United airway: upper and lower respiratory symptoms of COPD patients

Rationale: Upper and lower airways are considered a unified functional unit in the field of bronchial asthma. Presence of upper and lower respiratory symptoms in a cohort of COPD patients is discussed. Methods: The presence of upper (SNOT-22 questionnaire), and lower (mMRC scale, CAT questionnaire) respiratory symptoms were assessed in a group of non-mild COPD subjects from Czech Multicentre Research Database of COPD over the course of three years. Patients were stratified according to the GOLD guidelines, predefined clinical phenotypes (one patient = one phenotype), and basic treatable traits (one or more for each patient). Results: 614 COPD individuals (66.3yrs;73%males;post-BDFEV144.7%;RV/TLC182%;TLco53%) were enrolled. Of these 432, 345, and 216 were eligible for one, two, and three-yrs follow-up. Baseline total CAT score (15.7) correlated (Figure 1) with SNOT-22 (17). The same correlation was apparent in all eight CAT-items and SNOT-22. The total CAT scores positively correlated with SNOT-22 over all three yrs (p<0.001). Positive correlation of SNOT-22 and other respiratory symptoms (mMRC scale, cough, sputum production, fatigue) was noted. Total SNOT-22 score of B, and D patients significantly exceeds remaining categories (A, and C) in both versions of GOLD (2016, 2019). Moreover, presence of chronic bronchitis, pulmonary emphysema, frequent exacerbations, and cachexia were strongly associated with elevated SNOT-22 scores. Conclusion: Upper respiratory symptoms and lower respiratory symptoms in non-mild COPD individuals correlated in cross-sectional and prospective analyses. Some of the treatable traits, and GOLD categories were related with more pronounced upper respiratory symptoms.