Clinical Characteristics Of Patients With COPD With Different Frequency Of Exacerbation And Different Phenotypes And Their Correlation With Systemic Inflammatory Mediators

Objective:The clinical characteristics of patients with chronic obstructive pulmonary disease?COPD?with different states and different pathogenic mechanisms are different,which are a challenge for individualized treatment.This study is to explore and analyze the differences in clinical features of patients with different exacerbation frequency of COPD[frequent exacerbation?FE?,infrequent exacerbation?iFE?]and patients with clinical common phenotypes[chronic bronchitis?CB?,emphysema?EM?and Asthma COPD overlap Syndrome?ACOS?],and to compare the relationship between symptom scores and hematological inflammatory markers in patients with frequent episodes,so that to provide reference for clinical treatment and management to COPD patients.Methods:An analysis of 162 cases of COPD patients admitted to the Department of Respiratory Medicine,Yanjishan Hospital,Wannan Medical College from September2017 to October 2018,according to the history of previous acute attacks were performed,patients were divided into frequent exacerbation?FE?and infrequent exacerbation?iFE?groups or three common phenotypes[chronic bronchitis?CB?,emphysema?EM?and asthma-COPD overlap syndrome?ACOS?]according to the classification criteria.The clinical parameters from patients with FE or iFE and the clinical characteristics among patients with CB,EM or ACOS phenotypes were compared.Correlation between CAT?COPD Assessment Test?,mMRC?modified Medical Research Council?score in patients with frequent exacerbation and hematological inflammatory markers[C-reactive protein?CRP?,fibrinogen?Fibinogen,Fib?]were analysised.Results:A total of 162 eligible patients were enrolled,including 70 patients into the frequent exacerbation?FE?group and 92 into the infrequent exacerbation?iFE?group.There were 57 cases of CB phenotype,61 cases of EM phenotype and 44 cases of ACOS phenotype.Compared with the iFE group,patients in the FE group showed lower BMI?P=0.022?,worse lung function?lower FEV₁%,lower FEV₁/FVC??P=0.012,P=0.000,respectively?,higher smoking index and PaCO₂,in addition,CAT score,mMRC score,CRP,fibrinogen in the FE group were higher than that in the iFE group.Patients in the FE group showed more chest tightness,wheezing symptoms,and more signs of dry rales and moist rales.The proportion of pulmonary hypertension and coronary heart disease was also higher than that in the iFE group.The proportion of women was highest in CB phenotype subjects,while it was higher in subjects with ACOS phenotype compared to EM phenotype subgroups?P<0.05?.The smoking index in patients with EM phenotype[?56.7±26.30?pack*year]was greater than that in the CB phenotype[?39.2±21.87?pack*year],?P<0.05?.Patients with ACOS phenotype had the highest FEV₁%?55.81±12.7?,which was higher in subjects with CB phenotype?47.9±15.9?related to EM phenotype subgroups?41.9±13.5??P<0.05?.FEV₁/FVC had no difference among three groups with different phenotypes.In EM phenotype subgroups,mMRC score?3.27±0.79?was higher than that in CB phenotype COPD subjects?2.57±0.65?,P<0.05,and there were no significantly differences among COPD subjects with CB,EM or ACOS phenotypes in inflammation index such as CRP or Fib?P>0.05,respectively?.CB phenotype subjects showed more cough and sputum than that in EM phenotype subjects;while more chest tightness and wheezing were seen in EM phenotype subjects than in patients with CB phenotype.The proportion of dry rales is higher in EM phenotype subject than that in CB phenotype patients.There was no statistic difference in the prevalence of common comorbidities?coronary heart disease,hypertension,diabetes,pulmonary hypertension?among the three phenotypes subjects,P>0.05.CAT scores in patients with frequent exacerbation were positively correlated with CRP or Fib?r values were 0.315 and 0.318,P<0.05,respectively?Similar to CAT,mMRC score was positively correlated with CRP or Fib?r values were 0.276 and 0.289,P<0.05,respectively?.Conclusion:1.Patients with more frequent exacerbation have more severe symptoms,higher inflammatory conditions,worse lung function,and more comorbidities compared with patients with infrequent exacerbation.2.Compared with the other two phenotypes,patients with EM phenotype showed more severe dyspnea and poor lung function.The phenotypic inflammatory states among the three phenotypes were similar,and there was no difference in the risk of frequent exacerbation.3.CAT scores in patients with frequent exacerbation has a good correlation with inflammatory index,and can be used to self-assess the risk of acute exacerbation and prevent acute exacerbation.