Multiple treatable traits (TTs) were found to be highly prevalent in patients with COPD/advanced emphysema who were eligible for bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBV), according to study findings published in Respiratory Medicine.
Investigators in The Netherlands conducted a prospective multicenter randomized controlled trial (the SoLVE study; ClinicalTrials.gov Identifier: NCT03474471) to explore the impact of pulmonary rehabilitation on 16 treatable traits in patients with COPD/advanced emphysema receiving EBV treatment. As a secondary outcome, the researchers also characterized TTs associated with severely impaired health-related quality of life (HRQL) using the St. George’s Respiratory Questionnaire (SGRQ).
Eligible patients had a physician diagnosis of COPD/severe emphysema, forced expiratory volume in 1 second (FEV1) of no more than 45% predicted, FEV1/forced vital capacity (FVC) ratio less than 70%, total lung capacity (TLC) greater than 100% predicted, and residual volume greater than 175% predicted. Included patients had a COPD Assessment Test total score of at least 10. Patients with low exercise capacity (6-minute walk test <160 m) and/or severe respiratory failure (partial pressure of carbon dioxide [PaCO2]>8.0kPA and/or partial pressure of oxygen<6.0kPa) were excluded as were those with significant immunodeficiency, bronchiectasis, chronic bronchitis, or previous lobectomy.
The trial included 97 participants (mean [SD] age, 62.4 [6.8] years; 72.9% women). Among the participants, the mean smoking pack years was 39; 58.8% had frequent exacerbations; and 34.0% had at least 1 hospitalization in the previous year.
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COPD patients with advanced emphysema eligible for BLVR with EBV display a spectrum of treatable traits which were highly prevalent. Having more TTs and more specifically anxiety, depression or fatigue, is associated with a worse HRQL.
TTs assessed were: (1) severe dyspnea; (2) very severe airflow limitation; (3) frequent exacerbations; (4) poor exercise capacity; (5) low physical activity; (6) hypoxemia; (7) hypercapnia; (8) underweight; (9) obesity; (10) low muscle mass; (11) decreased bone mineral density; (12) impaired handgrip force; (13) impaired quadriceps force; (14) severe fatigue; (15) anxiety; and (16) depression.
The mean (SD) TTs per participant was 8.1 (2.5; range 2-15); the most prevalent TTs included low physical activity (95%), poor exercise capacity (94%), and severe fatigue (75%).
Overall, participants were characterized by severe lung hyperinflation, severe airflow limitation, and poor HRQL (median total SGRQ score was 60).
When participants were stratified by low vs high SGRQ total score (less than 60 points vs 60 or greater points), the researchers found that the most significant predictors of having a higher SGRQ total score were severe fatigue, depression, and anxiety. A significant although moderate positive correlation was found between the sum of TTs present in a participant and that participant’s SGRQ total score (r=0.53; P <.001).
Study limitations include the strict inclusion/exclusion criteria, which may have affected the prevalence of specific TTs; lack of examination of some significant TTs (eg, persistent systemic inflammation, adherence to pharmacotherapy, family/social support); and lack of a comparator severe COPD group not eligible for BLVR-EBV.
The study authors concluded that “COPD patients with advanced emphysema eligible for BLVR with EBV display a spectrum of treatable traits which were highly prevalent. Having more TTs and more specifically anxiety, depression or fatigue, is associated with a worse HRQL. Findings of this study advocate a multidimensional assessment and management of this specific COPD phenotype.”
