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Original Research: COPD |

Physiologic Characterization of the Chronic Bronchitis Phenotype in GOLD Grade IB COPDThe Chronic Bronchitis Phenotype in Mild COPD

Amany F. Elbehairy, MD; Natya Raghavan, MD; Sicheng Cheng, BSc; Ling Yang, MD; Katherine A. Webb, MSc; J. Alberto Neder, MD; Jordan A. Guenette, PhD; Mahmoud I. Mahmoud, MD, PhD; Denis E. O’Donnell, MD, FCCP on behalf of the Canadian Respiratory Research Network
Author and Funding Information

From the Department of Medicine (Drs Elbehairy, Yang, Neder, and O’Donnell and Mss Cheng and Webb), Queen’s University & Kingston General Hospital, Kingston, ON, Canada; Department of Chest Diseases (Drs Elbehairy and Mahmoud), Faculty of Medicine, Alexandria University, Alexandria, Egypt; Department of Medicine (Dr Raghavan), McMaster University, Hamilton, ON, Canada; and Department of Physical Therapy and UBC Centre for Heart Lung Innovation (Dr Guenette), University of British Columbia, Vancouver, BC, Canada.

CORRESPONDENCE TO: Denis O’Donnell, MD, 102 Stuart St, Kingston, ON, K7L 2V6, Canada; e-mail: odonnell@queensu.ca


FUNDING/SUPPORT: This study was supported by the William Spear Endowment Fund/Start Memorial Fund, Queen’s University and the Canadian Respiratory Research Network. Financial support to Dr Elbehairy was provided by an Egyptian Ministry of Higher Education and Scientific Research Scholarship.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(5):1235-1245. doi:10.1378/chest.14-1491
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BACKGROUND:  Smokers with persistent cough and sputum production (chronic bronchitis [CB]) represent a distinct clinical phenotype, consistently linked to negative clinical outcomes. However, the mechanistic link between physiologic impairment, dyspnea, and exercise intolerance in CB has not been studied, particularly in those with mild airway obstruction. We, therefore, compared physiologic abnormalities during rest and exercise in CB to those in patients without symptoms of mucus hypersecretion (non-CB) but with similar mild airway obstruction.

METHODS:  Twenty patients with CB (≥ 3 months cough/sputum in 2 successive years), 20 patients without CB but with GOLD (Global Initiative for Chronic Obstructive Lung Disease) grade IB COPD, and 20 age- and sex-matched healthy control subjects underwent detailed physiologic testing, including tests of small airway function and a symptom-limited incremental cycle exercise test.

RESULTS:  Patients with CB (mean ± SD postbronchodilator FEV1, 93% ± 12% predicted) had greater chronic activity-related dyspnea, poorer health-related quality of life, and reduced habitual physical activity compared with patients without CB and control subjects (all P < .05). The degree of peripheral airway dysfunction and pulmonary gas trapping was comparable in both patient groups. Peak oxygen uptake was similarly reduced in patients with CB and those without compared with control subjects (% predicted ± SD, 70 ± 26, 71 ± 29 and 106 ± 43, respectively), but those with CB had higher exertional dyspnea ratings and greater respiratory mechanical constraints at a standardized work rate than patients without CB (P < .05).

CONCLUSIONS:  Patients with CB reported greater chronic dyspnea and activity restriction than patients without CB and with similar mild airway obstruction. The CB group had greater dynamic respiratory mechanical impairment and dyspnea during exercise than patients without CB, which may help explain some differences in important patient-centered outcomes between the groups.

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