Association between COPD exacerbations and lung function decline during maintenance therapy

Thorax
Marjan KerkhofDavid B Price

Abstract

Little is known about the impact of exacerbations on COPD progression or whether inhaled corticosteroid (ICS) use and blood eosinophil count (BEC) affect progression. We aimed to assess this in a prospective observational study. The study population included patients with mild to moderate COPD, aged ≥35 years, with a smoking history, who were followed up for ≥3 years from first to last spirometry recording using two large UK electronic medical record databases: Clinical Practice Research Datalink (CPRD) and Optimum Patient Care Research Database (OPCRD). Multilevel mixed-effects linear regression models were used to determine the relationship between annual exacerbation rate following initiation of therapy (ICS vs non-ICS) and FEV1 decline. Effect modification by blood eosinophils was studied through interaction terms. Of 12178 patients included (mean age 66 years; 48% female), 8981 (74%) received ICS. In patients with BEC ≥350 cells/µL not on ICS, each exacerbation was associated with subsequent acceleration of FEV1 decline of 19.4 mL/year (95% CI 12.0 to 26.7, p<0.0001). This excess decline was reduced by 15.1 mL/year (6.6 to 23.6) to 4.3 mL/year (1.9 to 6.7, p<0.0001) in those with BEC ≥350 cells/µL treated with ICS. Exacerb...Continue Reading

References

May 31, 2008·American Journal of Respiratory and Critical Care Medicine·Bartolomé R CelliPeter M A Calverley
Oct 20, 2010·European Respiratory Review : an Official Journal of the European Respiratory Society·A Anzueto
Dec 24, 2010·The European Respiratory Journal·J C A TrappenburgE M Monninkhof
Mar 1, 2012·International Journal of Chronic Obstructive Pulmonary Disease·Claudio Tantucci, Denise Modina
Mar 27, 2012·American Journal of Respiratory and Critical Care Medicine·Mona BafadhelChristopher E Brightling
Jul 15, 2015·The New England Journal of Medicine·Peter LangeJørgen Vestbo
Jan 26, 2016·American Journal of Respiratory and Critical Care Medicine·Surya P BhattUNKNOWN COPDGene Investigators
Feb 27, 2016·The European Respiratory Journal·Neil C BarnesPeter M A Calverley
Dec 7, 2016·Clinical Epidemiology·Kieran J RothnieJennifer K Quint
Feb 13, 2017·Cell and Tissue Research·Heinz FehrenbachMichael Wegmann
Jun 12, 2017·The Lancet. Respiratory Medicine·Mona BafadhelRichard E K Russell
Jun 28, 2017·International Journal of Chronic Obstructive Pulmonary Disease·Kieran J RothnieJennifer K Quint
Jul 22, 2017·The European Respiratory Journal·Marjan KerkhofDavid B Price
Feb 13, 2018·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·Mette JørgensenSøren Paaske Johnsen
May 5, 2018·Respiratory Medicine·Guy BrusselleEmma Hilton
Nov 23, 2018·International Journal of Chronic Obstructive Pulmonary Disease·Salman H SiddiquiStefano Petruzzelli
Jun 20, 2019·International Journal of Chronic Obstructive Pulmonary Disease·Hannah R WhittakerJennifer K Quint

❮ Previous
Next ❯

Citations

Aug 22, 2020·International Journal of Chronic Obstructive Pulmonary Disease·Marjan KerkhofDavid B Price
Jun 26, 2020·Thorax·Hannah Whittaker, Jennifer K Quint
Jun 15, 2021·Clinical and Translational Allergy·Rita AmaralKjell Alving
Aug 21, 2021·International Journal of Chronic Obstructive Pulmonary Disease·Rachel PullenDavid B Price

❮ Previous
Next ❯

Software Mentioned

Stata
ISOLDE

Related Concepts

Related Feeds

Allergy and Asthma

Allergy and asthma are inflammatory disorders that are triggered by the activation of an allergen-specific regulatory t cell. These t cells become activated when allergens are recognized by allergen-presenting cells. Here is the latest research on allergy and asthma.