Prevalence and clinical features of most frequent phenotypes in the Italian COPD population: the CLIMA Study

  • Roberto W. Dal Negro | National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology - CESFAR, Verona, Italy.
  • Mauro Carone ICS Maugeri IRCCS, Cassano delle Murge (BA), Italy.
  • Giuseppina Cuttitta Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy.
  • Luca Gallelli Pharmacology Operative Unit, University Hospital Authority “Mater Domini”, Catanzaro, Italy.
  • Massimo Pistolesi Pneumologia e Fisiopatologia Toraco-Polmonare, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
  • Salvatore Privitera C.P.M., Giarre (CT), Italy.
  • Piero Ceriana Occupational Health and Rehabilitation Clinic, ICS Maugeri IRCCS, Pavia, Italy.
  • Pietro Pirina Pneumology Operative Unit, University Hospital Authority, Sassari, Italy.
  • Bruno Balbi Pneumology Rehabilitation Unit, ICS Maugeri IRCCS, Veruno (NO), Italy.
  • Carlo Vancheri Pneumology Rehabilitation Unit, University Hospital Authority, Policlinico Vittorio Emanuele, Catania, Italy.
  • Franca M. Gallo Departmental Structure for Territorial Pneumology, Local Health Authority, Matera, Italy.
  • Alfredo Chetta Pneumology Clinic, University Hospital Authority, Hospital “G. Rasori”, Parma, Italy.
  • Paola Turco Research and Clinical Governance, Verona, Italy.
  • on behalf of the CLIMA Study Group*


Background: Chronic obstructive pulmonary disease (COPD) is a complex, progressive respiratory condition characterized by heterogeneous clinical presentations (phenotypes). The aim of this study was to assess the prevalence of the main COPD phenotypes and match each phenotype to the most fitting clinical and lung function profile.
Methods: The CLIMA (Clinical Phenotypes in Actual Clinical Practice) study was an observational, cross-sectional investigation involving twenty-four sites evenly distributed throughout Italy. Patients were tentatively grouped based on their history and claimed prevailing symptoms at recruitment: chronic cough (CB, suggesting chronic bronchitis); dyspnoea (possible emphysema components, E); recurrent wheezing (presuming asthma components, A). Variables collected were: anagraphics; smoking habit; history of asthma; claim of >1 exacerbations in the previous year; blood eosinophil count; total blood IgE and alpha1 anti-trypsin (α1-AT) levels; complete lung function, and the chest X-ray report. mMRC, CAT, BCS, EQ5d-5L were also used. The association between variables and phenotypes were checked by Chi-square test and multinomial logistic regression.
Results: The CB phenotype was prevalent (48.3%), followed by the E and the A phenotypes (38.8% and 12.8%, respectively). When dyspnea was the prevailing symptom, the probability of belonging to the COPD-E phenotype was 3.40 times higher. Recurrent wheezing was mostly related to the COPD-A phenotype. Lung function proved more preserved in the COPD-CB phenotype. Smoke; n. exacerbations/year; VR, and BODE index were positively correlated with the COPD-E phenotype, while SpO2, FEV1/FVC, FEV1/VC, and FEV1 reversibility were negatively correlated. Lower DLco values were highly probative for the COPD-E phenotype (p<0.001). Conversely, smoke, wheezing, plasma eosinophils, FEV1 reversibility, and DLco were positively correlated with the COPD-A phenotype. The probability of belonging to the COPD-A phenotype raised by 2.71 times for any increase of one unit in % plasma eosinophils (p<0.001). Also multiparametrical scores contributed to discriminate the three phenotypes.
Conclusion: the recognition of the main phenotypes of COPD can be effectively pursued by means of a few clinical and instrumental parameters, easy to obtain also in current daily practice. The phenotypical approach is crucial in the management of COPD as it allows to individualize the therapeutic strategy and to obtain more effective clinical outcomes



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Author Biography

on behalf of the CLIMA Study Group*

R.W. Dal Negro, Centro Nazionale Studi di Farmacoeconomia e Farmacoepidemiologia Respiratoria, Verona; M. Carone, Fondazione S. Maugeri, Cassano delle Murge (BA); G. Cuttitta, IBIM-CNR, Palermo; L. Gallelli, Azienda Ospedaliera-Universitaria Mater Domini, U.O. Farmacologia, Catanzaro; M. Pistolesi, Azienda Ospedaliera Universitaria Careggi - Pneumologia e Fisiopatologia Toraco-Polmonare, Firenze; S. Privitera, C.P.M., Giarre, Catania; P. Ceriana, IRCCS ICS Maugeri, Clinica del Lavoro e della Riabilitazione, Pavia; P. Pirina, U.O. di Pneumologia, Azienda Ospedaliera Universitaria, Sassari; B. Balbi, Unità Operativa di Pneumologia Riabilitativa, IRCCS ICS Maugeri, Istituto di Veruno, Novara; C. Vancheri, Pneumologia Riabilitativa, Azienda Ospedaliera Universitaria Policlinico, Vittorio Emanuele, Catania; F.M. Gallo, SSD Pneumologia Territoriale, Azienda Sanitaria Locale, Matera; A. Chetta, Clinica Pneumologica, Azienda Ospedaliera Universitaria-Ospedale G. Rasori, Parma; S. Baglioni, S.C. Pneumologia, Azienda Ospdealiera, Perugia; C. Bucca, AOU Molinette, SCDU Pneumologia, Torino; F. Mazza, S.C. Pneumologia, Azienda per l’Assistenza Sanitaria n. 5, Friuli Occidentale, Pordenone; A. Melani, Policlinico S. Maria alle Scotte, Ambulatorio Fisiopatologia Respiratoria, Siena; A. Sanna, U.O. di Pneumologia, Ospedale Civile, Pistoia; M. Latorre, Presidio Ospedaliero delle Apuane. U.O. Pneumologica, Massa-Carrara; C. Micheletto, Azienda U.L.S.S. n. 21, UOC di Pneumologia, Legnago (VR); S. Marinari, Ospedale Policlinico SS. Annunziata, Divisione di Pneumologia, Chieti; F. De Blasio, Casa di Cura Clinic Center, Pneumologia, Napoli; S. Bellofiore, Presidio Ospedaliero A.O.U., Policlinico Vittorio Emanuele di Catania, Chirurgia Toracica Padiglione M1, Catania; P. Turco, Research & Clinical Governance, Verona, Italy. 


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Original Research Articles
Conflict of interest statement
Authors declare no conflict of interest in the present investigation. RWD is Associate Editor of Multidisciplinary Respiratory Medicine
COPD, COPD phenotypes, clinical pictures, chronic bronchitis, emphysema, bronchial asthma, airway disease
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How to Cite
Dal Negro, R. W., Carone, M., Cuttitta, G., Gallelli, L., Pistolesi, M., Privitera, S., Ceriana, P., Pirina, P., Balbi, B., Vancheri, C., Gallo, F. M., Chetta, A., Turco, P., & CLIMA Study Group*, on behalf of the. (2021). Prevalence and clinical features of most frequent phenotypes in the Italian COPD population: the CLIMA Study. Multidisciplinary Respiratory Medicine, 16.