Clinical Impact of Multidisciplinary Outpatient Care on Outcomes of Patients with COPD

Figures & data

Table 1 Confirmed COPD Patients vs Misdiagnosed

Total Patients (n)	COPD Patients (98)	Misdiagnosed COPD (26)	P value
Age (Median [IQR])	63 [57, 70]	64 [53, 74]	0.97
Sex			0.73
Male (%)	49 (50%)	14 (54%)
Female (%)	49 (50%)	12 (46%)
Active smoker (%)	43 (44%)	11 (42%)	0.89
Initial visit BODE quartile (Median [IQR])	2 [1, 3]	n.a.
IV spirometry post BD (Median [IQR])
FVC (Liter)	2.79 [1.97, 3.54]	3.02 [2.37, 3.74]	0.27
%FVC (% predicted)	78 [66, 89]	83 [75, 102]	0.017
FEV1 (Liter)	1.35 [0.93, 2.02]	2.23 [1.78, 2.87]	<0.001
%FEV1(% predicted)	54 [39, 66]	87 [74, 98]	<0.001
FEV1/FVC	0.53 [0.42, 0.61]	0.76 [0.73, 0.80]	<0.001

Note: P value was generated by Mann–Whitney U-test.

Abbreviations: IQR, interquartile range; IV, initial visit; BD, bronchodilator; FVC, forced vital capacity; %FVC, percent predicted FVC; FEV1, Forced expiratory volume in 1 s; %FEV1, percent predicted FEV1.

Table 2 Demographics of COPD Patients

Total Patients (n = 98)	COPD Patients with Complete IV and FV (n = 62)	COPD Patients Without Complete IV and FO (n = 36)	P value
Age average (Median [IQR])	61 [55, 67]	66 [58, 71]	0.07
Sex			0.09
Male (%)	27 (44%)	22 (61%)
Female (%)	35 (56%)	14 (39%)
Active smoker (%)	24 (39%)	19 (53%)	0.18
IV BODE quartile (Median [IQR])	2 [1, 3]	2.5 [2, 3]	0.61
IV BODE quartiles
First (%)	18 (29%)	8 (22%)
Second (%)	14 (23%)	10 (28%)
Third (%)	19 (31%)	10 (28%)
Fourth (%)	11 (18%)	8 (22%)
IV spirometry post-BD, (Median [IQR])
FVC (Liter)	2.84 [2.05, 3.54]	2.74 [1.82, 3.62]	0.47
FVC (% predicted)	79 [71, 90]	75 [62, 87]	0.19
FEV1(Liter)	1.40 [1.00, 2.00]	1.30 [0.83, 2.02]	0.81
FEV1(% predicted)	54 [40, 66]	55 [38, 70]	0.89
FEV1/FVC	0.52 [0.42, 0.59]	0.57 [0.40, 0.64]	0.49
6 MWD in meters (Median [IQR])	281 [227, 327]	249 [150, 316]	0.11
mMRC (Median [IQR])	2 [1, 3]	2 [1, 3]	0.95
BMI < 21 (%)	8 (13%)	2 (6%)	0.25

Note: P value was generated by Mann–Whitney U-test.

Abbreviations: IQR, interquartile range; IV, initial visit; BD, bronchodilator; FV, follow-up visit; FVC, Forced Vital Capacity; %FVC, percent predicted FVC; FEV1, forced expiratory volume in 1 s; %FEV1, percent predicted FEV1.

Figure 1 Study population section and numbers.

Table 3 Demographics on Initial Visit by Change in BODE Quartile

Bode Quartile (n)	Worsened (13)	Stable (34)	Improved (15)	P value
Age (Median [IQR])	57 [55, 71]	61 [57, 67]	60 [57, 71]	0.89
Sex				0.26
Male (%)	4 (31%)	18 (53%)	5 (33%)
Female (%)	9 (69%)	16 (47%)	10 (67%)
Active smoker (%)	7 (54%)	9 (26%)	8 (53%)	0.093
Medication
SABA	12 (92%)	30 (86%)	14 (93%)	NA
SAMA	1 (8%)	8 (23%)	5 (33%)	NA
LABA	6 (46%)	22 (63%)	10 (67%)	0.45
LAMA	9 (69%)	18 (51%)	9 (60%)	0.59
ICS	10 (77%)	22 (63%)	11 (73%)	NA
Theophylline	0	1 (3%)	0	NA
Leukotriene modifier	0	1 (3%)	0	NA
OCS	3 (23%)	1 (3%)	1 (7%)	NA
Duration of follow-up (Months (Median [IQR]))	16 [10, 43]	12 [6, 26]	18 [5, 26]	0.63
IV spirometry Post BD (Median [IQR])
FVC (Liter)	2.76 [2.00, 3.58]	2.90 [2.22, 3.71]	2.51 [1.97, 3.33]	0.56
FVC (% predicted)	79 [74, 94]	79 [65, 90]	80 [71, 84]	0.73
FEV1(Liter)	1.26 [1.03, 1.95]	1.51 [0.88, 2.14]	1.33 [1.05, 1.68]	0.84
FEV1(% predicted)	54 [40, 64]	55 [38, 74]	51 [45, 61]	0.91
FEV1/FVC	0.52 [0.42, 0.58]	0.5 [0.41, 0.60]	0.52 [0.45, 0.58]	0.94
6 MWD in meters (Median [IQR])	300 [246, 325]	268 [224, 354]	276 [215, 300]	0.58
mMRC (Median [IQR])	2 [1, 2]	2 [1, 3]	3 [3, 4]	0.002
BMI < 21 (%)	0 (0%)	5 (15%)	2 (14%)	NA

Notes: P value was generated by Kruskal–Wallis test. NA= Unable to perform Chi-square calculations since it did not meet criteria of expected values being greater than 1.0 and at least 20% of the expected values to be greater than 5.

Abbreviations: IQR, interquartile range; SABA, short-acting β-agonist; SAMA, short-acting muscarinic antagonist; LABA, long-acting β-agonist; LAMA, long-acting muscarinic antagonist; ICS, inhaled corticosteroid; OCS, oral corticosteroid; IV, initial visit; BD, bronchodilator; FV, follow-up visit; FVC, Forced Vital Capacity; %FVC, percent predicted FVC; FEV1, Forced Expiratory Volume in 1 s; %FEV1, percent predicted FEV1; 6MWD, six-minute walk distance; mMRC, modified Medical Research Council dyspnea scale; BMI, body mass index.

Table 4 Change Between Initial Visit and Follow-Up Visit Within Each BODE Quartile Group

Change Between IV and FV	BODE Quartile Group	Median [95% CI]	P value
FVC Change (Liter)	Worsened	−0.37 [−0.71,-0.27]	0.002^a
	Unchanged	−0.27 [−0.41,-0.09]	<0.001^a
	Improved	−0.12 [−0.31,-0.02]	0.013^a
FVC Change (% Predicted)	Worsened	−14 [−27, −4]	0.011^a
	Unchanged	−5 [−7, −1]	0.003^a
	Improved	−2 [−5, 3]	0.40^a
FEV1 Change (Liter)	Worsened	−0.16[−0.49, −0.08]	<0.001^a
	Unchanged	−0.13[−0.28,-0.05]	<0.001^a
	Improved	−0.04[−0.23, 0.17]	0.2^a
FEV1 Change (% Predicted)	Worsened	−6[−17, 0]	0.007^a
	Unchanged	−3.5[−9, 0]	0.003^a
	Improved	−1[−7, 6]	0.86^a
FEV1/FVC Change	Worsened	−0.01[−0.08, 0.03]	0.44^a
	Unchanged	−0.02[−0.04, 0.01]	0.062^a
	Improved	0.03[−0.03, 0.7]	0.37^a
6 MWD Change (Meters)	Worsened	−53[−92, −7]	0.012^a
	Unchanged	−1[−25, 40]	0.92^b
	Improved	43[−53, 67]	0.23^b
mMRC Change	Worsened	1[0, 1]	0.031^a
	Unchanged	0[0, 0]	0.48^b
	Improved	−1[−1, 0]	0.016^c

Notes: P value was generated by Wilcoxon Rank Sum test. Groups with the same superscript (^{a, b} or ^c) accompanying the 95% confidence interval for the median change from V1 to V2 indicate that the between group comparison for the median change was not statistically different at the p<0.05 significant level.

Abbreviations: CI, confidence interval; FVC, forced vital capacity; %FVC, percent predicted FVC; FEV1, forced expiratory volume in 1 s; %FEV1, percent predicted FEV1; 6MWD, six-min walk distance; mMRC, modified Medical Research Council dyspnea scale; BMI, body mass index.

Figure 2 Change between V1 and V2 within each BODE quartile group (A-G). Groups with the same superscript (* and n.s.) accompanying the 95% confidence interval for the median change from V1 to V2 indicate that the between group comparison for the median change was not statistically different at the p<0.05 significant level. *p<0.05.

Abbreviation: n.s., not significant.