Identification of phenotypes in COPD patients: influence of physical activity in daily life, body composition and skeletal muscle dysfunction

Author(s)

Rafaella Fagundes Xavier

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2018-04-05

Examining board members

Celso Ricardo Fernandes de Carvalho; Alberto Cukier; Vinicius Cavalheri de Oliveira; João Marcos Salge

• Advisor: Celso Ricardo Fernandes de Carvalho

Abstract

Rationale: The chronic obstructive pulmonary disease (COPD) has systemic repercussions that contribute negatively to the evolution of the disease and increase mortality in these individuals. The level of physical activity and peripheral muscle strength have been evidenced as morbidity and mortality factors in individuals with COPD, however the phenotypes previously described in the literature do not include these factors as determinant of the phenotypes. Objective: To identify phenotypes in individuals with COPD according to their levels of physical activity in daily life, body composition and skeletal muscle force. Methods: We evaluated 190 individuals in relation to pulmonary function (spirometry), clinical control of COPD (CCQ), health factors related to quality of life (CRQ), physical activity in daily life (Actigraph GT3X), skeletal muscle force (maximal isometry) and body composition (bioimpedance). After 3, 6, 9 and 12 months of these evaluations, subjects were questioned about the occurrence of exacerbations and hospitalizations. Participants were classified using hierarchical cluster analysis. The comparisons between the identified phenotypes were performed using the ANOVA one-way test followed by Tukey\'s post test for parametric data and the Kruskal-Wallis test followed by the Dunn test for non-parametric data. The normality of the data was evaluated using the Kolmogorov-Smirnov test. The chi-square test was used to compare the categorical variables. The level of significance was adjusted to 5%. Results: Three distinct phenotypes (clusters) were identified according to age, physical activity, body composition, muscle strength, quality of life and clinical control. The individuals in phenotype 1 were younger, with worse clinical control, with more comorbidities and with higher frequency of exacerbation compared to phenotypes 2 and 3. Subjects of phenotype 3 had lower values of physical activity, sedentary status and greater frequency of hospitalization after exacerbations. Conclusions: The present study demonstrated the existence of different phenotypes in patients with COPD according to physical activity. These results are relevant for the clinical management of individuals with COPD and for the choice of strategies to increase the level of physical activity of these patients (AU)

• FAPESP's process: 13/20676-9 - Identification of phenotypes in COPD patients: influence of physical activity in daily life, body composition and skeletal muscle dysfunction
• Grantee: Rafaella Fagundes Xavier
• Support Opportunities: Scholarships in Brazil - Doctorate