{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T20:24:13Z","timestamp":1787689453232,"version":"build-2784847793"},"reference-count":30,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Chronic obstructive pulmonary disease (COPD) is heterogeneous, and phenotype-based classification may better capture differences in clinical burden and healthcare needs beyond standard GOLD categories. We aimed to describe the distribution of GesEPOC COPD phenotypes in Turkey and compare their demographic, clinical, functional, radiological, treatment, and healthcare utilization profiles. Materials and Methods: DIPTUR was a multicenter, observational, cross-sectional study conducted prospectively in 26 centers across 17 Turkish cities (October 2019\u2013June 2021). Stable COPD patients (\u226540 years; post-bronchodilator FEV1\/FVC &lt; 0.7) without exacerbation or major treatment modification within the previous four weeks were enrolled consecutively. Phenotypes were assigned per GesEPOC: exacerbator with emphysema (EE), exacerbator with chronic bronchitis (ECB), asthma\u2013COPD overlap (ACO), and non-exacerbator (NE). Frequent exacerbators were defined as patients who experienced two or more exacerbations during the 12 months preceding enrollment, based on medical records and patient reports. Results: Among 894 patients, phenotype distribution was NE 44.1%, ECB 26.2%, EE 20.5%, and ACO 9.3%. Male predominance was observed across groups (80\u201389%; p = 0.006). Active smoking was most frequent in ECB (37.6%; p &lt; 0.001), and BMI was lowest in EE (p &lt; 0.001). Comorbidity patterns differed, with hypertension (p &lt; 0.001), diabetes mellitus (p = 0.029), and heart failure (p &lt; 0.001) most prevalent in ECB. Pulmonary function (FEV1 and FVC) was lowest in EE (both p &lt; 0.001), and severe airflow limitation (GOLD III\u2013IV) was most common in EE and ECB (p &lt; 0.001). Dyspnea (mMRC \u2265 2) was more frequent in EE\/ECB than in ACO\/NE (p &lt; 0.001). Emphysematous changes on thoracic CT predominated in EE (91.7%; p &lt; 0.001). Long-term oxygen therapy was most common in EE (32.4%; p &lt; 0.001). Emergency admissions, hospitalizations, and total length of stay were markedly higher in EE and ECB than in ACO and NE (all p &lt; 0.001). Conclusions: COPD phenotypes in Turkey show substantial heterogeneity in clinical, functional, radiological, and utilization domains. Exacerbator phenotypes\u2014particularly EE and ECB\u2014represent higher-burden groups, supporting phenotype-oriented management and closer monitoring beyond GOLD classification.<\/jats:p>","DOI":"10.3390\/medicina62020402","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T15:57:29Z","timestamp":1771516649000},"page":"402","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical and Functional Heterogeneity of COPD Phenotypes: A Multicenter Study from Turkey (DIPTUR Study)"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4881-3097","authenticated-orcid":false,"given":"Tevfik","family":"Ozlu","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon 61080, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7005-3333","authenticated-orcid":false,"given":"Ozlem","family":"Sengoren Dikis","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Mugla Sitki Kocman University, Mugla 48000, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7018-7187","authenticated-orcid":false,"given":"Fulden Cantas","family":"Turkis","sequence":"additional","affiliation":[{"name":"Department of Biostatistic, Faculty of Medicine, Mugla Sitki Kocman University, Mugla 48000, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4274-0333","authenticated-orcid":false,"given":"Ceren","family":"Degirmenci","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Mu\u011fla Training and Research Hospital, Mugla 48000, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9017-2014","authenticated-orcid":false,"given":"Ahmet","family":"Ilgazl\u0131","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Kocaeli University, Kocaeli 41001, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inci","family":"G\u00fclmez","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Erciyes University, Kayseri 38038, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9281-871X","authenticated-orcid":false,"given":"Burcu","family":"Yalcin","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Konya Research and Training Hospital, Konya 42005, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1994-6723","authenticated-orcid":false,"given":"Gulistan","family":"Karadeniz","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir 35170, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0507-0767","authenticated-orcid":false,"given":"Yasemin","family":"Soyler","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Atat\u00fcrk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara 06290, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2597-6646","authenticated-orcid":false,"given":"Hatice","family":"Selimoglu Sen","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Dicle University, Diyarbak\u0131r 21280, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3379-3620","authenticated-orcid":false,"given":"Aysel","family":"Sunnetcioglu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Van Y\u00fcz\u00fcnc\u00fc Y\u0131l University, Van 65080, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8725-3323","authenticated-orcid":false,"given":"Nimet","family":"Aksel","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir 35170, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-7271","authenticated-orcid":false,"given":"Sibel","family":"Boga","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, S\u00fcreyyapa\u015fa Chest Diseases and Thoracic Surgery Training and Research Hospital, \u0130stanbul 34844, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5180-9649","authenticated-orcid":false,"given":"Nurhan","family":"Sarioglu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Bal\u0131kesir University, Bal\u0131kesir 10145, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8937-3679","authenticated-orcid":false,"given":"Haci Ahmet","family":"Bircan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, S\u00fcleyman Demirel University, Isparta 32260, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9195-7398","authenticated-orcid":false,"given":"Aylin","family":"Capraz","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Amasya University, Amasya 05100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4429-9441","authenticated-orcid":false,"given":"Serap","family":"Argun Baris","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Kocaeli University, Kocaeli 41001, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0183-6232","authenticated-orcid":false,"given":"Aycan","family":"Yuksel","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Ufuk University, Ankara 06510, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2869-9872","authenticated-orcid":false,"given":"Umut Sabri","family":"Kasapoglu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Malatya Training and Research Hospital, Malatya 44000, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibel","family":"Ar\u0131nc","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, S\u00fcreyyapa\u015fa Chest Diseases and Thoracic Surgery Training and Research Hospital, \u0130stanbul 34844, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9593-4441","authenticated-orcid":false,"given":"Esra","family":"Yarar","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Necip Faz\u0131l State Hospital, Kahramanmara\u015f 46050, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5974-9129","authenticated-orcid":false,"given":"Nur Aleyna","family":"Yetkin","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Kayseri State Hospital, Kayseri 38080, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8415-2524","authenticated-orcid":false,"given":"Fusun","family":"Sahin","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, \u0130stanbul 34020, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Tabaru","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Nigde Omer Halisdemir University Training and Research Hospital, Nigde 51100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dildar","family":"Duman","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, S\u00fcreyyapa\u015fa Chest Diseases and Thoracic Surgery Training and Research Hospital, \u0130stanbul 34844, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2913-9909","authenticated-orcid":false,"given":"Gunhan","family":"Yavasoglu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Bolvadin State Hospital, Bolvadin 03300, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dursun","family":"Tatar","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir 35170, 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Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4946-7029","authenticated-orcid":false,"given":"Buket","family":"Mermit","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Van Y\u00fcz\u00fcnc\u00fc Y\u0131l University, Van 65080, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9025-6605","authenticated-orcid":false,"given":"Murat","family":"Kavas","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, S\u00fcreyyapa\u015fa Chest Diseases and Thoracic Surgery Training and Research Hospital, \u0130stanbul 34844, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1724-7726","authenticated-orcid":false,"given":"Hakan Alp","family":"Yilmazli","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, S\u00fcleyman Demirel University, Isparta 32260, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7706-9311","authenticated-orcid":false,"given":"Ilknur","family":"Basyigit","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Kocaeli University, Kocaeli 41001, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0154-7775","authenticated-orcid":false,"given":"Esen","family":"Sayin Gulensoy","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Ufuk University, Ankara 06510, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meltem","family":"Agca","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, S\u00fcreyyapa\u015fa Chest Diseases and Thoracic Surgery Training and Research Hospital, \u0130stanbul 34844, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3117-7768","authenticated-orcid":false,"given":"Filiz","family":"Alkan Baylan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Necip Faz\u0131l State Hospital, Kahramanmara\u015f 46050, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0338-3978","authenticated-orcid":false,"given":"Canan","family":"Bol","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Kayseri State Hospital, Kayseri 38080, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6833-6876","authenticated-orcid":false,"given":"Berat","family":"Uslu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, \u0130stanbul 34020, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamze","family":"Celik","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Faculty of Medicine, Uluda\u011f University, Bursa 16059, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.55730\/1300-0144.5416","article-title":"Chronic obstructive pulmonary disease phenotypes in Turkey: The COPET study-a national, multicenter cross-sectional observational study","volume":"52","author":"Yazar","year":"2022","journal-title":"Turk. 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