J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 13, Number 7, July 2021, pages 392-402

Swiss Experience in Therapy With Dual Bronchodilation in Chronic Obstructive Pulmonary Disease in Relation to Self-Reported Physical Functionality

Figure 1. Pearson correlation analysis of change in PF-10 and mMRC in Switzerland. PF-10: 10-question physical functioning questionnaire; mMRC: modified Medical Research Council questionnaire.

Figure 2. Pearson correlation analysis of change in PF-10 and exacerbations in the last 12 months in Switzerland. PF-10: 10-question physical functioning questionnaire.

Figure 3. Pearson correlation analysis of change in PF-10 and mMRC in other countries. PF-10: 10-question physical functioning questionnaire; mMRC: modified Medical Research Council questionnaire.

Figure 4. Pearson correlation analysis of change in PF-10 and exacerbations in the last 12 months in other countries. PF-10: 10-question physical functioning questionnaire.

**Table 1.** Demographic Data and Baseline Characteristics
Demographic data and baseline characteristics	Switzerland, N (%)	Other countries, N (%)	Total, N (%)	P-value
COPD: chronic obstructive pulmonary disease; SD: standard deviation; mMRC: modified Medical Research Council questionnaire; Nmiss: number missings.
Number of patients	94 (100.00)	7,514 (100.00)	7,608 (100.00)
Age at registration (years)				< 0.0001
N	94	7,514	7,608
Mean	69.91	65.30	65.36
SD	10.07	9.33	9.35
Min	44.00	40.00	40.00
Median	71.00	66.00	66.00
Max	92.00	95.00	95.00
Nmiss	0	0	0
Age at registration (categorical)				< 0.0001
< 65 years	23 (24.47)	3,426 (45.59)	3,449 (45.33)
≥ 65 years	71 (75.53)	4,088 (54.41)	4,159 (54.67)
Gender				0.03
Male	54 (57.45)	5,121 (68.15)	5,175 (68.02)
Female	40 (42.55)	2,393 (31.85)	2,433 (31.98)
Duration between initial diagnosis of COPD and baseline visit (years)				0.03
N	94	7,514	7,608
Mean	5.63	4.91	4.92
SD	5.41	5.87	5.86
Min	0.00	0.00	0.00
Median	4.00	3.00	3.00
Max	26.00	72.00	72.00
Nmiss	0	0	0
COPD degree of severity (spirometric)				0.00
1	5 (5.32)	152 (2.02)	157 (2.06)
2	57 (60.64)	3,420 (45.52)	3,477 (45.70)
3	29 (30.85)	3,100 (41.26)	3,129 (41.13)
4	2 (2.13)	752 (10.01)	754 (9.91)
No previous findings	1 (1.06)	90 (1.20)	91 (1.20)
mMRC questionnaire				0.41
Grade 0	5 (5.32)	246 (3.27)	251 (3.30)
Grade 1	23 (24.47)	1,762 (23.45)	1,785 (23.46)
Grade 2	43 (45.74)	3,167 (42.15)	3,210 (42.19)
Grade 3	21 (22.34)	1,903 (25.33)	1,924 (25.29)
Grade 4	2 (2.13)	436 (5.80)	438 (5.76)
GOLD Group				0.91
A	20 (21.28)	1,479 (19.68)	1,499 (19.70)
B	39 (41.49)	3,214 (42.77)	3,253 (42.76)
C	8 (8.51)	529 (7.04)	537 (7.06)
D	27 (28.72)	2,292 (30.50)	2,319 (30.48)
Patients with concomitant diseases				< 0.0001
No	4 (4.26)	2,126 (28.29)	2,130 (28.00)
Yes	90 (95.74)	5,388 (71.71)	5,478 (72.00)
Patients with concomitant medication (except respiratory therapeutics)				< 0.0001
No	16 (17.02)	3,008 (40.03)	3,024 (39.75)
Yes	78 (82.98)	4,506 (59.97)	4,584 (60.25)
Smoking status				0.60
Smoker	37 (39.36)	3,025 (40.26)	3,062 (40.25)
Ex-smoker	47 (50.00)	3,454 (45.97)	3,501 (46.02)
Non-smoker	10 (10.64)	1,035 (13.77)	1,045 (13.74)
Pack-years				0.01
N	84	6479	6563
Mean	37.93	35.37	35.41
SD	14.19	20.03	19.97
Min	5.00	0.00	0.00
Median	40.00	32.00	32.00
Max	70.00	292.00	292.00
Nmiss	10	1,035	1,045
Patients with exacerbations in the last 12 months prior to study				0.83
Yes	60 (63.83)	4,874 (64.87)	4,934 (64.85)
No	34 (36.17)	2,640 (35.13)	2,674 (35.15)
Number of exacerbations in the last 12 months prior to study				0.55
N	94	7,514	7,608
Mean	1.17	1.08	1.08
SD	1.18	1.10	1.10
Min	0.00	0.00	0.00
Median	1.00	1.00	1.00
Max	5.00	12.00	12.00
Nmiss	0	0	0

Table 1. Demographic Data and Baseline Characteristics

Demographic data and baseline characteristics

Switzerland, N (%)

Other countries, N (%)

Total, N (%)

P-value

COPD: chronic obstructive pulmonary disease; SD: standard deviation; mMRC: modified Medical Research Council questionnaire; Nmiss: number missings.

Number of patients

94 (100.00)

7,514 (100.00)

7,608 (100.00)

Age at registration (years)

< 0.0001

7,514

7,608

Mean

69.91

65.30

65.36

10.07

9.33

9.35

Min

44.00

40.00

Median

71.00

66.00

Max

92.00

95.00

Nmiss

Age at registration (categorical)

< 0.0001

< 65 years

23 (24.47)

3,426 (45.59)

3,449 (45.33)

≥ 65 years

71 (75.53)

4,088 (54.41)

4,159 (54.67)

Gender

0.03

Male

54 (57.45)

5,121 (68.15)

5,175 (68.02)

Female

40 (42.55)

2,393 (31.85)

2,433 (31.98)

Duration between initial diagnosis of COPD and baseline visit (years)

0.03

7,514

7,608

Mean

5.63

4.91

4.92

5.41

5.87

5.86

Min

0.00

Median

4.00

3.00

Max

26.00

72.00

Nmiss

COPD degree of severity (spirometric)

0.00

5 (5.32)

152 (2.02)

157 (2.06)

57 (60.64)

3,420 (45.52)

3,477 (45.70)

29 (30.85)

3,100 (41.26)

3,129 (41.13)

2 (2.13)

752 (10.01)

754 (9.91)

No previous findings

1 (1.06)

90 (1.20)

91 (1.20)

mMRC questionnaire

0.41

Grade 0

5 (5.32)

246 (3.27)

251 (3.30)

Grade 1

23 (24.47)

1,762 (23.45)

1,785 (23.46)

Grade 2

43 (45.74)

3,167 (42.15)

3,210 (42.19)

Grade 3

21 (22.34)

1,903 (25.33)

1,924 (25.29)

Grade 4

2 (2.13)

436 (5.80)

438 (5.76)

GOLD Group

0.91

20 (21.28)

1,479 (19.68)

1,499 (19.70)

39 (41.49)

3,214 (42.77)

3,253 (42.76)

8 (8.51)

529 (7.04)

537 (7.06)

27 (28.72)

2,292 (30.50)

2,319 (30.48)

Patients with concomitant diseases

< 0.0001

4 (4.26)

2,126 (28.29)

2,130 (28.00)

Yes

90 (95.74)

5,388 (71.71)

5,478 (72.00)

Patients with concomitant medication (except respiratory therapeutics)

< 0.0001

16 (17.02)

3,008 (40.03)

3,024 (39.75)

Yes

78 (82.98)

4,506 (59.97)

4,584 (60.25)

Smoking status

0.60

Smoker

37 (39.36)

3,025 (40.26)

3,062 (40.25)

Ex-smoker

47 (50.00)

3,454 (45.97)

3,501 (46.02)

Non-smoker

10 (10.64)

1,035 (13.77)

1,045 (13.74)

Pack-years

0.01

6479

6563

Mean

37.93

35.37

35.41

14.19

20.03

19.97

Min

5.00

0.00

Median

40.00

32.00

Max

70.00

292.00

Nmiss

1,035

1,045

Patients with exacerbations in the last 12 months prior to study

0.83

Yes

60 (63.83)

4,874 (64.87)

4,934 (64.85)

34 (36.17)

2,640 (35.13)

2,674 (35.15)

Number of exacerbations in the last 12 months prior to study

0.55

7,514

7,608

Mean

1.17

1.08

1.18

1.10

Min

0.00

Median

1.00

Max

5.00

12.00

Nmiss

**Table 2.** Analysis of Responder and Non-Responder
Demographic data and baseline characteristics	Responder	Non-responder	Responder vs. non-responder in Switzerland, P-value	Responder vs. non-responder in other countries, P-value
*Chi-Square might not be valid, test changed to Fishers exact test. COPD: chronic obstructive pulmonary disease; mMRC: modified Medical Research Council questionnaire.
Number of patients	59 (100.00)	5,031 (100.00)		35 (100.00)	2,483 (100.00)
Age at registration (categorical)			0.00			0.01	0.78	0.81
< 65 years	15 (25.42)	2,290 (45.52)		8 (22.86)	1,136 (45.75)
≥ 65 years	44 (74.58)	2,741 (54.48)		27 (77.14)	1,347 (54.25)
COPD degree of severity (spirometric)			0.02			0.03*	0.46*	< 0.0001
1	2 (3.39)	91 (1.81)		3 (8.57)	61 (2.46)
2	36 (61.02)	2,156 (42.85)		21 (60.00)	1,264 (50.91)
3	20 (33.90)	2,179 (43.31)		9 (25.71)	921 (37.09)
4	1 (1.69)	533 (10.59)		1 (2.86)	219 (8.82)
No previous findings	0 (0.00)	72 (1.43)		1 (2.86)	18 (0.72)
mMRC questionnaire			0.34			0.99	0.19*	< 0.0001
Grade 0	2 (3.39)	73 (1.45)		3 (8.57)	173 (6.97)
Grade 1	11 (18.64)	931 (18.51)		12 (34.29)	831 (33.47)
Grade 2	29 (49.15)	2,177 (43.27)		14 (40.00)	990 (39.87)
Grade 3	16 (27.12)	1,495 (29.72)		5 (14.29)	408 (16.43)
Grade 4	1 (1.69)	355 (7.06)		1 (2.86)	81 (3.26)
GOLD Group			0.89			0.64	0.05	< 0.0001
A	10 (16.95)	708 (14.07)		10 (28.57)	771 (31.05)
B	24 (40.68)	2,238 (44.48)		15 (42.86)	976 (39.31)
C	3 (5.08)	296 (5.88)		5 (14.29)	233 (9.38)
D	22 (37.29)	1,789 (35.56)		5 (14.29)	503 (20.26)
Patients with concomitant diseases			< 0.0001			0.00	0.63*	0.37
No	2 (3.39)	1,407 (27.97)		2 (5.71)	719 (28.96)
Yes	57 (96.61)	3,624 (72.03)		33 (94.29)	1,764 (71.04)
Smoking status			0.62			0.89	0.81	< 0.0001
Smoker	22 (37.29)	2,012 (39.99)		15 (42.86)	1,013 (40.80)
Ex-smoker	30 (50.85)	2,259 (44.90)		17 (48.57)	1,195 (48.13)
Non-smoker	7 (11.86)	760 (15.11)		3 (8.57)	275 (11.08)
Patients with exacerbations in the last 12 months prior to study			0.30			0.30	0.46	< 0.0001
Yes	36 (61.02)	3,388 (67.34)	.	24 (68.57)	1,486 (59.85)
No	23 (38.98)	1,643 (32.66)	.	11 (31.43)	997 (40.15)

Table 2. Analysis of Responder and Non-Responder

Demographic data and baseline characteristics

Responder

Non-responder

Responder vs. non-responder in Switzerland, P-value

Responder vs. non-responder in other countries, P-value

Switzerland, N (%)

Other countries, N (%)

P-value

Switzerland, N (%)

Other countries, N (%)

P-value

*Chi-Square might not be valid, test changed to Fishers exact test. COPD: chronic obstructive pulmonary disease; mMRC: modified Medical Research Council questionnaire.

Number of patients

59 (100.00)

5,031 (100.00)

35 (100.00)

2,483 (100.00)

Age at registration (categorical)

0.00

0.01

0.78

0.81

< 65 years

15 (25.42)

2,290 (45.52)

8 (22.86)

1,136 (45.75)

≥ 65 years

44 (74.58)

2,741 (54.48)

27 (77.14)

1,347 (54.25)

COPD degree of severity (spirometric)

0.02

0.03*

0.46*

< 0.0001

2 (3.39)

91 (1.81)

3 (8.57)

61 (2.46)

36 (61.02)

2,156 (42.85)

21 (60.00)

1,264 (50.91)

20 (33.90)

2,179 (43.31)

9 (25.71)

921 (37.09)

1 (1.69)

533 (10.59)

1 (2.86)

219 (8.82)

No previous findings

0 (0.00)

72 (1.43)

1 (2.86)

18 (0.72)

mMRC questionnaire

0.34

0.99

0.19*

< 0.0001

Grade 0

2 (3.39)

73 (1.45)

3 (8.57)

173 (6.97)

Grade 1

11 (18.64)

931 (18.51)

12 (34.29)

831 (33.47)

Grade 2

29 (49.15)

2,177 (43.27)

14 (40.00)

990 (39.87)

Grade 3

16 (27.12)

1,495 (29.72)

5 (14.29)

408 (16.43)

Grade 4

1 (1.69)

355 (7.06)

1 (2.86)

81 (3.26)

GOLD Group

0.89

0.64

0.05

< 0.0001

10 (16.95)

708 (14.07)

10 (28.57)

771 (31.05)

24 (40.68)

2,238 (44.48)

15 (42.86)

976 (39.31)

3 (5.08)

296 (5.88)

5 (14.29)

233 (9.38)

22 (37.29)

1,789 (35.56)

5 (14.29)

503 (20.26)

Patients with concomitant diseases

< 0.0001

0.00

0.63*

0.37

2 (3.39)

1,407 (27.97)

2 (5.71)

719 (28.96)

Yes

57 (96.61)

3,624 (72.03)

33 (94.29)

1,764 (71.04)

Smoking status

0.62

0.89

0.81

< 0.0001

Smoker

22 (37.29)

2,012 (39.99)

15 (42.86)

1,013 (40.80)

Ex-smoker

30 (50.85)

2,259 (44.90)

17 (48.57)

1,195 (48.13)

Non-smoker

7 (11.86)

760 (15.11)

3 (8.57)

275 (11.08)

Patients with exacerbations in the last 12 months prior to study

0.30

0.46

< 0.0001

Yes

36 (61.02)

3,388 (67.34)

24 (68.57)

1,486 (59.85)

23 (38.98)

1,643 (32.66)

11 (31.43)

997 (40.15)

**Table 3.** Pearson (Partial) Correlation Analysis in Switzerland (N = 94)
Changes in PF-10 score	mMRC	Number of exacerbations
PF-10: 10-question physical functioning questionnaire; mMRC: modified Medical Research Council questionnaire.
Nothing
Correlation coefficient	0.33	0.0945
P-value	0.00	0.3649
Age (< 65 vs. ≥ 65)
Correlation coefficient	0.35	0.0948
P-value	0.00	0.3660
Concomitant disease (yes vs. no)
Correlation coefficient	0.33	0.0931
P-value	0.00	0.3748
Age (< 65 vs. ≥ 65) and concomitant disease (yes vs. no)
Correlation coefficient	0.35	0.0937
P-value	0.00	0.3744

Table 3. Pearson (Partial) Correlation Analysis in Switzerland (N = 94)

Changes in PF-10 score

mMRC

Number of exacerbations

PF-10: 10-question physical functioning questionnaire; mMRC: modified Medical Research Council questionnaire.

Nothing

Correlation coefficient

0.33

0.0945

P-value

0.00

0.3649

Age (< 65 vs. ≥ 65)

Correlation coefficient

0.35

0.0948

P-value

0.00

0.3660

Concomitant disease (yes vs. no)

Correlation coefficient

0.33

0.0931

P-value

0.00

0.3748

Age (< 65 vs. ≥ 65) and concomitant disease (yes vs. no)

Correlation coefficient

0.35

0.0937

P-value

0.00

0.3744

**Table 4.** Pearson (Partial) Correlation Analysis in Other Countries (N = 7,514)
Changes in PF-10 score	mMRC	Number of exacerbations
PF-10: 10-question physical functioning questionnaire; mMRC: modified Medical Research Council questionnaire.
Nothing
Correlation coefficient	0.31	0.1181
P-value	< 0.00	< 0.0001
Age (< 65 vs. ≥ 65)
Correlation coefficient	0.32	0.1183
P-value	< 0.00	< 0.0001
Concomitant disease (yes vs. no)
Correlation coefficient	0.32	0.1193
P-value	< 0.00	< 0.0001
Age (< 65 vs. ≥ 65) and concomitant disease (yes vs. no)
Correlation coefficient	0.32	0.1197
P-value	< 0.00	< 0.0001

Table 4. Pearson (Partial) Correlation Analysis in Other Countries (N = 7,514)

Changes in PF-10 score

mMRC

Number of exacerbations

PF-10: 10-question physical functioning questionnaire; mMRC: modified Medical Research Council questionnaire.

Nothing

Correlation coefficient

0.31

0.1181

P-value

< 0.00

< 0.0001

Age (< 65 vs. ≥ 65)

Correlation coefficient

0.32

0.1183

P-value

< 0.00

< 0.0001

Concomitant disease (yes vs. no)

Correlation coefficient

0.32

0.1193

P-value

< 0.00

< 0.0001

Age (< 65 vs. ≥ 65) and concomitant disease (yes vs. no)

Correlation coefficient

0.32

0.1197

P-value

< 0.00

< 0.0001