Chronic bronchitis linked to worse outcomes in mild-to-moderate COPD

In the COMPASS cohort, 1,375 patients with GOLD I or II COPD were assessed according to chronic bronchitis status. Those with chronic bronchitis had more exacerbations, worse lung function and health status, and differences in CT and sputum microbiome findings.

Chronic bronchitis affected 63.7% of the cohort.
Exacerbation rate was higher with chronic bronchitis.
Health status and lung function were worse.
CT and microbiome findings were assessed in a subset.

The COMPASS cohort study examined whether chronic bronchitis is associated with worse outcomes in milder COPD, a population less represented in previous research. It included 1,375 patients with GOLD I or II airflow limitation; 88.7% were male, mean age was 65 years, and mean post-bronchodilator FEV₁ was 74.8% predicted. Chronic bronchitis was present in 63.7%. Quantitative CT and sputum microbiome analyses were conducted in a subset.

Compared with patients without chronic bronchitis, those with it had a higher annual rate of moderate or severe exacerbations (rate ratio 2.24, 95% CI 1.64–3.06) and lower post-bronchodilator FEV₁ (72.6% versus 76.0% predicted; p<0.001). COPD Assessment Test and St George’s Respiratory Questionnaire scores were worse by more than their respective minimal clinically important differences. Patients with GOLD I COPD and chronic bronchitis had more exacerbations and worse health status than patients with GOLD II COPD without chronic bronchitis.

CT findings indicated greater expiratory/inspiratory ratio and functional small-airways disease in the chronic bronchitis group. Sputum samples showed higher relative abundances of Streptococcus and Pseudomonas. These observational associations do not establish causality; proposed mechanisms involving small-airways disease and microbiome changes require further study.

In practice

For patients with GOLD I–II COPD, chronic bronchitis identifies a group associated with substantially more moderate or severe exacerbations and worse lung function and health status. The findings may support considering chronic bronchitis symptoms when characterizing disease burden, including in patients with relatively preserved airflow limitation. However, this was a cohort analysis and does not show that chronic bronchitis caused these differences or establish a treatment change; CT and sputum microbiome analyses were limited to a subset.

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Source

ERJ Open Research: Chronic bronchitis worsens all measured outcomes in mild–moderate COPD ↗

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