Original Study
Incorporating Comprehensive Assessment Parameters to Better Characterize and Plan Rehabilitation for Persons with Chronic Obstructive Pulmonary Disease

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Abstract

Objectives

The current management of chronic obstructive pulmonary disease (COPD) largely ignores its heterogeneous pulmonary and extrapulmonary manifestations in the individual patient. This study aimed to identify clusters of patients with COPD based on a thorough traits assessment.

Design

An observational, prospective, single-center study.

Setting and Participants

Patients with COPD referred by chest physicians for a comprehensive pulmonary rehabilitation program to CIRO (Horn, the Netherlands) were eligible to participate. CIRO is a specialized pulmonary rehabilitation center in the southern part of the Netherlands for patients with complex underlying respiratory diseases.

Methods

Clinically stable patients with COPD underwent a comprehensive assessment, including pulmonary traits (airflow limitation, static hyperinflation, gas transfer, respiratory pressures, and arterial blood gases), extrapulmonary functional traits, and health status (quadriceps muscle strength, physical functioning, body composition, comorbidities, symptoms perception, and social and emotional functioning). Clusters were generated using the SOM-Ward Cluster algorithm, a hybrid algorithm that applies the classical hierarchical method of Ward on top of the self-organizing map topology.

Results

Based on the abovementioned attributes of 518 patients with mild to very severe COPD (44% women, age 64.1 ± 9.1 years, forced expiratory volume in the first second 48.6% ± 20.0% of predicted), 7 clusters were identified. Clusters had unique patterns differing in demographics, pulmonary, extrapulmonary functional, and behavioral traits and/or health status.

Conclusion and Implications

The tremendous heterogeneity in pulmonary, extrapulmonary functional and behavioral traits, and health status in patients with COPD supports the need for an individual comprehensive assessment and a goal-directed personalized management strategy.

Section snippets

Study Design

The current analyses are based on data from the Chance Study: an observational, prospective, single-center study about COPD, health status, and cardiovascular comorbidities in relation to the outcomes of pulmonary rehabilitation.16 This study was approved by the Medical Ethical Committee of the Maastricht University Medical Centre (METC 11-3-070) and is registered at http://www.trialregister.nl (NTR 3416).

Study Sample

Patients with COPD referred by chest physicians from general and academic hospitals for a

Patient Characteristics

A total of 518 patients were analyzed (Table 1). The majority of patients had COPD GOLD D (72%). Patients had a substantial smoking history, and a high disease burden and medical resource use reflected by the mean number of exacerbations as well as hospitalizations in the last year (2.2 and 0.9, respectively). A quarter of them used LTOT. On average, patients had an impaired physical fitness, 1 or more comorbidities, and experienced a high impact on activities in daily life.

Patient Profiles of the 7 Clusters

Seven clusters were

Discussion

In a sample of patients with moderate to very severe COPD referred for pulmonary rehabilitation, clustering based on a thorough assessment of a broad set of pulmonary and extrapulmonary (functional, behavioral) traits and health status resulted in 7 distinct clusters. However, heterogeneity within clusters and overlap regarding individual traits between clusters remain large. Our data suggest that a broad assessment of treatable traits might be useful in individual patients in order to offer

Conclusion and Implications

Based on respiratory, functional, and emotional treatable traits, patients with COPD were divided into 7 clusters: the overall best-functioning cluster, the ADL-limited cluster, the multimorbid cluster, the low-burden cluster, the emotionally dysfunctioning cluster, the overall worst-functioning cluster, and the physically dysfunctioning cluster. Our data clearly illustrate the tremendous heterogeneity in manifested pulmonary, extrapulmonary functional, and behavioral traits in patients with

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  • The CHANCE study was supported by the Lung Foundation Netherlands (3.4.10.015) and GlaxoSmithKline (SCO115406). These funding organizations provided only financial support, not playing a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    The authors declare no conflicts of interest.

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