Journal article
Novel Respiratory Disability Score Predicts COPD Exacerbations and Mortality in the SPIROMICS Cohort
International journal of chronic obstructive pulmonary disease, Vol.15, pp.1887-1898
01/01/2020
DOI: 10.2147/COPD.S250191
PMCID: PMC7417644
PMID: 32821092
Abstract
Rationale: Some COPD patients develop extreme breathlessness, decreased exercise capacity and poor health status yet respiratory disability is poorly characterized as a distinct phenotype.
Objective: To define respiratory disability in COPD based on available functional measures and to determine associations with risk for exacerbations and death.
Methods: We analyzed baseline data from a multi-center observational study (SPIROMICS). This analysis includes 2332 participants (472 with severe COPD, 991 with mild/moderate COPD, 726 smokers without airflow obstruction and 143 non-smoking controls).
Measurements: We defined respiratory disability by >= 4 of 7 criteria: mMRC dyspnea scale >= 3; Veterans Specific Activity Questionnaire <5; 6-minute walking distance <250 m; St George's Respiratory Questionnaire activity domain >60; COPD Assessment Test >20; fatigue (FACIT-F Trial Outcome Index) <50; SF-12 <20.
Results: Using these criteria, respiratory disability was identified in 315 (13.5%) participants (52.1% female). Frequencies were severe COPD 34.5%; mild-moderate COPD 11.2%; smokers without obstruction 5.2% and never-smokers 2.1%. Compared with others, participants with disability had more emphysema (13.2 vs. 6.6%) and air-trapping (37.0 vs. 21.6%) on HRCT (P<0.0001). Using principal components analysis to derive a disability score, two factors explained 71% of variance, and a cut point -1.0 reliably identified disability. This disability score independently predicted future exacerbations (beta=0.34; CI 0.12, 0.64; P=0.003) and death (HR 2.97; CI 1.54, 5.75; P=0.001). Thus, participants with disability by this criterion had almost three times greater mortality compared to those without disability.
Conclusion: Our novel SPIROMICS respiratory disability score in COPD was associated with worse airflow obstruction as well as airway wall thickening, lung parenchymal destruction and certain inflammatory biomarkers. The disability score also proved to be an independent predictor of future exacerbations and death. These findings validate disability as an important phenotype in the spectrum of COPD.
Details
- Title: Subtitle
- Novel Respiratory Disability Score Predicts COPD Exacerbations and Mortality in the SPIROMICS Cohort
- Creators
- Christopher B. Cooper - University of California, Los AngelesRobert Paine - University of UtahJeffrey L. Curtis - University of Michigan–Ann ArborRichard E. Kanner - University of UtahCarlos H. Martinez - University of Michigan–Ann ArborCatherine A. Meldrum - University of Michigan–Ann ArborRussell Bowler - University of DenverWanda O'Neal - University of North Carolina at Chapel HillEric A. Hoffman - University of IowaDavid Couper - University of North Carolina at Chapel HillMiguel Quibrera - University of North Carolina at Chapel HillGerald Criner - Temple UniversityMark T. Dransfield - University of Alabama at BirminghamMeiLan K. Han - University of MichiganNadia N. Hansel - Johns Hopkins MedicineJerry A. Krishnan - University of Illinois ChicagoStephen C. Lazarus - University of California, San FranciscoStephen P. Peters - Wake Forest UniversityR. Graham Barr - Columbia UniversityFernando J. Martinez - Cornell UniversityPrescott G. Woodruff - University of California, San FranciscoSubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Investigators
- Resource Type
- Journal article
- Publication Details
- International journal of chronic obstructive pulmonary disease, Vol.15, pp.1887-1898
- DOI
- 10.2147/COPD.S250191
- PMID
- 32821092
- PMCID
- PMC7417644
- NLM abbreviation
- Int J Chron Obstruct Pulmon Dis
- ISSN
- 1178-2005
- eISSN
- 1178-2005
- Publisher
- Dove Medical Press Ltd
- Number of pages
- 12
- Grant note
- HHSN268200900013C; HHSN268200900014C; HHSN268200900015C; HHSN268200900016C; HSN26820 0900017C; HHSN268200900018C; HHSN268200900019C; HHSN268200900020C; U01 HL137880; U24 HL141762 / NIH/NHLBI; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Language
- English
- Date published
- 01/01/2020
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
- Record Identifier
- 9984318817502771
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