School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Centre for Clinical Research and Education, Karlstad, Sweden.
Int J Chron Obstruct Pulmon Dis. 2023 Apr 6;18:483-492. doi: 10.2147/COPD.S392070. eCollection 2023.
Patients with chronic obstructive pulmonary disease (COPD) and no exacerbations may need less maintenance treatment and follow-up. The aim was to identify factors associated with a non-exacerbator COPD phenotype.
Cross-sectional analysis of 1354 patients from primary and secondary care, with a doctor's diagnosis of COPD. In 2014, data on demographics, exacerbation frequency and symptoms using COPD Assessment Test (CAT) were collected using questionnaires and on spirometry and comorbid conditions by record review. The non-exacerbator phenotype was defined as having reported no exacerbations the previous six months. Multivariable logistic regression with the non-exacerbator phenotype as dependent variable was performed, including stratification and interaction analyses by sex.
The non-exacerbator phenotype was found in 891 (66%) patients and was independently associated with COPD stage 1 (OR [95% CI] 5.72 [3.30-9.92]), stage 2 (3.42 [2.13-5.51]) and stage 3 (2.38 [1.46-3.88]) compared with stage 4, and with CAT score <10 (3.35 [2.34-4.80]). Chronic bronchitis and underweight were inversely associated with the non-exacerbator phenotype (0.47 [0.28-0.79]) and (0.68 [0.48-0.97]), respectively. The proportion of non-exacerbators was higher among patients with no maintenance treatment or a single bronchodilator. The association of COPD stage 1 compared with stage 4 with the non-exacerbator phenotype was stronger in men (p for interaction 0.048). In women, underweight and obesity were both inversely associated with the non-exacerbator phenotype (p for interaction 0.033 and 0.046 respectively), and in men heart failure was inversely associated with the non-exacerbator phenotype (p for interaction 0.030).
The non-exacerbator phenotype is common, especially in patients with no maintenance treatment or a single bronchodilator, and is characterized by preserved lung function, low symptom burden, and by absence of chronic bronchitis, underweight and obesity and heart failure. We suggest these patients may need less treatment and follow-up, but that management of comorbid conditions is important to avoid exacerbations.
无加重的慢性阻塞性肺疾病（COPD）患者可能需要较少的维持治疗和随访。本研究旨在确定与非加重 COPD 表型相关的因素。
对来自初级和二级保健的 1354 例患者进行横断面分析，这些患者均经医生诊断为 COPD。2014 年，通过问卷调查收集了患者的人口统计学、加重频率和 COPD 评估测试（CAT）症状数据，并通过记录回顾收集了肺功能和合并症数据。非加重表型定义为过去 6 个月无加重。将非加重表型作为因变量进行多变量逻辑回归分析，包括按性别进行分层和交互分析。
1354 例患者中 891 例（66%）为非加重表型，与 COPD 第 4 阶段相比，1 期（OR [95%CI] 5.72 [3.30-9.92]）、2 期（3.42 [2.13-5.51]）和 3 期（2.38 [1.46-3.88]）与非加重表型独立相关，CAT 评分<10 分（3.35 [2.34-4.80]）也是如此。慢性支气管炎和体重不足与非加重表型呈负相关（0.47 [0.28-0.79]）和（0.68 [0.48-0.97]）。无维持治疗或单一支气管扩张剂的患者中，非加重者比例较高。与 COPD 第 4 阶段相比，1 期与非加重表型的关联在男性中更强（交互作用的 p 值为 0.048）。在女性中，体重不足和肥胖均与非加重表型呈负相关（交互作用的 p 值分别为 0.033 和 0.046），而在男性中，心力衰竭与非加重表型呈负相关（交互作用的 p 值为 0.030）。
非加重表型很常见，尤其是在无维持治疗或单一支气管扩张剂的患者中，其特征是肺功能保存、症状负担低、无慢性支气管炎、体重不足、肥胖和心力衰竭。我们建议这些患者可能需要较少的治疗和随访，但管理合并症对于避免加重很重要。
