Study Identifies Treatable Traits Associated With Declining Lung Function, QOL in COPD

Investigators identified treatable traits (TTs) found to independently predict declines in lung function and quality of life (QOL) in people with chronic obstructive pulmonary disease (COPD), suggesting new avenues for physicians to target to better individualize disease management tactics.

“This work advances knowledge of a precision medicine approach in COPD management and provides novel insights into the design of future trials targeting TTs and their implementation in clinical practice,” wrote the investigators.

The 4-year study, published in ERS Open Research, is the first comprehensive longitudinal analysis of TTs and their relation to health status in patients with COPD.

Targeting TTs is a precision medicine strategy for patients with chronic airway diseases, as researchers seek to find traits associated with disease outcomes that could benefit from targeted treatments. TTs allow for a multidimensional assessment of a patient’s condition and clinical history, which provides information for physicians to personalize COPD management.

Past research has identified several TTs associated with greater declines in forced expiratory volume in 1 second (FEV₁) and QOL. However, which TTs are the most relevant for optimizing COPD management is uncertain. In addition, data from longitudinal studies evaluating TT prevalence among patients with COPD and their influence on lung function and QOL are scarce.

“A comprehensive and multidisciplinary approach is necessary for identifying the needs of people with COPD and this may have a positive effect on lung function and other health outcomes,” said the investigators.

The investigators collected data from the ongoing English Longitudinal Study of Ageing (ELSA) cohort study on people 50 years and older who were born before 1952 and lived in England. The participants were interviewed and given self-completed questionnaires. The investigators focused on the 7666 respondents from Wave 2 (2004-2005) and the 8643 from Wave 4 (2008-2009).

After excluding those who had an asthma diagnosis or lacked valid lung function measurements, 3726 individuals (mean age, 67 years) who participated in both waves were included in the analysis, of whom 10.9% had a COPD diagnosis.

All the TTs were more prevalent among participants with COPD compared with other participants, including airflow limitation, breathlessness, chronic bronchitis, chronic sputum production, and frequent chest infections.

Nonpulmonary traits, such as osteoporosis, arthritis, depression, sarcopenia, systemic inflammation, disability, current smoking status, physical inactivity, and poor social support, were also more prevalent among those with COPD.

A multivariate analysis showed that 5 TTs were associated with declines in FEV₁ in patients with COPD: chronic bronchitis, breathlessness, underweight, sarcopenia, and current smoking status.

Additionally, 7 TTs were significantly associated with a decline in QOL in participants with COPD: chronic bronchitis, cardiovascular disease, arthritis, depression, anemia, disability, and poor family and social support.

The investigators listed several suggestions for mitigating the effects of TTs. Roflumilast, mucolytics, and macrolides are pharmacological methods that could reduce exacerbation risks among patients with COPD and chronic bronchitis. Breathing retraining can also aid in improving lung function and breathlessness.

Underweight individuals were advised that developing healthy dietary patterns and increasing consumption of fruits, vegetables, and other nutrients could help them improve and maintain lung function when combined with pulmonary rehabilitation programs.

The investigators noted that respiratory muscle training could improve lung function and dyspnea in patients with sarcopenia and that smoking cessation can play a vital role in preventing lung function decline associated with smoking.

Lack of social support could be resolved with enrolling patients in support groups and family therapy. Interactions with multidisciplinary teams, including social workers, could also be beneficial to patients with and without COPD.

“Future studies should investigate holistic interventions targeting those core traits using a precision medicine approach and their short-term and long-term effects on health outcomes in COPD,” the investigators suggested.

The investigators acknowledged study limitations, including that data pertaining to exacerbations were unavailable, the number of traits was limited to the information presented in the ELSA study, and there was a lack of medication data.

Reference

Sarwar MR, McDonald VM, Abramson MJ, Paul E, George J. Treatable traits in an English cohort: Prevalence and predictors of future decline in lung function and quality of life in COPD. ERS Open Res. 2021;7(2):00934-2020. doi: 10.1183/23120541.00934-2020