Phenotype-based therapy of COPD: Effect on the rate of COPD exacerbations

Background: Czech National COPD Guideline defines six COPD phenotypes and recommends phenotype-specific therapy for each COPD phenotype. Aim: The evaluation of effect of COPD therapy based on clinical phenotypes on exacerbations of COPD during 24 months follow-up. Methods: The Czech Multicentre Research Database of COPD is a multicenter observational real-life prospective study of patients with COPD and post bronchodilator FEV1≤60%, with enrolled 784 patients treated according to the Czech National COPD Guideline. Cohorts of patients with distinct phenotype and using phenotype-specific therapy were observed for 24 months and compared with control cohorts of patients without phenotype-specific therapy. Exacerbations in each cohort were analyzed. Results: Higher reduction of exacerbations was found in a cohort of patients with bronchitic phenotype treated by mucolytics drugs (-0.61 vs -0.17, p=0.028) and in a cohort treated by roflumilast (-1.07 vs -0.08, p=0.043), in comparison to control cohorts. Frequent exacerbators treated by ICS+LABA had a higher reduction of exacerbations (-1.83 vs -1.24), similarly to frequent exacerbators treated by roflumilast (-2.50 vs -1.38). Higher reduction of exacerbations was found in cohort of patients with ACO(S) treated by ICS+LABA (-0.42 vs +0.17) and in cohort of patients with bronchiectasis/COPD overlap treated by mucolytics drugs (-0.57 vs +0.88). There was no difference in reduction of exacerbations between cohort with emphysematic phenotype treated by theophylline and control cohort. Conclusion: Using of phenotype-based therapy is associated with reduction of number of COPD exacerbations in a real-life study.