A phenotype analysis of the effect of spinal manipulative therapy and pulmonary rehabilitation in chronic obstructive pulmonary disease

Progressive loss of lung function is a hallmark of Chronic Obstructive PulmonaryDisease (COPD). People with COPD are classified according to the degree of airflow obstruction measured by spirometry. They are categorised into stages: mild, moderate,severe or very severe. As COPD is now considered a heterogeneous disease with manyother predictors of mortality, such as exercise capacity and dyspnoea levels providing important therapeutic targets, an additional classification system is required that moreaccurately addresses these facets of the disease. This research, including a review of the literature regarding COPD phenotypes,proposes an additional classification system that encompasses the different phenotypesin COPD. A systematic review was performed to comment on the methodological qualityof the evidence for including spinal manipulative therapy (SMT) in the management of COPD. The methodology describes an algorithm that classifies the participants of arandomised controlled trial (RCT) into one of four phenotypes. Phenotype groupanalyses that examined the effect of SMT and exercise on the different phenotypes wereperformed. The results of the analysis showed that there was a difference between phenotypes in response to intervention, and that different proportions of phenotypes within groups may have influenced the results of the original RCT. It is concluded that performing a phenotype analysis provides new informationabout underlying disease process in COPD, particularly in response to SMT and exercise.