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. 2021 May 10:16:1275-1284.
doi: 10.2147/COPD.S295381. eCollection 2021.

Burden and Characteristics of Severe Chronic Hypoxemia in a Real-World Cohort of Subjects with COPD

Maéva Zysman  1 , Gaëtan Deslee  2 , Thierry Perez  3 , Pierre-Régis Burgel  4 , Olivier Le Rouzic  3 , Graziella Brinchault-Rabin  5 , Pascale Nesme-Meyer  6 , Isabelle Court-Fortune  7 , Gilles Jebrak  8 , Pascal Chanez  9 , Denis Caillaud  10 , Jean-Louis Paillasseur  11 , Nicolas Roche  4
Affiliations

Burden and Characteristics of Severe Chronic Hypoxemia in a Real-World Cohort of Subjects with COPD

Maéva Zysman et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Chronic respiratory failure may occur as a consequence of chronic obstructive pulmonary disease (COPD) and is associated with significant morbidity and mortality. Hypoxemia is determined by underlying disease characteristics and comorbidities. Severe hypoxemia is typically only found in subjects with severe airflow obstruction (FEV1<50% predicted). However, how hypoxemia relates to disease characteristics is not fully understood.

Methods: In the French Initiatives BPCO real-life cohort, arterial blood gases were routinely collected in most patients. Relationships between severe hypoxemia, defined by a Pa02<60 mmHg (8 kPa) and clinical/lung function features, comorbidities and mortality were assessed. In subjects with severe hypoxemia, clinical characteristics and comorbidities were compared between those with non-severe versus severe airflow limitation. Classification and regression trees (CART) were used to define clinically relevant subgroups (phenotypes).

Results: Arterial blood gases were available from 887 subjects, of which 146 (16%) exhibited severe hypoxemia. Compared to subjects with a PaO2≥60 mmHg, the severe hypoxemia group exhibited higher mMRC dyspnea score, lower FEV1, higher RV and RV/TLC, more impaired quality of life, lower 6-minute walking distance, less frequent history of asthma, more frequent diabetes and higher 3-year mortality rate (14% versus 8%, p=0.026). Compared to subjects with Pa02<60 mmHg and FEV1<50% (n=115, 13%), those with severe hypoxemia but FEV1≥50% predicted (n=31) were older, had higher BMI, less hyperinflation, better quality of life and a higher rate of diabetes (29% versus 13%, p=0.02). Severe hypoxemia was better related to CART-defined phenotypes than to GOLD ABCD classification.

Conclusion: In this cohort of stable COPD subjects, severe hypoxemia was associated with worse prognosis and more severe symptoms, airflow limitation and hyperinflation. Compared to subjects with severe hypoxemia and severe airflow limitation, subjects with severe hypoxemia despite non-severe airflow limitation were older, had higher BMI and more diagnosed diabetes.

Trial registration: 04-479.

Keywords: airflow limitation; chronic obstructive pulmonary disease; severe hypoxemia.

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Conflict of interest statement

MZ reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, personal fees from Chiesi, personal fees from Astra Zeneca and personal fees from GSK outside the submitted work. PRB reports personal fees from Aptalis, personal fees from Astra-Zeneca, grants and personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from GSK, personal fees from Novartis, personal fees from Pfizer, personal fees from Vertex, personal fees from Zambon, personal fees from Insmed, outside the submitted work. ICF reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, and GSK outside the submitted work. GBR reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, grants and personal fees from Astra Zeneca, personal fees and non-financial support from Chiesi, outside the submitted work. PNM reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from NOVARTIS, personal fees and non-financial support from Chiesi, outside the submitted work. PS reports grants and personal fees from Boehringer Ingelheim outside the submitted work. GD reports personal fees from Novartis, personal fees and grants from Astra Zeneca, personal fees from BTG/PneumRx, personal fees from Chiesi, personal fees from Boehringer Ingelheim, personal fees from GSK, outside the submitted work. TP reports personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from GSK, personal fees from Chiesi, personal fees from Pierre Fabre, outside the submitted work. OLR reports grants and personal fees personal fees and non-financial support from Astra Zeneca, Boehringer Ingelheim, Chiesi, Lilly and Novartis; non-financial support from Glaxo Smith Kline, Correvio, Mayoli, Mylan, MSD, PulmonX, Zambon, Novartis, MundiPharma, Pfizer, Teva, Santelys Association, Vertex and Vitalaire, all outside the submitted work. GJ reports personal fees from Boehringer Ingelheim, personal fees from GSK, personal fees from Novartis, personal fees from Menarini, personal fees from Astra Zeneca, personal fees from Chiesi, outside the submitted work. PC reports personal fees from Boehringer Ingelheim, personal fees from GSK, personal fees and grants from ALK, personal fees and grants from Almirall, personal fees and grants from Boehringer-Ingelheim, personal fees from Novartis, personal fees from Teva, personal fees from Astra Zeneca, grants and personal fees from Chiesi, personal fees from Sanofi, personal fees and non-financial support from SNCF, personal fees from GlaxoSmithKline, grants and personal fees from Sanofi-Aventis, grants from Amu, outside the submitted work. JLP reports grants from iBPCO association, during the conduct of the study. DC has nothing to disclose. NR reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, grant and personal fees from Pfizer, grants and personal fees from GSK, personal fees from AstraZeneca, personal fees from Chiesi, personal fees from Sanofi, personal fees from Zambon, personal fees and grants from Boehringer Ingelheim, outside the submitted work.

Figures

Figure 1
Figure 1
Distribution of PaO2 (A) and relationships between PaO2 and PaCO2 (B). 887 COPD subjects were included. Values are in mmHg.
Figure 2
Figure 2
Relationships between PaO2 and FEV1, and distribution of COPD subjects for severe hypoxemia and severe airflow limitation. 887 COPD subjects were included. High PaO2/high FEV1 are in the right and upper part of the graph. High PaO2/low FEV1 are in the left and upper part of the graph. Low paO2/high FEV1 are in the right and lower part of the graph. Low PaO2/high FEV1 are in the left and lower part of the graph. Values are in mmHg or %.
Figure 3
Figure 3
Repartition of PaO2 according to GOLD stage 2007 1 to 4 (A–D, respectively) or according to CART classification 1 to 5 (E–I, respectively) (with a cut-off at 60 mmHg, (8)). 887 COPD subjects were included.
See this image and copyright information in PMC

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