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

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®...

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Published in:	Respiratory Medicine Vol. 128; pp. 85 - 91
Main Authors:	Halpin, David M.G., Decramer, Marc, Celli, Bartolome R., Mueller, Achim, Metzdorf, Norbert, Tashkin, Donald P.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01.07.2017 Elsevier BV Elsevier Limited
Subjects:	Administration, Inhalation Adrenal Cortex Hormones Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - pharmacology Adrenergic beta-2 Receptor Agonists Adrenergic beta-2 Receptor Agonists - administration & dosage Adrenergic beta-2 Receptor Agonists - pharmacology Aged Bronchitis Bronchodilator Bronchodilator Agents Bronchodilator Agents - therapeutic use Bronchodilators Chronic obstructive pulmonary disease COPD Disease Progression Exacerbation Female Forced Expiratory Volume Forced Expiratory Volume - drug effects Gene expression Humans Inflammation Lung diseases Lung function decline Lungs Male Middle Aged Parasympatholytics Parasympatholytics - administration & dosage Parasympatholytics - pharmacology PFT Pulmonary Disease, Chronic Obstructive 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 Respiratory Function Tests - methods Retrospective Studies Scopolamine Derivatives Scopolamine Derivatives - therapeutic use Smoking Smoking - adverse effects Smoking - epidemiology Tiotropium Tiotropium Bromide Tiotropium Bromide - administration & dosage Tiotropium Bromide - pharmacology Treatment Outcome Understanding Potential Long-term Impacts on Function with Tiotropium UPLIFT Vital Capacity Vital Capacity - drug effects Wessex Classification Subject Headings::Respiratory medicine UPLIFT Exacerbation Tiotropium Pulmonary function test Understanding Potential Long-term Impacts on Function with Tiotropium Bronchodilator Lung function decline PFT COPD (max 6): bronchodilator Understanding potential long-term impacts on function with tiotropium UPLIFT(®)
ISSN:	0954-6111, 1532-3064, 1532-3064
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Summary:	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. 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. 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. A single COPD exacerbation may result in significant increase in the rate of decline in lung function. •Retrospective analysis of the 4-year UPLIFT® trial of patients with COPD.•Examined the impact of a moderate-to-severe exacerbation on lung function decline.•Rate of lung function decline was compared with that of non-exacerbator controls.•The rate of decline was significantly increased following a single exacerbation.
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ISSN:	0954-6111 1532-3064 1532-3064
DOI:	10.1016/j.rmed.2017.04.013