Facial wrinkling: A possible mirror of COPD severity.....

Background and objective: The objective of our study was to test the hypothesis that facial wrinkling is a reflection to the severity of COPD disease and whether there is an association between facial wrinkling score and the severity of COPD as assessed by different parameters retrieved from GOLD criteria as well as clinical based parameters. Therefore we aimed to investigate whether extensive facial wrinkling should promote the screening of affected individuals for airflow obstruction.Subjects and methods: The study included 100 patients diagnosed with COPD. Demographic data, smoking exposure as well as spirometric measures were obtained from all patients. Each patient was given a score based on combined assessment of COPD system. The extent of facial wrinkling in the “crows’ feet area” was determined using the scoring system described by Daniell.Results: The results of our study demonstrated that wrinkling score was statistically significantly higher in COPD patients with high risk based on combined assessment system compared to those with low risk with p < 0.001. Also, a statistically significantly higher score of wrinkling was found in COPD patients with more symptoms based on mMRC breathlessness scale compared to those with low symptoms with p < 0.001. We also found that wrinkling was statistically significantly higher in COPD patients with concomitant comorbidities compared to those without comorbidities with p < 0.00. Positive correlations existed between wrinkling score and: age of the patients (r = 0.738, p < 0.001), smoking severity of the patients (r = 0.326, p < 0.001), and severity of COPD based on post bronchodilator FEV1 (r = 0.547, p < 0.001). There were also positive correlations between wrinkling score and: risk of exacerbations (r = 0.333, p < 0.001), modified medical research council breathlessness scale (r = 0.602, p < 0.001) and Combined COPD assessment (r = 0.573, p < 0.001). There was a negative correlation between wrinkling score and post bronchodilator FEV1% of predicted values (r = −0.673, p < 0.001). We demonstrated in Multivariate Linear regression model of predictive factors that age and concomitant COPD comorbidities were the main predictive factors for wrinkling in patients with COPD with t = 6.968, at p < 0.001 and t = 3.473, at p < 0.002, respectively.Conclusion: Facial wrinkling is strongly associated with the risk of airflow obstruction. Extensive facial wrinkling may be a marker of susceptibility to the effects of cigarette smoking and should promote the screening of affected individuals for airflow obstruction