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 Igarashi & 98 others Kiyonobu 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

170 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
Externally publishedYes

Fingerprint

Emphysema
Chronic Obstructive Pulmonary Disease
Phenotype
Body Mass Index
Chronic Bronchitis
Quality of Life
Tetraodontiformes
Albuterol
Bronchodilator Agents
Respiratory Function Tests
Eosinophils
Immunoglobulin E
Inhalation
Asthma
Smoking
History
Interviews
Physicians

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Makita, H., Nasuhara, Y., Nagai, K., Ito, Y., Hasegawa, M., Betsuyaku, T., ... 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

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

In: Thorax, Vol. 62, No. 11, 11.2007, p. 932-937.

Research output: Contribution to journalArticle

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, Igarashi, T, Kimura, K, Nakano, I, Itabashi, K, Morikawa, K, Tagami, S, Sato, R, Kojima, J, Nigawara, S, Fujii, S, Kanehira, K, Funakoshi, R, Takashima, Y, Awaka, M, Ishii, H, Nakayama, M, Honda, H, Kaneda, R, Takagi, M, Yamamoto, H, Ogura, S, Akie, K, Baba, K, Goya, H, Kitamura, K, Mineta, S, Takeda, T, Kubo, K, Nara, H, Nakano, T, Takeyabu, K, Naka, C, Sato, H, Yamamoto, T, Abe, T, Akiyama, Y, Kishi, F, Ito, A, Ooe, M, Fujino, M, Noda, Y, Takahashi, T, Abe, K, Souma, M, Sato, E, Miyakawa, S, Indo, T, Taguchi, S, Nakajima, A, Fujii, T, Mori, H, Taguchi, H, Kojima, T, Minami, R, Murakami, S, Oono, Y, Ishigamori, O, Akimoto, S, Emoto, T, Kamimura, A, Harada, T, Hakuma, N, Anada, E, Numata, T, Itakura, T, Iizawa, T, Honoki, Y, Takaoka, K, Doi, I, Suzuki, M, Komuro, S, Yoshida, Y, Seki, H, Ishimine, A, Nakano, R, Ishihara, M, Itagaki, F, Matsuzaka, N, Kosukegawa, T, Miyajima, E, Nakamura, K, Funayama, W, Tsuchiya, K, Kaihatsu, R, Kamishima, K, Hasegawa, Y, Kobayashi, M, Hosokawa, T, Fuke, S, Odajima, N, Hamaaa, K, Shibuya, E, Obata, Y, Hosono, K, Yoshikuni, K, Akiyama, T, Nitta, K, Yamamoto, M & Miyamoto, K 2007, 'Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease', Thorax, vol. 62, no. 11, pp. 932-937. https://doi.org/10.1136/thx.2006.072777
Makita H, Nasuhara Y, Nagai K, Ito Y, Hasegawa M, Betsuyaku T et al. Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease. Thorax. 2007 Nov;62(11):932-937. https://doi.org/10.1136/thx.2006.072777
Makita, Hironi ; Nasuhara, Yasuyuki ; Nagai, Katsura ; Ito, Yoko ; Hasegawa, Masaru ; Betsuyaku, Tomoko ; Onodera, Yuya ; Hizawa, Nobuyuki ; Nishimura, Masaharu ; Kawakami, Yoshikazu ; Nishiura, Youichi ; Saito, Hiroshi ; Kojima, Tetsuya ; Sakai, Kazuhiko ; Demura, Yoriko ; Tsuchida, Yukihiro ; Tsubono, Motoko ; Tsuboya, Kazuhiro ; Kakimoto, Shinichi ; Igarashi, Takeshi ; Kimura, Kiyonobu ; Nakano, Ikuo ; Itabashi, Kouichi ; Morikawa, Kiyoshi ; Tagami, Seiichi ; Sato, Rika ; Kojima, Junichiro ; Nigawara, Shinji ; Fujii, Shiro ; Kanehira, Kazuyoshi ; Funakoshi, Ryota ; Takashima, Yui ; Awaka, Masahiro ; Ishii, Hitoshi ; Nakayama, Makoto ; Honda, Hiroki ; Kaneda, Ryo ; Takagi, Masahisa ; Yamamoto, Hiroshi ; Ogura, Shigeaki ; Akie, Kenji ; Baba, Kensuke ; Goya, Hiroki ; Kitamura, Kihoko ; Mineta, Shiho ; Takeda, Takayo ; Kubo, Kiyoshi ; Nara, Hiroshi ; Nakano, Tsuyoshi ; Takeyabu, Kimihiro ; Naka, Chihiro ; Sato, Hiroko ; Yamamoto, Teiji ; Abe, Toshio ; Akiyama, Yasushi ; Kishi, Fujiya ; Ito, Akihide ; Ooe, Masashi ; Fujino, Michihiro ; Noda, Yasuko ; Takahashi, Teruyo ; Abe, Keiko ; Souma, Mayumi ; Sato, Emiko ; Miyakawa, Sumiyo ; Indo, Tomokazu ; Taguchi, Shizuko ; Nakajima, Azusa ; Fujii, Tomonori ; Mori, Hironari ; Taguchi, Hideo ; Kojima, Takashi ; Minami, Ryouji ; Murakami, Shigeki ; Oono, Yuzuri ; Ishigamori, Osamu ; Akimoto, Satoru ; Emoto, Takashi ; Kamimura, Akira ; Harada, Toshiyuki ; Hakuma, Nobuyuki ; Anada, Eriko ; Numata, Tamaki ; Itakura, Teiko ; Iizawa, Tomoko ; Honoki, Yoshihiro ; Takaoka, Kazuo ; Doi, Isamu ; Suzuki, Miki ; Komuro, Sachiko ; Yoshida, Yoshiko ; Seki, Hitoshi ; Ishimine, Atsushi ; Nakano, Ryouji ; Ishihara, Masako ; Itagaki, Fumiyo ; Matsuzaka, Naoya ; Kosukegawa, Takae ; Miyajima, Eriko ; Nakamura, Kimitsugu ; Funayama, Wako ; Tsuchiya, Katsumigi ; Kaihatsu, Ryouji ; Kamishima, Kaoru ; Hasegawa, Yasushi ; Kobayashi, Motoko ; Hosokawa, Takeshi ; Fuke, Satoshi ; Odajima, Nao ; Hamaaa, Kunio ; Shibuya, Eiji ; Obata, Yoshiko ; Hosono, Kotomi ; Yoshikuni, Kana ; Akiyama, Tomoko ; Nitta, Katsuaki ; Yamamoto, Masashi ; Miyamoto, Kenji. / Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease. In: Thorax. 2007 ; Vol. 62, No. 11. pp. 932-937.
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title = "Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease",
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.",
author = "Hironi Makita and Yasuyuki Nasuhara and Katsura Nagai and Yoko Ito and Masaru Hasegawa and Tomoko Betsuyaku and Yuya Onodera and Nobuyuki Hizawa and Masaharu Nishimura and Yoshikazu Kawakami and Youichi Nishiura and Hiroshi Saito and Tetsuya Kojima and Kazuhiko Sakai and Yoriko Demura and Yukihiro Tsuchida and Motoko Tsubono and Kazuhiro Tsuboya and Shinichi Kakimoto and Takeshi Igarashi and Kiyonobu Kimura and Ikuo Nakano and Kouichi Itabashi and Kiyoshi Morikawa and Seiichi Tagami and Rika Sato and Junichiro Kojima and Shinji Nigawara and Shiro Fujii and Kazuyoshi Kanehira and Ryota Funakoshi and Yui Takashima and Masahiro Awaka and Hitoshi Ishii and Makoto Nakayama and Hiroki Honda and Ryo Kaneda and Masahisa Takagi and Hiroshi Yamamoto and Shigeaki Ogura and Kenji Akie and Kensuke Baba and Hiroki Goya and Kihoko Kitamura and Shiho Mineta and Takayo Takeda and Kiyoshi Kubo and Hiroshi Nara and Tsuyoshi Nakano and Kimihiro Takeyabu and Chihiro Naka and Hiroko Sato and Teiji Yamamoto and Toshio Abe and Yasushi Akiyama and Fujiya Kishi and Akihide Ito and Masashi Ooe and Michihiro Fujino and Yasuko Noda and Teruyo Takahashi and Keiko Abe and Mayumi Souma and Emiko Sato and Sumiyo Miyakawa and Tomokazu Indo and Shizuko Taguchi and Azusa Nakajima and Tomonori Fujii and Hironari Mori and Hideo Taguchi and Takashi Kojima and Ryouji Minami and Shigeki Murakami and Yuzuri Oono and Osamu Ishigamori and Satoru Akimoto and Takashi Emoto and Akira Kamimura and Toshiyuki Harada and Nobuyuki Hakuma and Eriko Anada and Tamaki Numata and Teiko Itakura and Tomoko Iizawa and Yoshihiro Honoki and Kazuo Takaoka and Isamu Doi and Miki Suzuki and Sachiko Komuro and Yoshiko Yoshida and Hitoshi Seki and Atsushi Ishimine and Ryouji Nakano and Masako Ishihara and Fumiyo Itagaki and Naoya Matsuzaka and Takae Kosukegawa and Eriko Miyajima and Kimitsugu Nakamura and Wako Funayama and Katsumigi Tsuchiya and Ryouji Kaihatsu and Kaoru Kamishima and Yasushi Hasegawa and Motoko Kobayashi and Takeshi Hosokawa and Satoshi Fuke and Nao Odajima and Kunio Hamaaa and Eiji Shibuya and Yoshiko Obata and Kotomi Hosono and Kana Yoshikuni and Tomoko Akiyama and Katsuaki Nitta and Masashi Yamamoto and Kenji Miyamoto",
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month = "11",
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pages = "932--937",
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TY - JOUR

T1 - Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease

AU - Makita, Hironi

AU - Nasuhara, Yasuyuki

AU - Nagai, Katsura

AU - Ito, Yoko

AU - Hasegawa, Masaru

AU - Betsuyaku, Tomoko

AU - Onodera, Yuya

AU - Hizawa, Nobuyuki

AU - Nishimura, Masaharu

AU - Kawakami, Yoshikazu

AU - Nishiura, Youichi

AU - Saito, Hiroshi

AU - Kojima, Tetsuya

AU - Sakai, Kazuhiko

AU - Demura, Yoriko

AU - Tsuchida, Yukihiro

AU - Tsubono, Motoko

AU - Tsuboya, Kazuhiro

AU - Kakimoto, Shinichi

AU - Igarashi, Takeshi

AU - Kimura, Kiyonobu

AU - Nakano, Ikuo

AU - Itabashi, Kouichi

AU - Morikawa, Kiyoshi

AU - Tagami, Seiichi

AU - Sato, Rika

AU - Kojima, Junichiro

AU - Nigawara, Shinji

AU - Fujii, Shiro

AU - Kanehira, Kazuyoshi

AU - Funakoshi, Ryota

AU - Takashima, Yui

AU - Awaka, Masahiro

AU - Ishii, Hitoshi

AU - Nakayama, Makoto

AU - Honda, Hiroki

AU - Kaneda, Ryo

AU - Takagi, Masahisa

AU - Yamamoto, Hiroshi

AU - Ogura, Shigeaki

AU - Akie, Kenji

AU - Baba, Kensuke

AU - Goya, Hiroki

AU - Kitamura, Kihoko

AU - Mineta, Shiho

AU - Takeda, Takayo

AU - Kubo, Kiyoshi

AU - Nara, Hiroshi

AU - Nakano, Tsuyoshi

AU - Takeyabu, Kimihiro

AU - Naka, Chihiro

AU - Sato, Hiroko

AU - Yamamoto, Teiji

AU - Abe, Toshio

AU - Akiyama, Yasushi

AU - Kishi, Fujiya

AU - Ito, Akihide

AU - Ooe, Masashi

AU - Fujino, Michihiro

AU - Noda, Yasuko

AU - Takahashi, Teruyo

AU - Abe, Keiko

AU - Souma, Mayumi

AU - Sato, Emiko

AU - Miyakawa, Sumiyo

AU - Indo, Tomokazu

AU - Taguchi, Shizuko

AU - Nakajima, Azusa

AU - Fujii, Tomonori

AU - Mori, Hironari

AU - Taguchi, Hideo

AU - Kojima, Takashi

AU - Minami, Ryouji

AU - Murakami, Shigeki

AU - Oono, Yuzuri

AU - Ishigamori, Osamu

AU - Akimoto, Satoru

AU - Emoto, Takashi

AU - Kamimura, Akira

AU - Harada, Toshiyuki

AU - Hakuma, Nobuyuki

AU - Anada, Eriko

AU - Numata, Tamaki

AU - Itakura, Teiko

AU - Iizawa, Tomoko

AU - Honoki, Yoshihiro

AU - Takaoka, Kazuo

AU - Doi, Isamu

AU - Suzuki, Miki

AU - Komuro, Sachiko

AU - Yoshida, Yoshiko

AU - Seki, Hitoshi

AU - Ishimine, Atsushi

AU - Nakano, Ryouji

AU - Ishihara, Masako

AU - Itagaki, Fumiyo

AU - Matsuzaka, Naoya

AU - Kosukegawa, Takae

AU - Miyajima, Eriko

AU - Nakamura, Kimitsugu

AU - Funayama, Wako

AU - Tsuchiya, Katsumigi

AU - Kaihatsu, Ryouji

AU - Kamishima, Kaoru

AU - Hasegawa, Yasushi

AU - Kobayashi, Motoko

AU - Hosokawa, Takeshi

AU - Fuke, Satoshi

AU - Odajima, Nao

AU - Hamaaa, Kunio

AU - Shibuya, Eiji

AU - Obata, Yoshiko

AU - Hosono, Kotomi

AU - Yoshikuni, Kana

AU - Akiyama, Tomoko

AU - Nitta, Katsuaki

AU - Yamamoto, Masashi

AU - Miyamoto, Kenji

PY - 2007/11

Y1 - 2007/11

N2 - 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.

AB - 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.

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U2 - 10.1136/thx.2006.072777

DO - 10.1136/thx.2006.072777

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VL - 62

SP - 932

EP - 937

JO - Thorax

JF - Thorax

SN - 0040-6376

IS - 11

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