الفهرس 
Chronic Obstructive Pulmonary DiseaseOnly 14 pages are availabe for public view
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Abstract
Summary
Background
COPD, is a major cause of death worldwide, is important public health challenge and the burden of COPD is projected to increase in the incoming decades due to continuous exposure to risk factors.
Not all COPD patients are presented with the same symptoms and clinical presentation, as repeated exacerbation may be the main clinical presentation for COPD patients, while comorbidity or breathlessness might be the main symptoms for other patients. (183)
Because of the heterogenicity of COPD, Optimal treatment needs multidisciplinary and tailored approach focused on patient’s symptoms, risk and needs. (147)
SO, phenotyping of COPD patients received increasing awareness recent years in order to promote treatment tailored to disease presentation. (2)
Aim of the work
To assess, identify different phenotypes and detect the commonest type during the period from November 2016 to June 2017 in Mansoura chest hospital.
Subject and method
All patients fulfilling the diagnostic criteria of COPD according to GOLD guidelines (12) All patients were subjected to:
1. Full medical history and examination.
2. Pre and post bronchodilator spirometric study according to GOLD guidelines. (12).
3. Chest X-Ray: Chest X-Ray with PA view to exclude any other Chest diseases.
4. CAT Questionnaire in Arabic version,6MWT is performed and BODE index is calculated.
The following algorithm was used to determine phenotypes:
1) Patients with 0 or 1 exacerbation in the previous year were classified as Non-Exacerbator.
2) Patients who experienced at least two exacerbations in the previous year and clinical/radiological evidence of emphysema were classified as Exacerbator Emphysema.
3) Exacerbators with cough and expectoration for 3 months of the year over two consecutive years were classified as Exacerbator chronic Bronchitis.
4) Patients who met two major criteria or one major and two minor criteria were considered as ACO.
Major criteria were previous history of asthma, sputum eosinophilia, and bronchodilator response to salbutamol higher than 15% and 400 ml.
Minor criteria were high total IgE, history of atopy, two separated bronchodilator responses to salbutamol higher than 12% and 200 mL, and blood eosinophils 5%.
Assessment of severity is evaluated according to Spanish guide lines by using (CAT, mMRC, Hospitalization, FEV1, BODE Index and 6MWT). (4)
Results
• The distribution of identified phenotypes among studied cases was as follows NE (54%), ECB (22%), ACO (14%) and EE (10%).
• As regards the age distribution among our studied groups there was significant difference between different phenotypes (P<0.015) in which NE and ACO were younger than the other phenotypes with mean age of NE was 51.37, ECB was 58.55, ACO 58 and EE 60.6.
• For Gender distribution the COPD phenotypes men were more prevalent with no statistically significant difference the percent of males in NE was 66.7%, ECB 100%, ACO 71.4%, and EE 80%.
• In our study, as regards the smoking practice the percent of current smokers among NE was 43.14%, ECB 54.5%, ACO 71.4%, and EE 80% with no statistical significant difference. And the mean pack per year for NE 65.83, ECB 70.73, ACO 75, and EE 53.75. Most of the phenotypes were current smokers with high pack /year especially EE.
• Exacerbator phenotypes had lower BMI. with the mean BMI for NE was 30.19, ECB 26.9, ACO 29, and EE 26.
• As regards dyspnea scale mMRC was more severe in EE and ECB. Showing statistically significant difference (P<0.001) with the mean dyspnea score for NE was 2.19, ECB 3.27, ACO 3.14, and EE 3.4.
• According to CAT questionnaire, the mean score of NE was 13 ECB 30.82 ACO 27.57 EE 31.6 with statistically significant difference(P<0.001) showing that ECB and EE phenotypes had the highest scores indicating severe symptoms with more impact on patient health.
• Regarding 6MWT in the current study show statistically significant difference among different phenotypes (P<0.001) with mean result for NE was 273.33, ECB 148, ACO 140, EE 139. Exacerbator phenotypes had the worest exercise field capacity.
• In the present study as regards BODE index, there was statistically significant difference (P<0.001) the mean index for NE was 4.44, ECB 7.82, ACO 7.71, and EE 9. This means that ECB and EE phenotypes had the highest score and more severe symptoms with worse mortality index.
• Regarding this study the number of previous hospitalization in previous year there was statistical significant difference (P<0.001) with the mean for NE was 0.63, ECB 4.55, ACO 2.86, and EE 5.4. Indicating that Exacerbator phenotypes had more hospitalization than other phenotypes.
• In the concurrent study as regards post bronchodilator spirometric parameters among different phenotypes, the mean FEV1 for NE was 51.14, ECB 39.18, ACO 52.57, and EE 34.6. Showing that Exacerbator phenotypes had the worst spirometry (post B.D FEV1), especially EE phenotype.
• In concurrent study the assessment of the severity of COPD according to Spanish guideline by using (CAT, mMRC, Hospitalization, FEV1, BODE Index and 6MWT). There is significant relation between severity and COPD phenotypes (P<0.001), as severity increased in the exacerbator phenotypes (72.7%,60%) for ECB, EE respectively.
• According to this study, there is significant correlation between post BD FEV1 And CAT questionnaire. Which reinforces the validity of CAT and its importance as a complement in the evaluation of the true impact of COPD on patients’ daily lives as the mean CAT score changed significantly between different COPD phenotypes.
Conclusion
This study revealed that among the selected studied cases Non-Exacerbator phenotype was the commonest phenotype.
Different phenotypes had different clinical characteristics.
Exacerbator emphysema was older, with more sever disease and more symptoms.
Exacerbator phenotypes had the worst spirometric results more severe BODE Index and more hospitalization.