PT  - JOURNAL ARTICLE
AU  - Vasilis Nikolaou
AU  - Sebastiano Massaro
AU  - Wolfgang Garn
AU  - Masoud Fakhimi
AU  - Lampros Stergioulas
AU  - David B Price
TI  - Fast decliner phenotype of chronic obstructive pulmonary disease (COPD): applying machine learning for predicting lung function loss
AID  - 10.1136/bmjresp-2021-000980
DP  - 2021 Oct 01
TA  - BMJ Open Respiratory Research
PG  - e000980
VI  - 8
IP  - 1
4099  - http://bmjopenrespres.bmj.com/content/8/1/e000980.short
4100  - http://bmjopenrespres.bmj.com/content/8/1/e000980.full
SO  - BMJ Open Resp Res2021 Oct 01; 8
AB  - Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous group of lung conditions challenging to diagnose and treat. Identification of phenotypes of patients with lung function loss may allow early intervention and improve disease management. We characterised patients with the ‘fast decliner’ phenotype, determined its reproducibility and predicted lung function decline after COPD diagnosis.Methods A prospective 4 years observational study that applies machine learning tools to identify COPD phenotypes among 13 260 patients from the UK Royal College of General Practitioners and Surveillance Centre database. The phenotypes were identified prior to diagnosis (training data set), and their reproducibility was assessed after COPD diagnosis (validation data set).Results Three COPD phenotypes were identified, the most common of which was the ‘fast decliner’—characterised by patients of younger age with the lowest number of COPD exacerbations and better lung function—yet a fast decline in lung function with increasing number of exacerbations. The other two phenotypes were characterised by (a) patients with the highest prevalence of COPD severity and (b) patients of older age, mostly men and the highest prevalence of diabetes, cardiovascular comorbidities and hypertension. These phenotypes were reproduced in the validation data set with 80% accuracy. Gender, COPD severity and exacerbations were the most important risk factors for lung function decline in the most common phenotype.Conclusions In this study, three COPD phenotypes were identified prior to patients being diagnosed with COPD. The reproducibility of those phenotypes in a blind data set following COPD diagnosis suggests their generalisability among different populations.Data may be obtained from a third party and are not publicly available.