Application of the Lancet Commission Copd Classification to Copd Cohort Population

Abstract

Objectives The Lancet Commissions on COPD recommended a new classification based on five main risk factors. To apply the proposed typing to a real-world patient cohort, evaluate the distribution of patients across each type, determine the extent of overlap, and compare and analyze the characteristics of non-overlapping patients.

Methods Patients with COPD were prospectively enrolled in a Korean COPD subgroup study cohort between April 2012 and June 2022. Patients were asked questions were about their history and classified based on their answers.

Results The database enrolled 3477 patients, including 52, 1293, 2931, and 2221 patients with type 2, 3, 4, and 5, respectively. Most patients (69.2%, 2406) had multiple risk factors contributing to their COPD. However, 93, 712, and 182 patients had only type 3, 4, and 5, respectively. Type 3 only patients were significantly younger, more often female, and had lower lung function. Both the rate and frequency of severe exacerbations were significantly higher in type 3 only patients (p=0.038 and p=0.048, respectively). Compared with type 5 only, type 3 only was significantly associated with the risk of severe exacerbation (Odds ratio, 5.713 [95% CI, 1.007-32.403]; P=0.049, incident rate ratio, 8.689 [95% CI, 1.7147 - 43.972]; P=0.009).

Conclusions Many patients were affected by multiple factors. Therefore, it is important to consider not only smoking history, but also other potential risk factors when evaluating patients with COPD. Further research is needed to explore the implications of this new COPD classification system for clinical practice and treatment strategies.

Note:
Funding Declaration: None.

Conflicts of Interest: None.

Ethical Approval: All hospitals involved in the study obtained approval from their respective institutional review board committees, and informed consent was obtained from all patients. The present study complied with the Declaration of Helsinki and all methods were performed in accordance with the relevant guidelines.

Keywords: Chronic obstructive pulmonary disease, Classification, exacerbation