Title : Treatable traits in COPD: Differences between GOLD-classes.
Introduction: The classification and management of COPD are currently based on a patient-centric approach, emphasising the importance of symptoms and exacerbation history (GOLD-classes). Since COPD patients present hight individual heterogeneity, the treatable traits (TT) strategy has been proposed as a further personalized method, identifying therapeutic targets trough treat identification markers (TIM).
Objectives: Identify and compare TT between GOLD-classes on a COPD patients’ population.
Methods: 22 TT and respective TIMs were defined. Retrospective study of COPD patients followed in a specialized consultation on a tertiary hospital, during 2021 first semester. Descriptive and comparative analysis was made between different GOLD classes, using SPSS program.
Results: Totally, 128 patients were studied, with a median age of 72.5 years old and male predominance (82%). The majority belonged to Class B (56.3%), followed by classes D (22.7%), A (15.6%) and C (5.5%). There was a statistically significant difference in the mean number of TT found in each GOLD class (p=0.007): 7.28 TT in class D, 6.49 in B, 5.1 in A and 4.7 in C. The least researched or registered TT were: osteoporosis (97.7%), GERD (71.9%), SAS (54.7%) and depression (52.3%). In class-D patients (n=29), the TTs found in most patients (>50%) were: desaturation in exertion (88.9%), eosinophilic airway inflammation (79.3%), cardiovascular disease (CVD | 76%), respiratory failure (RF | 72.4%), depression (66.7%), sleep apnea syndrome (SAS | 66.7%), emphysema (65.4%), exercise intolerance (61.1%) and bronchitis (58.6%). Within class B (n=72) were: emphysema (74.6%), SAS (75%), CVD (72.9%), depression/anxiety (72.2%), eosinophilic airway inflammation (62.2%), exercise intolerance (60.8%), gastroesophageal reflux disease (GERD | 55.6%) and desaturation in exertion (54%). In class A (n=20) most patients were found with: SAS (90%), emphysema (80%), eosinophilic airway inflammation (56.3%) and cardiovascular disease (56.3%%). Most class C patients (n=7) presented: depression/anxiety (100%), airway eosinophilic inflammation (85.7%), GERD and SAS (66.7%) and bronchiectasis (BQ | 57.1%). A statistically significant difference between GOLD classes was found in the presence of several TT: respiratory failure (p=0.003), desaturation (p=0.006) and effort intolerance (p=0.014), which were more prevalent in classes B and D, and also, bronchiectasis (p=0.01), more prevalent in classes A and C.
Conclusions: The symptomatic GOLD groups (B and D) present a higher number of TT, outlining a wider therapeutic window. These groups showed a higher prevalence of RF, exercise intolerance and desaturation at exertion, with statistical significance. The less symptomatic groups (A and C), showed a statistically significant higher prevalence of BQ. Associated extrapulmonary comorbidities were the least researched or recorded TT.