Prognostic Potential of Phenotyping of Patients with Chronic Obstructive Pulmonary Disease of Occupational Etiology in Combination with Hypertension

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease of the lungs with systemic manifestations which affect the phenotypic expression of the disease, its course and outcomes. COPD is associated with significant morbidity and mortality globally. The aim of this investigation was to determine the predictive potential of phenotyping of patients with COPD in combination with hypertension in the evaluation of cardiovascular risk based on the study of structural and functional changes of heart. Materials and methods. The study included 51 patients with COPD of occupational etiology 2nd degree of severity who were treated at the clinic of the Institute of Occupational Hygiene and Occupational Diseases of the KhNMU. Among them, the most prevalent emphysematous phenotype was detected in 27 patients, bronchial – in 18 patients and asthma-COPD overlap syndrome (ACOS) – in 6 patients. 43 patients had hypertension stage II. All patients performed general clinical examinations, laboratory investigations, pulse oximetry, spirometry, electrocardiographic and echocardiographic investigations. Results. According to BMI, there was a statistically significant difference between patients with emphysematous and bronchial phenotypes, as well as between the bronchial phenotype and ACOS. The waist circumference significantly differed in patients with phenotypes of emphysema and chronic bronchitis. Patients with predominance of bronchial phenotype had a statistically significant increase in the frequency of exacerbations during the year, in contrast to patients with emphysema phenotype. The results of the six-minute walking test (6-MWT) and the degree of shortness of breath on the G. Borg scale after 6-MWT revealed statistically significant differences between patients with emphysematous and bronchial phenotypes. Patients with a phenotype of emphysema demonstrated a decrease in the tolerance to physical activity and an increase in shortness of breath compared with the bronchial phenotype. We revealed statistically significant differences in the degree of saturation (SpO2) after 6-MWT between the emphysematous and bronchial phenotypes, as well as between ACOS and bronchial phenotype. Desaturation was among the patients with the phenotype of emphysema and ACOS. The severity of productive cough is strongly associated with the phenotype of chronic bronchitis. Fatigue is more characteristic of the emphysematous phenotype, proven statistically. Hypertension significantly more often accompanies the bronchial phenotype of COPD. The obtained results indicate an overload of the left heart in patients with a bronchial phenotype. Signs of overloading by pressure of the right heart are observed in the emphysematous phenotype patients. Conclusions. The data which we have received show the prognostic significance of the allocation of COPD phenotypes in assessing the future risks of adverse events. Prospects for further research are the search for the most prognostically relevant criteria for various COPD phenotypes in order to early assess the risk of future adverse events based on a comprehensive analysis of individual components of the pathogenesis of COPD.