@article{adacb42d056443929e688c6239881766,
title = "Association between COPD exacerbations and lung function decline during maintenance therapy",
abstract = "Background: 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. Methods: 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.ResultsL 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 19.4mL/year (95% CI 12.0 to 26.7, p<0.0001). This excess decline was reduced by 15.1mL/ year (6.6 to 23.6) to 4.3mL/year (1.9 to 6.7, p<0.0001) in those with BEC ≥350 cells/µL treated with ICS. Conclusion: Exacerbations are associated with a more rapid loss of lung function among COPD patients with elevated blood eosinophils, defined as ≥350 cells/µL, not treated with ICS. More aggressive prevention of exacerbations using ICS in such patients may prevent excess loss of lung function.",
keywords = "COPD exacerbations, COPD pharmacology, eosinophil biology, lung physiology, OBSTRUCTIVE PULMONARY-DISEASE, IMPACT, BIOMARKER, BLOOD EOSINOPHILS, INHALED CORTICOSTEROIDS, FEV1 DECLINE",
author = "Marjan Kerkhof and Jaco Voorham and Paul Dorinsky and Claudia Cabrera and Patrick Darken and Kocks, {Janwillem WH} and Mohsen Sadatsafavi and Sin, {Don D.} and Victoria Carter and Price, {David B.}",
note = "Acknowledgements: Writing and editorial support was provided by Dr Julia Granerod, supported by the Observational and Pragmatic Research Institute Pte. Ltd (OPRI). Funding: This study was funded by AstraZeneca.Data availability statement: Data may be obtained from a third party and are not publicly available. The dataset supporting the conclusions of this article was derived from the Clinical Practice Research Datalink (www.cprd.com) and the Optimum Patient Care Research Database (www.opcrd.co.uk). The CPRD has broad National Research Ethics Service Committee (NRES) ethics approval for purely observational research using the primary care data and established data linkages. The OPCRD has ethical approval from the National Health Service (NHS) Research Authority to hold and process anonymised research data (Research Ethics Committee reference: 5/EM/0150). This study was approved by the Anonymised Data Ethics Protocols and Transparency (ADEPT) committee – the independent scientific advisory committee for the OPCRD, and the Independent Scientific Advisory Committee (ISAC) for the CPRD. The authors do not have permission to give public access to the study dataset; researchers may request access to CPRD or OPCRD data for their own purposes. Access to CPRD can be made via the CPRD website (https://www.cprd.com/researcher/) or via the enquiries email enquiries@cprd. com. Access to OCPRD can be made via the OCPRD website(https://opcrd.co.uk/our-database/data-requests/) or via the enquiries email info@opcrd.co.uk. The study was designed, implemented, and registered in accordance with the criteria of the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (EUPAS19879).",
year = "2020",
month = sep,
day = "30",
doi = "10.1136/thoraxjnl-2019-214457",
language = "English",
volume = "75",
pages = "744--753",
journal = "Thorax",
issn = "0040-6376",
publisher = "BMJ Publishing Group Ltd",
number = "9",
}