[en] BACKGROUND AND AIMS: Chronic bronchitis (CB) in chronic obstructive pulmonary disease (COPD) patients is associated with increased mortality, frequent exacerbations and faster disease progression. This study investigates the prevalence of CB in a large population of COPD patients to identify features associated with CB. METHODS: Cross-sectional multicentre study in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 2-4 from Belgium and Luxembourg. RESULTS: The 974 patients included were on average 67.8 +/- 9.6 years old; 72% were male, FEV1 was 52.5 +/- 15.8% of predicted. The prevalence of CB was 64% (622/974). In patients with CB, the number of pack-years smoked and the prevalence of chronic respiratory failure, cachexia and skeletal muscle wasting were significantly higher, whereas FEV1 and FEV1 /VC were lower. The prevalence of CB increased with GOLD stage and was higher in patients with emphysema and those exposed to occupational risk factors. The CB group had more exacerbations, a higher percentage of patients with frequent exacerbations (37.3% vs. 14.2% of patients; p < 0.0001), increased COPD-related, non-intensive care unit hospitalisations and all-cause hospitalisation rates. In multiple logistic regression analysis, frequent exacerbation was the most important independent variable associated with CB, followed by current smoking, chronic respiratory failure, COPD duration and age. CONCLUSIONS: CB prevalence in GOLD stage 2-4 COPD patients is high. CB is related to current tobacco smoking, and prevalence increases with COPD severity and duration, emphysema and age. CB could be the hallmark of a subtype of COPD easy to identify in clinical practice, associated with increased disease severity and increased risk of exacerbation.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Corhay, Jean-Louis ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Vincken, W.
Schlesser, M.
Bossuyt, P.
Imschoot, J.
Language :
English
Title :
Chronic bronchitis in COPD patients is associated with increased risk of exacerbations: a cross-sectional multicentre study.
Agusti A, Calverley P, Celli B, et al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res 2010; 11: 122-35.
From the Global Strategy for the Prevention of Chronic Obstructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD) [Internet]. 2013. http://www.goldcopd.org/ (accessed July 2013).
Lu M, Yao W, Zhong N, et al. Chronic obstructive pulmonary disease in the absence of chronic bronchitis in China. Respirology 2010; 15: 1072-8.
Montes de Oca M, Halbert RJ, Lopez MV, et al. The chronic bronchitis phenotype in subjects with and without COPD: the PLATINO study. Eur Respir J 2012; 40: 28-36.
Kanner RE, Anthonisen NR, Connett JE,. Lower respiratory illnesses promote FEV(1) decline in current smokers but not ex-smokers with mild chronic obstructive pulmonary disease: results from the lung health study. Am J Respir Crit Care Med 2001; 164: 358-64. (Pubitemid 32778199)
Marsh SE, Travers J, Weatherall M, et al. Proportional classifications of COPD phenotypes. Thorax 2008; 63: 761-7.
Kim V, Han MK, Vance GB, et al. The chronic bronchitic phenotype of COPD: an analysis of the COPDGene Study. Chest 2011; 140: 626-33.
Vestbo J, Edwards LD, Scanlon PD, et al. Changes in forced expiratory volume in 1 second over time in COPD. N Engl J Med 2011; 365: 1184-92.
Miravitlles M, Guerrero T, Mayordomo C, Sánchez-Agudo L, Nicolau F, Segú JL,. Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: a multiple logistic regression analysis. The EOLO Study Group. Respiration 2000; 67: 495-501.
Burgel P-R, Nesme-Meyer P, Chanez P, et al. Cough and sputum production are associated with frequent exacerbations and hospitalizations in COPD subjects. Chest 2009; 135: 975-82.
Prescott E, Lange P, Vestbo J,. Chronic mucus hypersecretion in COPD and death from pulmonary infection. Eur Respir J 1995; 8: 1333-8.
Pelkonen M, Notkola I-L, Nissinen A, Tukiainen H, Koskela H,. Thirty-year cumulative incidence of chronic bronchitis and COPD in relation to 30-year pulmonary function and 40-year mortality: a follow-up in middle-aged rural men. Chest 2006; 130: 1129-37. (Pubitemid 44583744)
Ekberg-Aronsson M, Pehrsson K, Nilsson J-A, Nilsson PM, Löfdahl C-G,. Mortality in GOLD stages of COPD and its dependence on symptoms of chronic bronchitis. Respir Res 2005; 6: 98.
Vestbo J, Prescott E, Lange P,. Association of chronic mucus hypersecretion with FEV1 decline and chronic obstructive pulmonary disease morbidity. Copenhagen City Heart Study Group. Am J Respir Crit Care Med 1996; 153: 1530-5. (Pubitemid 26141336)
Snoeck-Stroband JB, Lapperre TS, Gosman MME, et al. Chronic bronchitis sub-phenotype within COPD: inflammation in sputum and biopsies. Eur Respir J 2008; 31: 70-7.
Kim V, Criner GJ,. Chronic bronchitis and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 187: 228-37.
Dompeling E, Van Schayck CP, Molema J, Folgering H, Van Grunsven PM, Van Weel C,. Inhaled beclomethasone improves the course of asthma and COPD. Eur Respir J 1992; 5: 945-52.
Paggiaro PL, Dahle R, Bakran I, Frith L, Hollingworth K, Efthimiou J,. Multicentre randomised placebo-controlled trial of inhaled fluticasone propionate in patients with chronic obstructive pulmonary disease. Lancet 1998; 351: 773-80. (Pubitemid 28112338)
Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med 1995; 152 (5 Pt 2): S77-121.
Burgel P-R,. Chronic cough and sputum production: a clinical COPD phenotype? Eur Respir J 2012; 40: 4-6.
Montnémery P, Adelroth E, Heuman K, et al. Prevalence of obstructive lung diseases and respiratory symptoms in southern Sweden. Respir Med 1998; 92: 1337-45. (Pubitemid 29002771)
Meteran H, Thomsen SF, Harmsen L, Kyvik KO, Skytthe A, Backer V,. Risk of chronic bronchitis in twin pairs discordant for smoking. Lung 2012; 190: 557-61.
Barnes PJ, Celli BR,. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009; 33: 1165-85.
Portillo K, Martinez-Rivera C, Ruiz-Manzano J,. Anaemia in chronic obstructive pulmonary disease. Does it really matter? Int J Clin Pract 2013; 67: 558-65.
Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 2010; 363: 1128-38.
Tashkin DP, Celli B, Senn S, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med 2008; 359: 1543-54.
Nannini LJ, Lasserson TJ, Poole P,. Combined corticosteroid and long-acting beta(2)-agonist in one inhaler versus long-acting beta(2)-agonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012; 9: CD006829. doi: 10.1002/14651858.CD006829.pub2.
Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA,. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157 (5 Pt 1): 1418-22.