Three phenotypes of obstructive lung disease in the elderly

SETTING: Eleven referring hospitals in South Korea. OBJECTIVE: To classify the phenotypes in elderly subjects with obstructive lung disease (OLD). METHODS: We analysed 191 subjects aged ≥60 years with chronic respiratory symptoms and either obstructive spirometry or bronchial hyperresponsiveness. Factor analysis was performed using commonly measured variables and revealed four significant variables: 1) the ratio of inspiratory capacity to total lung capacity, 2) the total score on the St George's Respiratory Questionnaire, 3) the volume fraction of the lung less than 950 Hounsfield Unit at full inspiration on volumetric computed tomography and 4) post-bronchodilator forced expiratory volume in 1 second (FEV1) changes. We performed a cluster analysis on these four variables. RESULTS: The mean age was 68.5 (±5.2 SD) years and the mean post-bronchodilator FEV1 was 52.4% (±16.5) predicted. Three clusters with the following phenotypes were identified: Cluster 1 included subjects with moderate to severe airflow obstruction and bronchodilator reversibility; Cluster 2 subjects had moderate airflow obstruction without bronchodilator reversibility, and Cluster 3 subjects had severe airflow obstruction without bronchodilator reversibility. CONCLUSIONS: We identified three phenotypes in elderly subjects with OLD. Follow-up studies are needed to explore the clinical significance of each phenotype.