Phenotypes of COPD patients with a smoking history in Central and Eastern Europe: the POPE Study

Abstract

Chronic obstructive pulmonary disease (COPD) represents a major health problem in Central and Eastern European (CEE) countries; however, there are no data regarding clinical phenotypes of these patients in this region.Participation in the Phenotypes of COPD in Central and Eastern Europe (POPE) study was offered to stable patients with COPD in a real-life setting. The primary aim of this study was to assess the prevalence of phenotypes according to predefined criteria. Secondary aims included analysis of differences in symptom load, comorbidities and pharmacological treatment.3362 patients with COPD were recruited in 10 CEE countries. 63% of the population were nonexacerbators, 20.4% frequent exacerbators with chronic bronchitis, 9.5% frequent exacerbators without chronic bronchitis and 6.9% were classified as asthma-COPD overlap. Differences in the distribution of phenotypes between countries were observed, with the highest heterogeneity observed in the nonexacerbator cohort and the lowest heterogeneity observed in the asthma-COPD cohort. There were statistically significant differences in symptom load, lung function, comorbidities and treatment between these phenotypes.The majority of patients with stable COPD in CEE are nonexacerbators; however, there are distinct differences in surrogates of disease severity and therapy between predefined COPD phenotypes.

FIGURE 1

Enrolment of chronic obstructive pulmonary disease (COPD) subjects. SM: smokers or ex-smokers with COPD; N-SM: nonsmokers with COPD. ^#: 130 patients were excluded from the analysis because of missing information regarding bronchodilator reversibility (n=128) and exacerbation history (n=2); ^¶: patients from Latvia were excluded due to small sample size.

FIGURE 2

Phenotypes of chronic obstructive pulmonary disease (COPD) in central and Eastern Europe (n=3362). p-values were calculated using Fisher's exact test. ACOS: asthma–COPD overlap syndrome; AE-CB: frequent exacerbator with chronic bronchitis; AE NON-CB: frequent exacerbator without chronic bronchitis.

FIGURE 3

Country-specific heterogeneity distribution of chronic obstructive pulmonary disease (COPD) phenotypes. Data are presented as % (95% CI). a) Nonexacerbators; b) frequent exacerbators without chronic bronchitis; c) frequent exacerbators with chronic bronchitis; d) asthma–COPD overlap syndrome.