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. 2017 Aug;24(4):571-583.
doi: 10.1007/s12529-016-9622-3.

Integral Health Status-Based Cluster Analysis in Moderate-Severe COPD Patients Identifies Three Clinical Phenotypes: Relevant for Treatment As Usual and Pulmonary Rehabilitation

Jeannette B Peters  1   2 , Lonneke M Boer  3 , Johan Molema  4 , Yvonne F Heijdra  4 , Judith B Prins  3 , Jan H Vercoulen  4   3
Affiliations

Integral Health Status-Based Cluster Analysis in Moderate-Severe COPD Patients Identifies Three Clinical Phenotypes: Relevant for Treatment As Usual and Pulmonary Rehabilitation

Jeannette B Peters et al. Int J Behav Med. 2017 Aug.

Abstract

Purpose: The purposes of the study are to identify clinical phenotypes that reflect the level of adaptation to the disease and to examine whether these clinical phenotypes respond differently to treatment as usual (TAU) and pulmonary rehabilitation (PR), the latter with its strong emphasis on improving adaptation.

Methods: Clusters were identified by a cluster analysis using data on many subdomains of the four domains of health status (HS) (physiological functioning, functional impairment, symptoms and quality of life) in 160 outpatients with chronic obstructive pulmonary disease (COPD) receiving TAU. By discriminant analysis in the TAU sample, all 459 PR patients could be assigned to one of the identified clusters. The effect of TAU and PR on HS was examined with paired t tests.

Results: Three distinct phenotypes were identified in the TAU sample. Two types were labelled adapted: phenotype 1 (moderate COPD-low impact on HS, n = 53) and phenotype 3 (severe COPD-moderate impact on HS, n = 73). One type was labelled non-adapted: phenotype 2 (moderate COPD-high impact on HS, n = 34). After 1-year TAU, the integral health status of all patients did not improve in any subdomain. In contrast, at the end of PR, significant improvements in HS were found in all three phenotypes especially the non-adapted.

Conclusions: Different phenotypes exist in COPD that are based on behavioural aspects (i.e. the level of adaptation to the disease). Non-adapted patient responds better to treatments with a strong emphasis on improving adaptation by learning the patient better self-management skills. Knowing to which clinical phenotype a patient belongs helps to optimize patient-tailored treatment.

Keywords: Adaptation; COPD; Clinical phenotypes; Cluster analysis; Integral health status; Pulmonary rehabilitation.

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Conflict of interest statement

Conflict of Interest

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Dendrogram of the identified three distinct clusters based on the hierarchical cluster analysis using Ward’s method
Fig. 2
Fig. 2
Graphs showing the relationship between phenotype and parameters physiological functioning, symptoms, functional impairment and quality of life
Fig. 3
Fig. 3
Graphs showing Z scores at baseline and 12 months of parameters FEV1% predicted, BMI, subjective symptoms, dyspnoea emotions, fatique, subjective impairments, behavioural impairments, general QoL, HrQoL and satisfaction relations
Fig. 4
Fig. 4
Graphs showing Z scores before and end of pulmonary rehabilitation of parameters FEV1% predicted, VO2% predicted, BMI, subjective symptoms, dyspnoea emotions, fatique, subjective impairments, behavioural impairments, general QoL, HrQoL and satisfaction relations
See this image and copyright information in PMC

Comment in

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