A
B
12
6
More
¼ cup
10
Average Daily
Sputum Index
8
6
4
2
5
Average
Sputum Quantity
4
3
2
1
0
0
Less
None
0
10
20 30 40
Patient ID
50
0
10
20 30 40
Patient ID
50
C
2
D Brown
Thick
3
Average
Sputum Color
1
0
Average Sputum
Consistency
1
2
0
Thin
0
10
20 30 40
Patient ID
50
None/
White
0
10
20 30 40
Patient ID
50
Figure 2. Average daily sputum index by individual patient, shown in Panel A. Average individual components of the sputum index (quantity, color,
and consistency) shown in Panels B, C, and D. Patients ranked by average daily sputum index. x = Low, + = Medium, ; = High.
phenotype of COPD patients, and it helps identify a more
symptomatic subset of patients that is at increased risk of
poor outcomes. Furthermore, our study shows that the use
of a relatively simple assessment of sputum symptomatology
adds valuable clinical information that should be more frequently utilized.
The utility of the detailed daily quantification of symp-
toms was to quickly identify an escalation of symptoms
that signaled an impending COPD exacerbation; in our
analysis, an aggregate assessment of these daily data was
used to describe clinical and radiographic phenotype of
patients with severe COPD. Therefore, it appears that a
one time aggregate assessment of the multiple qualities of
sputum symptoms over several months would have sim-
ilar predictive value as multiple daily assessments, as it
was performed in the Pa-SCOPE study. Long-term evalua-
tion of this novel method of daily symptom assessment is
needed and should prove to be valuable in developing more
40
30
A
40
30
B
%EMPH
10
20
%EMPH
10
20
0
0
r=-0.449
p<0.05
r=-0.584
p<0.05
0
AVERAGE SPUTUM INDEX
24 68
10
12
0
AVERAGE SPUTUM QUANTITY
12345
6
Figure 3. Average daily Sputum Index (A) and quantity (B) compared to percent emphysema. %Emph = percent lung attenuation at −950 Hounsfield
units. n = 23.
