Effect of a single exacerbation on decline in lung function in COPD

• Published in: Respiratory medicine 2017-07, Vol.128, p.85-91
• Main Authors: Halpin, David M.G, Decramer, Marc, Celli, Bartolome R, Mueller, Achim, Metzdorf, Norbert, Tashkin, Donald P
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - pharmacology; Adrenergic beta-2 Receptor Agonists - administration & dosage; Adrenergic beta-2 Receptor Agonists - pharmacology; Aged; Bronchitis; Bronchodilator; Bronchodilator Agents - therapeutic use; Bronchodilators; Chronic obstructive pulmonary disease; COPD; Disease Progression; Exacerbation; Female; Forced Expiratory Volume - drug effects; Gene expression; Humans; Inflammation; Lung diseases; Lung function decline; Lungs; Male; Middle Aged; Parasympatholytics - administration & dosage; Parasympatholytics - pharmacology; Patients; PFT; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary function test; Pulmonary/Respiratory; Respiratory function; Respiratory Function Tests - methods; Retrospective Studies; Scopolamine Derivatives - therapeutic use; Sensitivity; Sensitivity analysis; Smoking; Smoking - adverse effects; Smoking - epidemiology; Tiotropium; Tiotropium Bromide - administration & dosage; Tiotropium Bromide - pharmacology; Treatment Outcome; Understanding Potential Long-term Impacts on Function with Tiotropium; UPLIFT; Vital Capacity - drug effects
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2017.04.013

Abstract Background COPD exacerbations are associated with accelerated lung function decline, but whether they are causal is unknown. We evaluated the effect of a single exacerbation on rate of lung function change using data from the 4-year Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT® ) trial. Methods Retrospective analysis of annual rates of decline in FEV1 and FVC before and after a single (and the only) moderate-to-severe exacerbation in patients during UPLIFT® (exacerbator subgroup), compared with changes between the first and second half of the study in a non-exacerbator subgroup. A sensitivity analysis examined annual rates of decline in matched pairs of exacerbators and non-exacerbators. Results Following the single moderate-to-severe exacerbation, mean annual decline in post-bronchodilator lung function increased compared with the rate of decline before the exacerbation (FEV1 76.5 vs. 39.1 mL/year, p  = 0.003; FVC 106.5 vs. 34.7 mL/year, p  = 0.011). In non-exacerbators, there were no differences in rates of decline between the first and second halves of the study (post-bronchodilator FEV1 38.2 vs. 41.8 mL/year, FVC 45.3 vs. 43.9 mL/year. Before the single (moderate-to-severe) exacerbation in the exacerbator subgroup, declines in post-bronchodilator FEV1 or FVC were similar to non-exacerbators in the first half of the study; after the single exacerbation they were significantly higher than for non-exacerbators in the second half of the study. The sensitivity analysis showed similar results. Conclusion A single COPD exacerbation may result in significant increase in the rate of decline in lung function.