Global Health Outcomes, Merck and Co, Inc, West Point, PA, USA.
Int J Chron Obstruct Pulmon Dis. 2012;7:779-87. doi: 10.2147/COPD.S35501. Epub 2012 Nov 22.
Recent literature has suggested that emphysema and chronic bronchitis, traditionally considered to be entities overlapping within chronic obstructive pulmonary disease (COPD), may be distinct disorders. Few studies have examined the differences in patient characteristics and health outcomes between these conditions. This study examined whether COPD phenotypes represent distinct patient populations, in a large nationally representative US sample.
Data were obtained from the 2010 US National Health and Wellness Survey (NHWS). NHWS respondents (n = 75,000) were categorized as a COPD phenotype based on their self-reported diagnosis of COPD only (n = 970), emphysema only (n = 399), or chronic bronchitis only (n = 2071). Phenotypes were compared on demographics, health characteristics, treatment patterns, health outcomes, work productivity, and resource use. Variables were compared using Chi-square and analysis of variance tests for categorical and continuous outcomes, respectively. Health outcomes were also examined using regression modeling, controlling for demographic and health characteristic covariates.
Patients with chronic bronchitis were significantly younger (51.38 years versus 63.24 years for COPD versus 63.30 years for emphysema, P < 0.05) and more likely to be employed (46.98% versus 23.81% for COPD versus 28.33% for emphysema, P < 0.05). Relative to the other phenotypes, patients with chronic bronchitis were also significantly more likely to be female, nonwhite, and to exercise currently (all P < 0.05), and were significantly less likely to be a current or former smoker (P < 0.05). Controlling for demographic and health characteristics, patients self-identified as having COPD only reported significantly worse physical quality of life (adjusted mean 36.69) and health utilities (adjusted mean 0.65) and significantly more absenteeism (adjusted mean 7.08%), presenteeism (adjusted mean 30.73%), overall work impairment (adjusted mean 34.06%), and activity impairment (adjusted mean 46.59%) than the other phenotypes (all P < 0.05).
These results suggest considerable heterogeneity among different COPD phenotypes with respect to demographics, health characteristics, disease characteristics, treatment patterns, and health outcomes. Research aimed at understanding the differences in patient characteristics and disease presentation of these phenotypes could be used to guide treatment recommendations.
最近的文献表明，肺气肿和慢性支气管炎，传统上被认为是重叠在慢性阻塞性肺疾病（COPD）中的实体，可能是不同的疾病。很少有研究检查这些病症在患者特征和健康结果方面的差异。本研究在一个大型的具有全国代表性的美国样本中，研究了 COPD 表型是否代表不同的患者群体。
数据来自 2010 年美国国家健康和健康调查（NHWS）。根据他们自我报告的 COPD 诊断（n = 970）、肺气肿（n = 399）或慢性支气管炎（n = 2071），NHWS 受访者（n = 75000）被归类为 COPD 表型。根据人口统计学、健康特征、治疗模式、健康结果、工作生产力和资源使用情况比较表型。使用卡方检验和方差分析分别比较分类和连续结果的变量。使用回归建模检查健康结果，控制人口统计学和健康特征协变量。
慢性支气管炎患者明显更年轻（51.38 岁，COPD 为 63.24 岁，肺气肿为 63.30 岁，P < 0.05），更有可能就业（COPD 为 46.98%，肺气肿为 28.33%，P < 0.05）。与其他表型相比，慢性支气管炎患者也更有可能是女性、非白人、目前正在锻炼（所有 P < 0.05），且不太可能是当前或曾经的吸烟者（P < 0.05）。在控制人口统计学和健康特征后，自我报告患有 COPD 仅有的患者报告的身体生活质量明显更差（调整后的平均值 36.69）和健康效用（调整后的平均值 0.65），旷工（调整后的平均值 7.08%）、在职病假（调整后的平均值 30.73%）、总体工作障碍（调整后的平均值 34.06%）和活动障碍（调整后的平均值 46.59%）明显更高（所有 P < 0.05）。
这些结果表明，在人口统计学、健康特征、疾病特征、治疗模式和健康结果方面，不同的 COPD 表型存在相当大的异质性。旨在了解这些表型患者特征和疾病表现差异的研究可以用于指导治疗建议。
