JOPIC
Journal of Pulmonology and Intensive Care

The JoPIC is an independent-unbiased, peer-reviewed, and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, surgical techniques, differential diagnoses, editorial opinions, letters to the editor, and educational papers in pulmonology, thoracic surgery, occupational diseases, allergology, and intensive care medicine.

eISSN: 2980-0803
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
Phenotypic assessment of COPD using clinical, radiological, and functional parameters
Abstract
Aims: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous condition with variable clinical presentation and disease progression. This study aimed to investigate the distribution of patients across defined COPD phenotypes and to compare their clinical, radiological, and functional characteristics.
Methods: This cross-sectional descriptive study included 96 patients diagnosed with COPD. Patients were classified into four phenotype groups: asthma–COPD overlap syndrome (ACOS), non-exacerbator (NE), frequent exacerbator with emphysema (FEE), and frequent exacerbator with chronic bronchitis (FECB). Demographic, clinical, and pulmonary function parameters were analyzed and compared among groups. Forced expiratory volume in one second (FEV1), body mass index (BMI), COPD Assessment Test (CAT), diffusing capacity for carbon monoxide (DLCO), and inspiratory capacity/total lung capacity (IC/TLC) ratio were evaluated.
Results: Of the patients, 83 (86.5%) were male and 13 (13.5%) were female, with a mean age of 65.22±7.85 years. The distribution of phenotypes was as follows: ACOS (9%), NE (53%), FEE (19%), and FECB (19%). The mean annual exacerbation rate was 1.27±1.2, and the mean FEV1 was 50.21±16.56%. The ACOS phenotype was characterized by a higher proportion of female patients, younger age, history of asthma and atopy, better clinical status, and relatively preserved lung function. In contrast, the FEE phenotype demonstrated a higher exacerbation frequency, poorer quality of life, and more severe airflow limitation. Patients in the FEE group had lower FEV1 and BMI, higher CAT scores, increased lung volumes and airway resistance, lower DLCO and partial pressure of oxygen (pO2), and an IC/TLC ratio below 25%.
Conclusion: Distinct COPD phenotypes, particularly ACOS and FEE, exhibit significant differences in clinical and functional characteristics. Recognition of these phenotypes may help guide individualized management strategies, including pulmonary rehabilitation, nutritional support, and optimization of pharmacological and interventional treatments.

Keywords : Asthma–COPD overlap syndrome (ACOS), chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, frequent exacerbation, phenotype.

Download Article


1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2024 report. Available from: https://goldcopd.org/
2. Agustí A, Hogg JC. Update on the pathogenesis of chronic obstructive pulmonary disease. N Engl J Med. 2019;381(13):1248-1256. doi:10.1056/NEJMra1900475
3. Han MK, Agusti A, Celli BR, et al. From GOLD 0 to pre-COPD. Am J Respir Crit Care Med. 2021;203(4):414-423. doi:10.1164/rccm.202008-3328PP
4. Agusti A, Vogelmeier CF. GOLD 2024: a brief overview of key changes. J Bras Pneumol. 2023;49(6):e20230369. doi:10.36416/1806-3756/e20230369
5. Agustí A, Celli B, Faner R. What does endotyping mean for treatment in chronic obstructive pulmonary disease? Lancet. 2017;390(10098):980-987. doi:10.1016/S0140-6736(17)32136-0
6. Celli BR, Wedzicha JA. Update on clinical aspects of chronic obstructive pulmonary disease. N Engl J Med. 2019;381(13):1257-1266. doi:10.1056/NEJMra1900500
7. Christenson SA. COPD phenotyping. Respir Care. 2023;68(7):871-880. doi:10.4187/respcare.11035
8. Han MK, Agusti A, Calverley PM, et al. Chronic obstructive pulmonary disease phenotypes: the future of COPD. Am J Respir Crit Care Med. 2010;182(5):598-604. doi:10.1164/rccm.200912-1843CC
9. Miravitlles M, Calle M, Soler-Cataluña JJ. Clinical phenotypes of COPD: identification, definition and implications for guidelines. Arch Bronconeumol. 2012;48(3):86-98. doi:10.1016/j.arbres.2011.10.007
10. Miravitlles M, Soler-Cataluña JJ, Calle M, Soriano JB. Treatment of COPD by clinical phenotypes: putting old evidence into clinical practice. Eur Respir J. 2013;41(6):1252-1256. doi:10.1183/09031936.00118912
11. Lynch DA, Al-Qaisi MA. Quantitative computed tomography in chronic obstructive pulmonary disease. J Thorac Imaging. 2013;28(5):284-290. doi:10.1097/RTI.0b013e318298733c
12. Raoof S, Shah M, Braman S, et al. Lung imaging in COPD part 2: emerging concepts. Chest. 2023;164(2):339-354. doi:10.1016/j.chest.2023.02.049
13. Gillenwater LA, Helmi S, Stene E, et al. Multi-omics subtyping pipeline for chronic obstructive pulmonary disease. PLoS One. 2021;16(8):e0255337. doi:10.1371/journal.pone.0255337
14. Tiew PY, Meldrum OW, Chotirmall SH. Applying next-generation sequencing and multi-omics in chronic obstructive pulmonary disease. Int J Mol Sci. 2023;24(3):2955. doi:10.3390/ijms24032955
15. Li CX, Wheelock CE, Sköld CM, Wheelock ÅM. Integration of multi-omics datasets enables molecular classification of COPD. Eur Respir J. 2018;51(5):1701930. doi:10.1183/13993003.01930-2017
16. Ragland MF, Benway CJ, Lutz SM, et al. Genetic advances in chronic obstructive pulmonary disease. Insights from COPDGene. Am J Respir Crit Care Med. 2019;200(6):677-690. doi:10.1164/rccm.201808-1455SO
17. Silverman EK. Genetics of COPD. Annu Rev Physiol. 2020;82:413-431. doi:10.1146/annurev-physiol-021317-121224
18. David B, Bafadhel M, Koenderman L, De Soyza A. Eosinophilic inflammation in COPD: from an inflammatory marker to a treatable trait. Thorax. 2021;76(2):188-195. doi:10.1136/thoraxjnl-2020-215167
19. Agustí A, Edwards LD, Rennard SI, et al. Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype. PLoS One. 2012;7(5):e37483. doi:10.1371/journal.pone.0037483
20. Barrecheguren M, Román-Rodríguez M, Miravitlles M. Is a previous diagnosis of asthma a reliable criterion for asthma-COPD overlap syndrome in a patient with COPD? Int J Chron Obstruct Pulmon Dis. 2015;10:1745-1752. doi:10.2147/COPD.S87025
21. Casanova C, Cote C, de Torres JP, et al. Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2005;171(6):591-597. doi:10.1164/rccm.200407-867OC
22. Tomioka R, Kawayama T, Suetomo M, et al. “Frequent exacerbator” is a phenotype of poor prognosis in Japanese patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2016; 11:207-216. doi:10.2147/COPD.S98205
23. Kim V, Davey A, Comellas AP, et al. Clinical and computed tomographic predictors of chronic bronchitis in COPD: a cross sectional analysis of the COPDGene study. Respir Res. 2014;15(1):52. doi:10.1186/1465-9921-15-52
24. de Oca MM, Halbert RJ, Lopez MV, et al. The chronic bronchitis phenotype in subjects with and without COPD: the PLATINO study. Eur Respir J. 2012;40(1):28-36. doi:10.1183/09031936.00141611
25. Massara L, Saber Cherif L, Ollivier A, et al. ?5 nicotinic receptor polymorphism affects cigarette smoke-induced inflammation and COPD development. Am J Respir Cell Mol Biol. 2026. doi:10.1093/ajrcmb/aanag093
26. Namvar A, Shan B, Hoff B, et al. Feature-based parametric response mapping on thoracic computed tomography for robust disease classification in COPD. medRxiv. 2026. doi:10.64898/2026.04.24.26351675
27. Jaiswal D, Puri MM, Mullick S, Kumar V. Blood and sputum eosinophilia in chronic obstructive pulmonary disease patients and their association with exacerbations: a prospective observational study from a tertiary care center. Monaldi Arch Chest Dis. 2026. doi:10.4081/monaldi.2026.3619
28. Mari PV, Ricci A, Coppola A, et al. Mucus plugging as a treatable trait across the asthma-COPD spectrum: the role of type 2 cytokine blockade and quantitative imaging. Biomedicines. 2026;14(4):891. doi:10.3390/biomedicines14040891
Article available in :
Volume 4, Issue 3, 2026
Page : 60-66
https://doi.org/10.51271/JOPIC-0082
Article Information
Received : 25 Nis 2026
Accepted : 02 Haz 2026
Published : 20 Ağu 2026
Corresponding Author :

Duygu Acar Karagül: Department of Occupational Diseases, Kocaeli City Hospital, Kocaeli, Turkiye

[email protected]
Citation : Acar Karagül D, Saryal SB. Phenotypic assessment of COPD using clinical, radiological, and functional parameters. J Pulmonol Intens Care. 2026;4(3):60-66. doi:10.51271/JOPIC-0082

Read: 181
Download : 142
Cited: 0
_Footer