Clinical Evolution and Quality of Life in Clinically Based COPD Chronic Bronchitic and Emphysematous Phenotypes: Results from the 1-Year Follow-Up of the STORICO Italian Observational Study

Abstract

Francesco Blasi, 1, 2 Raffaele Antonelli Incalzi, 3 Giorgio Walter Canonica, 4 Pietro Schino, 5 Giuseppina Cuttitta, 6 Alessandro Zullo, 7 Alessandra Ori, 7 Nicola Scichilone 8 On behalf of STORICO study group 1Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy; 2Department of Pathophysiology and Transplantation, University of Milan, Milan, 20122, Italy; 3University Biomedical Campus of Rome, Rome, 00128, Italy; 4Personalized Medicine Asthma & Allergy Clinic Humanitas University Humanitas research Hospital Rozzano, Rozzano (Milan), 20089, Italy; 5Miulli Hospital, Acquaviva delle Fonti, Bari, 70021, Italy; 6National Research Council, Palermo, 90146, Italy; 7Medineos Observational Research, Modena, 41123, Italy; 8DIBIMIS, University of Palermo, Palermo, 90127, ItalyCorrespondence: Francesco BlasiInternal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 35, Milan, 20122, ItalyEmail [email protected]: Understanding clinical evolution of chronic obstructive pulmonary disease (COPD) is crucial for improving disease management.Materials and Methods: STORICO (NCT03105999), an Italian, multicenter, non-interventional, observational study conducted in 40 pulmonology centers, aimed to describe the 1-year clinical evolution and health status of clinicallbased phenotypes. Baseline and follow-up data of COPD subjects with a chronic bronchitis (CB) or emphysema (EM) phenotype were collected. The frequency of COPD symptoms during the 24 hours (gathered via the night-time, morning and day-time symptoms of COPD questionnaire) and the anxiety and depression levels (via the HADS Scale) were recorded at each visit.Results: A total of 261 CB and 159 EM patients were analyzed. CB patients with ≥ 1 night-time symptom seemed to be more frequent (51.7%, 41.8% and 41.4% at baseline, 6-month and 12-month follow-up, respectively) than EM (37.7%, 32.1% and 30.2% at study visits) even if no statistical differences were observed at time points between phenotypes (chi-square test p-values presence/absence of night-time symptoms in CB vs EM at study visits > 0.0007). In the first 6 months, the frequency of patients with ≥ 1 night-time symptom decreased of 9.9% in CB and of 5.6% in EM. A clinically relevant decline of DLCO % predicted over 1 year in EM was observed, the mean (SD) being 61.5 (20.8) % at baseline and 59.1 (17.4) % at 12-month follow-up. EM had higher levels of anxiety and depression than CB (median (25th-75th percentile) HADS total score in CB: 7.0 (4.0– 13.0) and 7.0 (3.0– 12.0), in EM: 9.0 (3.0– 14.0) and 9.5 (3.0– 14.0) both at baseline and at 6-month follow-up, respectively), considering 1.17 as minimally clinical important difference (MCID) for the total score.Conclusion: EM patients, evaluated in a real-world setting, seem to suffer from a worse clinical condition and health status compared to CB patients, appearing to have “more treatable” traits.Keywords: COPD, clinical phenotype, clinical evolution, quality of life

Keywords

• copd
• clinical phenotype
• clinical evolution
• quality of life