The Long-term Burden of COPD Exacerbations during Maintenance Therapy and Lung Function Decline

Marjan Kerkhof, Jaco Voorham, Paul Dorinsky, Claudia Cabrera, Patrick Darken, Janwillem W.H. Kocks, Mohsen Sadatsafavi, Don D. Sin, Victoria Carter, David Price* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Introduction: Early identification of preventable risk factors of COPD progression is important. Whether exacerbations have a negative impact on disease progression is largely unknown. We investigated whether the long-term occurrence of exacerbations is associated with lung function decline at early stages of COPD.
Methods: Patients diagnosed with mild/moderate COPD (obstruction and FEV1% predicted 50– 90%), aged ≥ 35 years, and a smoking history, who had ≥ 6 years of UK electronic medical records after initiation of maintenance therapy were studied. Multilevel mixed-effect linear regression was performed to determine the association between the count of any year in which the patient had ≥ 1 exacerbation over a 6-year period and FEV1 decline, adjusted for sex, age, anthropometrics and smoking habits. Exacerbations were defined as any prescription for an acute oral corticosteroid course and/or lower respiratory-related antibiotics and/or any COPD-related emergency or inpatient hospitalization.
Results: Of 11,337 patients included (mean age 65 years; 49% female) 31.6%, 23.3%, 16.6%, 11.6%, 8.1%, 5.3% and 3.4% had 0, 1, 2, 3, 4, 5 and 6 years with ≥ 1 exacerbation. The mean annual FEV1 decline accelerated by 1.50 mL/year (95% Confidence Interval 1.02; 1.98) with every additional year with ≥ 1 exacerbation from 31.0 mL/year in subjects without any exacerbation to 40.0 mL/year in patients experiencing ≥ 1 exacerbation every year. Patients with more years with ≥ 1 exacerbation had a lower mean FEV1 at first diagnosis: 14.7 mL (11.7; 17.8) lower with every additional year with exacerbations. When counting years with ≥ 2 exacerbations, greater effects were observed (2.19 [1.50; 2.88]  mL/year excess decline per year with ≥ 2 exacerbations; 16.5 mL [12.1; 20.8] lower FEV1 at diagnosis).
Conclusion: Patients who experienced a greater exacerbation burden after initiation of maintenance therapy had worse lung function at diagnosis and a more rapid lung function decline thereafter, which emphasizes the need for better treatment strategies.
Original languageEnglish
Pages (from-to)1909-1918
Number of pages10
JournalInternational journal of chronic obstructive pulmonary disease
Volume15
DOIs
Publication statusPublished - 6 Aug 2020

Keywords

  • COPD
  • Exacerbations
  • Spirometry
  • Inhalation Therapy
  • Observational Study
  • inhalation therapy
  • POPULATION
  • OBSTRUCTIVE PULMONARY-DISEASE
  • spirometry
  • exacerbations
  • FREQUENCY
  • observational study

Fingerprint Dive into the research topics of 'The Long-term Burden of COPD Exacerbations during Maintenance Therapy and Lung Function Decline'. Together they form a unique fingerprint.

  • Cite this

    Kerkhof, M., Voorham, J., Dorinsky, P., Cabrera, C., Darken, P., Kocks, J. W. H., Sadatsafavi, M., Sin, D. D., Carter, V., & Price, D. (2020). The Long-term Burden of COPD Exacerbations during Maintenance Therapy and Lung Function Decline. International journal of chronic obstructive pulmonary disease , 15, 1909-1918. https://doi.org/10.2147/COPD.S253812