Figures
- FIGURE 1
Frequencies of the nine treatable traits. SM: self-management.
- FIGURE 2
Total number of treatable traits (TTs). a) 151 unique combinations of TTs are illustrated in relation to the total number of TTs per patient. Red represents the presence of a particular TT whereas green represents the absence. The blue lines mark the subgroups with a corresponding total number of TTs. b) Frequencies of the number of TTs present per patient displayed. c) and d) A scatter-plot is presented of the total number of TTs and the Clinical COPD Questionnaire (CCQ) total score (c) and forced expiratory volume in 1 s (FEV1) % predicted (d), respectively. SM: self-management.
- FIGURE 3
a) The COPD sTRAITosphere. A severely impaired health status (Clinical COPD Questionnaire (CCQ) total score >2 points) is at the very centre of the sTRAITosphere and each treatable trait (TT) is presented as sphere. The size of the spheres is proportional to the prevalence of the TT and the distance to the centre reflects the OR of having a severely impaired health status. b) Validation of the COPD sTRAITosphere.
Tables
- TABLE 1
Examined treatable traits, measurement instruments, cut-off values applied and appropriate evidence-based nonpharmacological interventions
Treatable trait Measurement instrument Cut-off value Possible (combinations of) intervention(s) 1 Current smoking Medical history Positive on history Simple advice, combination of behavioural treatment and pharmacotherapy [17] 2 Activity-related dyspnoea [18] Medical Research Council dyspnoea scale Grade ≥3 exercise training, pulmonary rehabilitation [19] 3 Frequent exacerbations [13] Medical history ≥2 exacerbations or ≥1 hospitalisation past year Exacerbation action plan [20], pulmonary rehabilitation [19] 4 Poor nutritional status [21] BMI BMI<21 or BMI>30 kg·m−2 Nutritional support [22], dietary counselling and calorie restriction plus resistance exercise training [23] 5 Severe fatigue [24] Checklist individual strength-fatigue ≥36 points Pulmonary rehabilitation [19] 6 Depressed mood [25] Beck depression inventory ≥4 points Cognitive behavioural therapy [26], pulmonary rehabilitation [19] 7 Poor exercise capacity [27] Six-minute walk test <70% predicted Exercise training, pulmonary rehabilitation [19] 8 Low habitual physical activity [27] Move monitor <5000 steps·day−1 Exercise training plus physical activity counselling [28] 9 Patient activation for self-management [29] Patient activation measure Level 1–2 Self-management program [30] - TABLE 2
General and COPD-specific patient characteristics
Attribute Patients with a valid registration Sociodemographic features Age years 63±9 402 (100) Female % 50 402 (100) Partnered % 71 402 (100) Pulmonary function FEV1 % predicted 55±18 402 (100) FVC % predicted 91±17 402 (100) FEV1/FVC ratio % 48±12 402 (100) FEV1 reversibility % patients 36 402 (100) GOLD class I/II/III/IV % 9/48/36/7 402 (100) Blood gas analysis Hb, mmol·L−1 8.9±0.9 182 (45) Hb<8.5 (male) or <7.5 (female) % 22/8 91/91 (45) pH 7.42±0.32 245 (61) PaCO2 kPa 5.15±0.66 245 (61) PaCO2 >6.5 kPa % 3 245 (61) PaO2 kPa 9.46±1.51 245 (61) PaO2 <8.0 kPa % 16 245 (61) BIC, mmol·L−1 24.7±2.7 245 (61) Base excess 0.67±2.33 245 (61) SaO2 % 94±3 245 (61) Comorbidities Number of comorbidities (0/1/2/3/4/5/6/7) % 19/30/22/15/9/2/1/1 402 (100) Cardiovascular % 49 402 (100) Metabolic% 11 402 (100) Musculoskeletal % 17 402 (100) Psychiatric % 13 402 (100) Others % 51 402 (100) Pulmonary medication Short-acting bronchodilator(s) % 46 402 (100) Long-acting bronchodilator(s) % 71 402 (100) Inhalation steroids % 52 402 (100) Maintenance systemic steroids % 1 402 (100) Burden of disease GOLD class (CCQ-based) A/B/C/D % 11/33/9/47 363 (90) CCQ total score points 1.95±1.05 363 (90) CCQ symptom subscore points 2.36±1.18 359 (89) CCQ functional limitation subscore points 1.84±1.21 359 (89) CCQ mental subscore points 1.28±1.44 359 (89) CCQ total score >1.0 % 80 363 (90) BODE index points 2.8±1.6 333 (83) BODE quartile 1/2/3/4 % 28/54/12/6 333 (83) Nonpharmacological interventions in primary care past 12 months Patients receiving physiotherapy % 20 402 (100) Patients receiving care from dietician % 10 402 (100) Patients receiving occupational therapy % 1 402 (100) Patients receiving care from psychologist % 4 402 (100) Treatable traits Smoking status, current/ex/never % 44/54/2 402 (100) Activity-based dyspnoea, MRC I/II/III/IV/V % 31/31/25/9/4 363 (90) Number of exacerbation past year, 0/1/≥2 or ≥1 hospitalisation % 52/18/30 379 (94) Nutritional status, BMI<21/BMI 21–25/BMI 25–30, BMI 30–35, BMI >35 % 20/31/28/16/5 392 (98) Fatigue, CIS-F score points 39±12 362 (90) Depressed mood, BDI score points 2.2±2.5 360 (90) Physical capacity 6MWD m 461±123 382 (95) 6MWD % predicted 71±18 382 (95) Habitual physical activity, steps·day−1 5465±3029 366 (91) Activation for self-management PAM score points 52±10 365 (91) PAM level I/II/III/IV % 34/28/31/7 365 (91) Data are presented as %, n (%) or mean±sd. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; GOLD: Global Initiative on Obstructive Lung Disease; Hb: haemoglobin; CCQ: Clinical COPD Questionnaire; BODE: BMI, airflow obstruction, dyspnoea, exercise capacity; MRC: Medical Research Council dyspnoea scale; BMI: body mass index; BDI: Beck depression inventory; CIS-F: checklist individual strength-fatigue; 6MWD: 6-minute walking distance; PAM: patient activation measure.
Supplementary Material
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Supplementary material 00438-2020.SUPPLEMENT
Figure E1 00438-2020.FigureE1
FIgure E2 00438-2020.FIgureE2
