Association between COPD exacerbations and lung function decline during maintenance therapy. Issue 9 (12th June 2020)

• Record Type: Journal Article
• Authors: Kerkhof, Marjan; Voorham, Jaco; Dorinsky, Paul; Cabrera, Claudia; Darken, Patrick; Kocks, Janwillem WH; Sadatsafavi, Mohsen; Sin, Don D; Carter, Victoria; Price, David B
• Is Part Of: Thorax. Volume 75:Issue 9(2020)
• Page Start: 744
• Page End: 753
• Publication Date: 2020-06-12
• Subjects: COPD exacerbations -- lung physiology -- eosinophil biology -- COPD pharmacology; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2019-214457
• Languages: English
• ISSNs: 0040-6376

Abstract

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. Results: 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. 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.