Turning subtypes into disease axes to improve prediction of COPD progression

Thorax. 2019 Sep;74(9):906-909. doi: 10.1136/thoraxjnl-2018-213005. Epub 2019 Jun 12.


Chronic obstructive pulmonary disease (COPD) is an umbrella definition encompassing multiple disease processes. COPD heterogeneity has been described as distinct subgroups of individuals (subtypes) or as continuous measures of COPD variability (disease axes). There is little consensus on whether subtypes or disease axes are preferred, and the relative value of disease axes and subtypes for predicting COPD progression is unknown. Using a propensity score approach to learn disease axes from pairs of subtypes, we demonstrate that these disease axes predict prospective forced expiratory volume in 1 s decline and emphysema progression more accurately than the subtype pairs from which they were derived.

Keywords: copd epidemiology; emphysema.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Disease Progression
  • Humans
  • Predictive Value of Tests
  • Proof of Concept Study
  • Propensity Score
  • Pulmonary Disease, Chronic Obstructive / classification*
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Respiratory Function Tests
  • Risk Factors