Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease

Hironi Makita, Yasuyuki Nasuhara, Katsura Nagai, Yoko Ito, Masaru Hasegawa, Tomoko Betsuyaku, Yuya Onodera, Nobuyuki Hizawa, Masaharu Nishimura, Yoshikazu Kawakami, Youichi Nishiura, Hiroshi Saito, Tetsuya Kojima, Kazuhiko Sakai, Yoriko Demura, Yukihiro Tsuchida, Motoko Tsubono, Kazuhiro Tsuboya, Shinichi Kakimoto, Takeshi IgarashiKiyonobu Kimura, Ikuo Nakano, Kouichi Itabashi, Kiyoshi Morikawa, Seiichi Tagami, Rika Sato, Junichiro Kojima, Shinji Nigawara, Shiro Fujii, Kazuyoshi Kanehira, Ryota Funakoshi, Yui Takashima, Masahiro Awaka, Hitoshi Ishii, Makoto Nakayama, Hiroki Honda, Ryo Kaneda, Masahisa Takagi, Hiroshi Yamamoto, Shigeaki Ogura, Kenji Akie, Kensuke Baba, Hiroki Goya, Kihoko Kitamura, Shiho Mineta, Takayo Takeda, Kiyoshi Kubo, Hiroshi Nara, Tsuyoshi Nakano, Kimihiro Takeyabu, Chihiro Naka, Hiroko Sato, Teiji Yamamoto, Toshio Abe, Yasushi Akiyama, Fujiya Kishi, Akihide Ito, Masashi Ooe, Michihiro Fujino, Yasuko Noda, Teruyo Takahashi, Keiko Abe, Mayumi Souma, Emiko Sato, Sumiyo Miyakawa, Tomokazu Indo, Shizuko Taguchi, Azusa Nakajima, Tomonori Fujii, Hironari Mori, Hideo Taguchi, Takashi Kojima, Ryouji Minami, Shigeki Murakami, Yuzuri Oono, Osamu Ishigamori, Satoru Akimoto, Takashi Emoto, Akira Kamimura, Toshiyuki Harada, Nobuyuki Hakuma, Eriko Anada, Tamaki Numata, Teiko Itakura, Tomoko Iizawa, Yoshihiro Honoki, Kazuo Takaoka, Isamu Doi, Miki Suzuki, Sachiko Komuro, Yoshiko Yoshida, Hitoshi Seki, Atsushi Ishimine, Ryouji Nakano, Masako Ishihara, Fumiyo Itagaki, Naoya Matsuzaka, Takae Kosukegawa, Eriko Miyajima, Kimitsugu Nakamura, Wako Funayama, Katsumigi Tsuchiya, Ryouji Kaihatsu, Kaoru Kamishima, Yasushi Hasegawa, Motoko Kobayashi, Takeshi Hosokawa, Satoshi Fuke, Nao Odajima, Kunio Hamaaa, Eiji Shibuya, Yoshiko Obata, Kotomi Hosono, Kana Yoshikuni, Tomoko Akiyama, Katsuaki Nitta, Masashi Yamamoto, Kenji Miyamoto

Research output: Contribution to journalArticle

176 Citations (Scopus)

Abstract

Background: Airflow limitation in chronic obstructive pulmonary disease (COPD) is caused by a mixture of small airway disease and emphysema, the relative contributions of which may vary among patients. Phenotypes of COPD classified purely based on severity of emphysema are not well defined and may be different from the classic phenotypes of "pink puffers" and "blue bloaters". Methods: To characterise clinical phenotypes based on severity of emphysema, 274 subjects with COPD were recruited, excluding those with physician-diagnosed bronchial asthma. For all subjects a detailed interview of disease history and symptoms, quality of life (QOL) measurement, blood sampling, pulmonary function tests before and after inhalation of salbutamol (0.4 mg) and high-resolution CT scanning were performed. Results: Severity of emphysema visually evaluated varied widely even among subjects with the same stage of disease. No significant differences were noted among three groups of subjects classified by severity of emphysema in age, smoking history, chronic bronchitis symptoms, blood eosinophil count, serum IgE level or bronchodilator response. However, subjects with severe emphysema had significantly lower body mass index (BMI) and poorer QOL scores, evaluated using St George's Respiratory Questionnaire (SGRQ), than those with no/mild emphysema (mean (SD) BMI 21.2 (0.5) vs 23.5 (0.3) kg/m 2, respectively; SGRQ total score 40 (3) vs 28 (2), respectively; p<0.001 for both). These characteristics held true even if subjects with the same degree of airflow limitation were chosen. Conclusions: The severity of emphysema varies widely even in patients with the same stage of COPD, and chronic bronchitis symptoms are equally distributed irrespective of emphysema severity. Patients with the phenotype in which emphysema predominates have lower BMI and poorer health-related QOL.

Original languageEnglish
Pages (from-to)932-937
Number of pages6
JournalThorax
Volume62
Issue number11
DOIs
Publication statusPublished - 2007 Nov

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Makita, H., Nasuhara, Y., Nagai, K., Ito, Y., Hasegawa, M., Betsuyaku, T., Onodera, Y., Hizawa, N., Nishimura, M., Kawakami, Y., Nishiura, Y., Saito, H., Kojima, T., Sakai, K., Demura, Y., Tsuchida, Y., Tsubono, M., Tsuboya, K., Kakimoto, S., ... Miyamoto, K. (2007). Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease. Thorax, 62(11), 932-937. https://doi.org/10.1136/thx.2006.072777