Tuberc Respir Dis.  2012 Apr;72(4):367-373.

Clinical Features according to the Frequency of Acute Exacerbation in COPD

• Lee SJ
• Lee SH
• Kim YE
• Cho YJ
• Jeong YY
• Kim HC
• Kim JH
• You JJ
• Yoon CH
• Lee JD
• Hwang YS

Abstract

BACKGROUND
Chronic obstructive pulmonary disease (COPD) is now regarded as a heterogenous disease, with variable phenotypes. Acute exacerbation of COPD is a major event that alters the natural course of disease. The frequency of COPD exacerbation is variable among patients. We analyzed clinical features, according to the frequency of acute exacerbation in COPD.
METHODS
Sixty patients, who visited Gyeongsang National University Hospital from March 2010 to October 2010, were enrolled. Patients were divided into two groups, according to their frequency of acute exacerbation. Frequent exacerbator is defined as the patient who has two or more exacerbation per one year. We reviewed patients' medical records and investigated modified Medical Research Council (MMRC) dyspnea scale, smoking history and frequency of acute exacerbation. We also conducted pulmonary function test and 6-minute walking test, calculated body mass index, degree of airway obstruction and dyspnea and exercise capacity (BODE) index and measured CD146 cells in the peripheral blood.
RESULTS
The number of frequent exacerbators and infrequent exacerbators was 20 and 40, respectively. The frequent exacerbator group had more severe airway obstruction (forced expiratory volume in one second [FEV1], 45% vs. 65.3%, p=0.001; FEV1/forced vital capacity, 44.3% vs. 50.5%, p=0.046). MMRC dyspnea scale and BODE index were significantly higher in the frequent exacerbator group (1.8 vs. 1.1, p=0.016; 3.9 vs. 2.1, p=0.014, respectively). The fraction of CD146 cells significantly increased in the frequent exacerbator group (2.0 vs. 1.0, p<0.001).
CONCLUSION
Frequent exacerbator had more severe airway obstruction and higher symptom score and BODE index. However, circulating endothelial cells measured by CD146 needed to be confirmed in the future.

Keyword

Pulmonary Disease, Chronic Obstructive; Phenotype; Endothelial Cells

MeSH Terms

Airway Obstruction
Body Mass Index
Dyspnea
Endothelial Cells
Humans
Medical Records
Phenotype
Pulmonary Disease, Chronic Obstructive
Respiratory Function Tests
Smoke
Smoking
Vital Capacity
Walking
Smoke

Figure

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  Figure 1 Comparison of FEV1 (% predicted) and FEV1/FVC (%) between frequentand infrequent exacerbator (45.0±17.2 vs. 65.3±21.8, p=0.001 and 44.3±11.9 vs. 50.5±10.8, p=0.046). FEV1: forced expiratory volume in one second; FVC: forced vital capacity.

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  Figure 2 Comparison of MMRC dyspnea scale (1.8±1.1 vs. 1.1±1.0, p=0.016), 6-MWT (395.5±144.2 vs. 438.8±108.8, p=0.198), body mass index (21.3±2.4 vs. 22.6±3.9, p=0.162) and BODE index (3.9±2.9 vs. 2.1±2.3, p=0.014) between frequent and infrequent exacerbator. MMRC: modified Medical Research Council; 6-MWT: 6-minute walking test; BODE: body mass index, degree of airway obstruction and dyspnea and exercise capacity.

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  Figure 3 Comparison of CD146 between frequent and infrequent exacerbator (2.0±0.4 vs. 1.0±0.5, p<0.001).

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