Diagnosis, assessment, and phenotyping of COPD: beyond FEV₁

Figures & data

Table 1 COPD categories based on a combined score for symptoms, degree of airflow limitation, exacerbation risk, and presence of comorbidities

Patient	Characteristic	Spirometric classification	Exacerbations per year	COPD Assessment Test	mMRC score
A	Low risk, less symptoms	GOLD 1–2	≤1a	<10	0–1
B	Low risk, more symptoms	GOLD 1–2	≤1a	≥10	≥2
C	High risk, less symptoms	GOLD 3–4	≥2b	<10	0–1
D	High risk, more symptoms	GOLD 3–4	≥2b	≥10	≥2

Notes: GOLD 1–2, mild-moderate airflow limitation; GOLD 3–4, severe-very severe airflow limitation;

a not leading to hospital admission;

b ≥1 leading to hospital admission. From the Global Strategy for Diagnosis, Management and Prevention of COPD 2015, © Global Initiative for Chronic Obstructive Lung Disease (GOLD), all rights reserved. Available from http://www.goldcopd.org.²

Abbreviations: GOLD, Global initiative for chronic Obstructive Lung Disease; mMRC, modified Medical Research Council.

Figure 1 Comparison of pulmonary dynamics in health and COPD showing tidal pressure-volume curves during rest (filled area) and exercise (open area).

Notes: Reproduced with permission of Taylor & Francis Ltd (http://www.tandfonline.com). O’Donnell DE, Laveneziana P. The clinical importance of dynamic lung hyperinflation in COPD. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2006;3(4):219–232.⁷⁹
Abbreviations: EELV, end-expiratory lung volume; IC, inspiratory capacity; IRV, inspiratory reserve volume; P, pressure; RV, residual volume; TLC, total lung capacity; V, volume.

Figure 2 Sputum inflammatory mediators in patients with asthma and COPD having phenotypes for (A) eosinophilic airway inflammation and (B) non-eosinophilic airway inflammation. Horizontal and error bars set at geometric mean and 95% confidence interval.

Notes: Reproduced with permission from S. Karger AG, Basel, Switzerland. Copyright ©2012 Bafadhel M, McCormick M, Saha S, et al. Profiling of sputum inflam matory mediators in asthma and chronic obstructive pulmonary disease. Respiration. 2012;83(1):36–44.⁵³
Abbreviations: CCL, CC chemokine ligand; CXCL, CXC chemokine ligand; IL, interleukin; MMP, matrix metallopeptidase; TNF, tumor necrosis factor; TNFR, tumor necrosis factor receptor; VEGF, vascular endothelial growth factor.

Table 2 Clinical and pathological similarities between asthma and COPD

Feature	Asthma	COPD
Thickened airway smooth muscle layer	Yes	Yes (minimally)
Inflammation involving goblet cells	Yes	Yes
Increased neutrophils in sputum	Yes (severe asthma)	Yes
Increased eosinophils in airways	Yes	Yes (steroid-sensitive COPD)
Increased CXC chemokine 8	Yes (severe asthma)	Yes
Increased TNF	Yes (severe asthma)	Yes
Increased leukotriene B4	Yes (severe asthma)	Yes
Oxidative stress	Yes (severe asthma)	Yes

Notes: Data from Barnes⁵² and Nakawah et al.⁶⁰

Abbreviation: TNF, tumor necrosis factor.

Figure 3 Potential reasons for the high prevalence of overlap between COPD and asthma.

Figure 4 Proposal for a COPD assessment control panel of variables that relate to three domains of the disease – severity, activity, and impact.

Notes: Adapted by permission from BMJ Publishing Group Ltd. Thorax. Agusti A, MacNee W. The COPD control panel: towards personalised medicine in COPD. Volume 68(7), pages 687–690. Copyright ©2013.⁷⁸
Abbreviations: 6MWD, 6-minute walk distance; CAT, COPD Assessment Test; IC/TLC, inspiratory to total lung capacity ratio; mMRC, modified Medical Research Council Dyspnea Scale; PaO₂, arterial oxygen pressure.

Global Initiative for Chronic Obstructive Lung DiseaseGlobal strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease [updated 2015] Available from: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2015_Feb18.pdfAccessed March 30, 2015

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