Higher symptom burden (CAT ≥20 vs <20) in COPD patients was associated with greater prevalence of treatable traits, including breathlessness (76.2% vs 37.1%, p<0.001).
Cohort (n=404)
Yes
In a primary care COPD cohort, higher symptom burden and frequent exacerbations are associated with a greater burden of treatable traits, supporting targeted screening in these high-risk subgroups.
Abstract Rationale/Introduction A treatable traits (TT) approach to Chronic obstructive pulmonary disease (COPD) applies precision care by systematically identifying pulmonary, extrapulmonary, and modifiable behavioral factors that can be targeted with tailored interventions. Understanding subgroup-specific TT prevalence can guide clinicians in prioritizing timely and targeted screening. In this pragmatic primary-care cohort, we examined how TT prevalence varied by symptom burden, airflow limitation severity, and recent exacerbation history. Methods Adults with post-bronchodilator spirometry-confirmed COPD (n = 404) recruited from Australian primary care clinics (n = 50) completed baseline assessment. TTs were assessed through spirometry, routine laboratory tests (eosinophils, C-Reactive Protein), and validated questionnaires including Work Productivity and Activity Impairment Questionnaire. Subgroups were defined as follows: (1) symptom burden by COPD Assessment Test (CAT ≥20 vs 20), (2) airflow limitation by GOLD 2025 stages (3-4 vs 1-2), and (3) frequent exacerbations (≥2 vs 2 in the previous 6 months). Group differences in TT prevalence were tested using chi-square; two-sided p-values are reported. Results Participants with higher symptom burden (CAT ≥20) had higher prevalence of breathlessness (76.2% vs 37.1%), cough (86.8% vs 53.6%), sputum (70.6% vs 40.8%), anxiety (50.0% vs 18.5%), depression (49.5% vs 14.9%), dysfunctional breathing (48.0% vs 12.1%), physical activity limitation (53.8% vs 20.4%) (all above p 0.001), daytime sleepiness (18.8% vs 10.7%, p = 0.024) and were underweight (BMI20 kg/m2) (11.5% vs 5.7%, p = 0.045). Greater airflow limitation (GOLD 3-4 vs 1-2) was associated with higher prevalence of breathlessness (61.6% vs 50.8%, p = 0.033).Frequent exacerbators (≥2 in 6 months) demonstrated higher prevalence of breathlessness (67.2% vs 45.6%, p = 0.003), cough (76.3% vs 58.5%, p = 0.009), anxiety (49.2% vs 27.5%, p = 0.002), dysfunctional breathing (43.5% vs 18.7%, p 0.001), and physical activity limitation (WPAI) (49.2% vs 35.0%, p = 0.049). Conclusions In this Australian primary care COPD cohort, higher symptom burden and frequent exacerbations were associated with a greater burden of TTs across pulmonary and extra-pulmonary domains. Severe airflow limitation was primarily associated with increased breathlessness. These findings support routine, systematic TT screening in higher-risk subgroups such as patients with high CAT scores and frequent exacerbations, to enable more targeted management in primary care. A brief care bundle for patients (measure of breathlessness, cough and sputum check, screen for dysfunctional breathing, smoking cessation support, anxiety and depression screening, and pulmonary rehabilitation referral) may be offered during routine consultation for patients with high symptom burden and frequent exacerbations. This abstract is funded by: GlaxoSmithKline
Madawala et al. (2026) conducted a cohort in Chronic obstructive pulmonary disease (COPD) (n=404). Higher symptom burden (CAT ≥20), severe airflow limitation (GOLD 3-4), and frequent exacerbations (≥2 in 6 months) vs. Lower symptom burden (CAT <20), mild/moderate airflow limitation (GOLD 1-2), and infrequent exacerbations (<2 in 6 months) was evaluated on Prevalence of treatable traits (TTs) across subgroups. Higher symptom burden (CAT ≥20 vs <20) in COPD patients was associated with greater prevalence of treatable traits, including breathlessness (76.2% vs 37.1%, p<0.001).