients entering PR are by definition complex. Recently, Augustin et al identified seven distinct clusters in more than 500 clinically stable COPD patients referred for PR, based on an integrated set of standard lung function attributes . In addition, previously, Vanfleteren et al identified in a similar population of PR patients five distinct clusters of co‐morbidities, without differences in airflow limitation or exercise capacity among clusters, but with marked differences in quality of life .…”

“…This heterogeneity and complexity is seen in the pulmonary expression of the disease such as chronic bronchitis without emphysema or emphysema without bronchitis. Furthermore, the presence or absence of exacerbations, differential diagnosis with asthma and also co‐morbidities and extrapulmonary manifestations have important contributions to disease expression, disease burden and survival . Pulmonary rehabilitation (PR) is a cornerstone of the treatment of patients with COPD and its associated persistent symptoms as PR reduces dyspnoea, increases exercise capacity and also improves quality of life .…”

Korelasi antara Kadar Kalsium Serum dengan Fungsi Paru pada Penderita Penyakit Paru Obstruksi Kronik (PPOK)

“…Hasil penelitian ini menunjukan jenis kelamin yang paling banyak dalam kasus PPOK yaitu laki-laki, hal ini sejalan dengan penelitian-penelitian sebelumnya yang mengatakan bahwa prevalensi lakilaki lebih banyak dibandingkan perempuan di berbagai negara di Eropa dan penelitian yang lain juga menemukan dari 518 sampel penelitian didominasi oleh lakilaki. 10,11 Hal ini juga berkaitan dengan faktor resiko dari PPOK yaitu polusi udara dan merokok, pada penelitian ini diketahui bahwa subjek penelitian mempunyai riwayat merokok dan riwayat perokok pasif, data ini didapatkan dari wawancara sebelum pengambilan sampel. Sedangkan berdasarkan usia, rata-rata yaitu 57.31±13.49.…”

“…Penelitian sebelumnya menemukan bahwa perempuan muda lebih mengalami hiperinflasi dan memiliki parameter pertukaran gas yang lebih buruk daripada pasien pria. 15 Penelitian lain juga mengungkapkan bahwa etiologi yang mendasari terjadinya PPOK yaitu adanya pajanan partikel berbahaya dan asap rokok per 5µg/m 3 setara dengan penambahan hilangnya fungsi paru pertahun, yang menyebabkan seseorang kehilangan VEP 1 rata-rata 32-46 mL/tahun setelah usia 30. 16 Penelitian tersebut sejalan dengan penelitian ini.…”