Geographic variations of the prevalence and distribution of COPD phenotypes in Spain: “the ESPIRAL-ES study”

Figures & data

Table 1 Characteristics of the study population

Study variables	Number of valid data	Total population
Sex	1,600
Male		1,314 (82.3)
Female		286 (17.9)
Age, years, mean (SD) [95% CI]	1,580	66.7 (9.7) [66.2–67.2]
Body mass index, kg/m^2, mean (SD) [95% CI]	1,581	27.9±4.7 (27.6–28.1)
Smoking status	1,608
Current smoker		891 (55.4)
Ex-smoker		677 (39.7)
Never smoker		40 (2.5)
Smoking index, pack-years, mean (SD) [95% CI]	849	65.0 (94.9) [58.2–71.4]
Years from COPD diagnosis, mean (SD) [95% CI]	1,505	8.9 (7.9) [8.5–9.3]
Comorbidities	1,610
Yes		1,349 (83.8)
No		261 (16.2)
Number of comorbidities, mean (SD) [95% CI]		2.0 (1.4) [1.4–1.9]
Spirometry, mean (SD) [95% CI]
FVC, mL	1,234	2,499.9 (869.4) [2,451.4–2,548.5]
FVC, %	1,329	73.5 (14.4) [72.7–74.2]
FEV1, mL	1,236	1,350 (551.9) [1,319.3–1,380.5]
FEV1, %	1,345	54.7 (15.1) [53.9–55.5]
FVC/FEV1	1,358	55.4 (12.2) [54.7–56.0]
Dyspnea	1,594
Grade 0		98 (6.1)
Grade 1		572 (35.9)
Grade 2		565 (35.4)
Grade 3		318 (19.9)
Grade 4		41 (2.6)
6-minute walking test, m	1,009
≥350		405 (40.1)
250–349		315 (31.2)
150–249		200 (19.8)
<149		89 (8.8)
Severe exacerbations in previous year, mean (SD) [95% CI]	1,567	0.9 (1.2) [0.9–1.0]
Two or more moderate-severe exacerbations	1,603	672 (41.9)
CAT score, mean (SD) [95% CI]	1,591	20.9 (8.9) [20.4–21.3]
COPD impact according to CAT	1,591
None, score <5		55 (3.5)
Low, score 5–9		128 (8.0)
Medium, score 10–20		559 (35.1)
High, score >20		614 (38.6)
Very high, score >30		235 (14.8)
BODEx index, mean (SD) [95% CI]	1,423	2.7 (1.9) [2.6–2.9]
0–2 points		692 (48.6)
3–4 points		449 (31.6)
5–6 points		236 (16.6)
≥7 points		46 (3.2)

Note: Data expressed as frequencies and percentages in parenthesis unless otherwise stated.

Abbreviations: FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; BODEx, body mass index, airflow obstruction, dyspnea, and exacerbations; CAT, COPD assessment test.

Figure 1 Overall prevalence of COPD phenotypes in 1,610 patients with COPD (percentages and 95% CI in parenthesis).

Figure 2 Geographic distribution of the prevalence of the non-exacerbator COPD phenotype showing the highest prevalence rates in the Canary Islands, Castilla-La Mancha, and the Basque Country.

Note: Courtesy of http://d-maps.com/carte.php?num_car=2210&lang=es.

Figure 3 Geographic distribution of the prevalence of the asthma–COPD overlap syndrome (ACOS) phenotype, with Murcia, Valencia, and Navarra showing the highest prevalence rates.

Note: Courtesy of http://d-maps.com/carte.php?num_car=2210&lang=es.

Figure 4 Geographic distribution of the prevalence of the exacerbator phenotype with emphysema. The highest prevalence rate in Asturias followed by Cataluña, Extremadura, and Andalucía.

Note: Courtesy of http://d-maps.com/carte.php?num_car=2210&lang=es.

Figure 5 Geographic distribution of the prevalence of the exacerbator phenotype with chronic bronchitis showing the highest prevalence rate in Castilla-León, Balearic Islands, and Madrid.

Note: Courtesy of http://d-maps.com/carte.php?num_car=2210&lang=es.

Table 2 Comparison of COPD phenotypes according to the study variables

Variables	COPD phenotypes				p-value
	Non-exacerbator	ACOS	Exacerbator with emphysema	Exacerbator with chronic bronchitis
Sex
Male	618 (47.9)	167 (12.9)	209 (16.2)	296 (22.9)	0.002
Female	117 (42.2)	60 (21.7)	48 (17.3)	52 (18.8)
Age, years
35–60	208 (50.5)	77 (18.7)	55 (13.3)	72 (17.5)	0.005
61–65	128 (46.5)	41 (14.9)	48 (17.4)	58 (21.1)
66–75	245 (44.8)	68 (12.4)	90 (16.4)	144 (26.3)
>75	144 (46.1)	35 (11.2)	59 (18.9)	74 (23.7)
Physician specialty
Primary care	154 (31.8)	105 (21.7)	70 (14.5)	155 (32.0)	0.0001
Pneumology	448 (58.3)	68 (8.8)	135 (17.6)	118 (15.3)
Smoking status
Current smoker	401 (54.6)	112 (48.9)	152 (58.9)	203 (57.7)	0.03
Ex-smoker	320 (43.5)	104 (45.4)	102 (39.5)	142 (40.3)
Never smoker	14 (1.9)	13 (5.7)	5 (1.6)	7 (2.0)
Comorbidities, mean (SD)	1.68 (1.30)	2.10 (1.35)	2.13 (1.45)	2.59 (1.48)	<0.001
One	202 (27.4)	38 (16.6)	55 (21.3)	56 (15.7)	<0.001
Two	207 (28.1)	74 (32.3)	63 (24.4)	110 (31.2)
Three	111 (15.1)	50 (21.8)	58 (22.5)	83 (23.5)
More than three	65 (8.8)	33 (14.4)	44 (17.1)	82 (23.2)
CAT score, mean (SD)	17.3 (8.2)	22.9 (8.0)	24.7 (8.3)	24.2 (8.6)	<0.001
COPD impact according to CAT
None, score <5	36 (4.1)	5 (2.2)	6 (2.4)	8 (2.3)	<0.001
Low, score 5–9	106 (14.5)	8 (3.5)	5 (2.0)	7 (2.0)
Medium, score 10–20	332 (45.3)	68 (29.8)	54 (21.3)	96 (27.5)
High, score >20	207 (28.2)	110 (48.2)	125 (49.4)	156 (44.7)
Very high, score >30	52 (7.1)	37 (16.2)	63 (24.9)	82 (23.5)
BODEx index
0–2 points	427 (62.7)	111 (16.3)	40 (5.9)	103 (15.1)	<0.001
3–4 points	182 (41.3)	57 (12.9)	82 (18.6)	120 (27.2)
5–6 points	60 (25.8)	14 (6.0)	86 (36.9)	73 (31.3)
≥7 points	4 (8.7)	3 (6.5)	23 (50.0)	16 (34.8)

Note: Data expressed as frequencies and percentages in parenthesis unless otherwise stated.

Abbreviations: ACOS, asthma-COPD overlap syndrome; CAT, COPD assessment test; BODEx, body mass index, airflow obstruction, dyspnea, and exacerbations.