Characterisation of COPD heterogeneity in the ECLIPSE cohort

Alvar Agusti, Peter M A Calverley, Bartolome Celli, Harvey O Coxson, Lisa D Edwards, David A Lomas, William MacNee, Bruce E Miller, Steve Rennard, Edwin K Silverman, Ruth Tal-Singer, Emiel Wouters, Julie C Yates, Jørgen Vestbo, Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) investigators, Y Ivanov, K Kostov, J Bourbeau, M Fitzgerald, P Hernández, K Killian, R Levy, F Maltais, D O'Donnell, J Krepelka, J Vestbo, E Wouters, D Quinn, P Bakke, M Kosnik, A Agusti, Jaume Sauleda, Y Feschenko, V Gavrisyuk, L Yashina, W MacNee, D Singh, J Wedzicha, A Anzueto, S Braman, R Casaburi, B Celli, G Giessel, M Gotfried, G Greenwald, N Hanania, D Mahler, B Make, S Rennard, C Rochester, P Scanlon, D Schuller, F Sciurba, A Sharafkhaneh, T Siler, E Silverman, A Wanner, R Wise, R ZuWallack, H Coxson, C Crim, L Edwards, D Lomas, W MacNee, E Silverman, R Tal-Singer, J Vestbo, J Yates, A Agusti, P Calverley, B Celli, C Crim, B Miller, W MacNee, S Rennard, R Tal-Singer, E Wouters, J Yates, Alvar Agusti, Peter M A Calverley, Bartolome Celli, Harvey O Coxson, Lisa D Edwards, David A Lomas, William MacNee, Bruce E Miller, Steve Rennard, Edwin K Silverman, Ruth Tal-Singer, Emiel Wouters, Julie C Yates, Jørgen Vestbo, Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) investigators, Y Ivanov, K Kostov, J Bourbeau, M Fitzgerald, P Hernández, K Killian, R Levy, F Maltais, D O'Donnell, J Krepelka, J Vestbo, E Wouters, D Quinn, P Bakke, M Kosnik, A Agusti, Jaume Sauleda, Y Feschenko, V Gavrisyuk, L Yashina, W MacNee, D Singh, J Wedzicha, A Anzueto, S Braman, R Casaburi, B Celli, G Giessel, M Gotfried, G Greenwald, N Hanania, D Mahler, B Make, S Rennard, C Rochester, P Scanlon, D Schuller, F Sciurba, A Sharafkhaneh, T Siler, E Silverman, A Wanner, R Wise, R ZuWallack, H Coxson, C Crim, L Edwards, D Lomas, W MacNee, E Silverman, R Tal-Singer, J Vestbo, J Yates, A Agusti, P Calverley, B Celli, C Crim, B Miller, W MacNee, S Rennard, R Tal-Singer, E Wouters, J Yates

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE).

Methods: We studied 2164 clinically stable COPD patients, 337 smokers with normal lung function and 245 never smokers. In these individuals, we measured clinical parameters, nutritional status, spirometry, exercise tolerance, and amount of emphysema by computed tomography.

Results: COPD patients were slightly older than controls and had more pack years of smoking than smokers with normal lung function. Co-morbidities were more prevalent in COPD patients than in controls, and occurred to the same extent irrespective of the GOLD stage. The severity of airflow limitation in COPD patients was poorly related to the degree of breathlessness, health status, presence of co-morbidity, exercise capacity and number of exacerbations reported in the year before the study. The distribution of these variables within each GOLD stage was wide. Even in subjects with severe airflow obstruction, a substantial proportion did not report symptoms, exacerbations or exercise limitation. The amount of emphysema increased with GOLD severity. The prevalence of bronchiectasis was low (4%) but also increased with GOLD stage. Some gender differences were also identified.

Conclusions: The clinical manifestations of COPD are highly variable and the degree of airflow limitation does not capture the heterogeneity of the disease.

Figures

Figure 1
Figure 1
Consort diagram.
Figure 2
Figure 2
Variability of age (panel A), gender (panel B), smoking status (panel C) and FEV1 (panel D) in the three groups of individuals recruited into ECLIPSE by the 46 participating centres.
Figure 3
Figure 3
Relationship between age (panel A) and cumulative smoking exposure (panel B) at entry into the study and degree of airflow limitation in patients with COPD. For further explanations see text.
Figure 4
Figure 4
Frequency distribution of the breathlessness as assessed by the mMRC questionnaire (panel A), exercise capacity as assessed by the 6MWD (panel B), reported exacerbations in the year before inclusion in the study (panel C), and health status assessed by SGRQ-C (panel D) according to severity of disease. For further explanations see text.
Figure 5
Figure 5
Relationship between the severity of airflow limitation and breathlessness as assessed by the mMRC questionnaire (panel A), exercise capacity as assessed by the 6MWD (panel B), reported exacerbations in the year before inclusion in the study (panel C), and health status as assessed by SGRQ-C (panel D). For further explanations see text.

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