Obesity in patients with chronic obstructive pulmonary disease: prerequisites for the isolation of a separate phenotype

Chronic Obstructive Pulmonary Disease (COPD) is highly lethal and has a pronounced impact on the patient's quality of life (QoL), representing a serious public healthcare problem. According to various studies, the prevalence of obesity in COPD, which can have a significant effect on the course of the disease, reaches 50%.

The aim of the study was to assess the disease course characteristics, symptom severity, QoL, concomitant diseases, and lung function in obese COPD patients.

Materials. Patients included in the study (n = 176) of COPD patients (GOLD II – IV, group D) were divided into 2 groups: 1^st (n = 88: 71 men, 17 women; mean age 62.40 ± 8.83 years) – normal weight COPD patients; 2^nd (n = 88: 64 men, 24 women; mean age 62.94 ± 5.96 years) – obese COPD patients. The number of COPD exacerbations in the last 12 months has been estimated. Visual analogue scale (VAS) was used to assess the severity of coughing, sputum production, shortness of breath, general weakness. Modified shortness of breath severity scale (Medical Research Council – mMRC), COPD Assessment Test (CAT) and the Chronic obstructive pulmonary disease control Questionnaire (CCQ) were also used, spirometry, 6-minute step test (6-MST) was performed, QoL was assessed using the SF-36 questionnaire, and BODE index was determined.

Results. It was shown that the frequency of exacerbations of COPD for the previous year, which did not require hospitalization, and hospitalizations to the inpatient department for exacerbation of COPD, in patients of the 1st group was significantly higher and was 1.21 ± 0.83 and 0.96 ± 0.42 (p = 0.016) and 1.82 ± 0.94 and 1.5 ± 0.81 cases (p = 0.0145) respectively. In patients of the 2^nd group the dyspnea severity, sputum production and general weakness according to VAS and the dyspnea according to mMRC scale were significantly lower. In patients of the 2^nd group reliably higher indices of the forced expiratory volume in the 1^st second (FEV1), forced vital capacity (FVC) and Tiffno index were noted. Patients of the 1^st group also have higher index BODE – 6.23 ± 2.81 and 4.53 ± 2.11 respectively (p = 0.0000).

Conclusion. It was found that patients with COPD with obesity have low indices of symptom severity at relatively high values of FEV1, FVC, relatively low risk of acute COPD and hospitalization, and low BODE index at frequent combination with diabetes mellitus and hypertension.

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