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Factors associated with change in exacerbation frequency in COPD.

Donaldson GC, Müllerova H, Locantore N, Hurst JR, Calverley PM, Vestbo J, Anzueto A, Wedzicha JA - Respir. Res. (2013)

Bottom Line: Patient characteristics compared between those patients who did or did not change exacerbation category from year 1 to year 2.More severe disease was associated with changing from IE to FE and less severe disease from FE to IE.Over the preceding year, small falls in FEV1 and 6-minute walking distance were associated with changing from IE to FE, and small falls in platelet count associated with changing from FE to IE.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Respiratory Medicine, UCL Medical School, Royal Free Campus, Rowland Hill Street Hampstead, London NW3 2PF, UK. g.donaldson@ucl.ac.uk

ABSTRACT

Background: Patients with chronic obstructive pulmonary disease (COPD) can be categorized as having frequent (FE) or infrequent (IE) exacerbations depending on whether they respectively experience two or more, or one or zero exacerbations per year. Although most patients do not change category from year to year, some will, and the factors associated with this behaviour have not been examined.

Methods: 1832 patients completing two year follow-up in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) study were examined at baseline and then yearly. Exacerbations were defined by health care utilisation. Patient characteristics compared between those patients who did or did not change exacerbation category from year 1 to year 2.

Findings: Between years 1 and 2, 221 patients (17%) changed from IE to FE and 210 patients (39%) from FE to IE. More severe disease was associated with changing from IE to FE and less severe disease from FE to IE. Over the preceding year, small falls in FEV1 and 6-minute walking distance were associated with changing from IE to FE, and small falls in platelet count associated with changing from FE to IE.

Conclusion: No parameter clearly predicts an imminent change in exacerbation frequency category.

Trial registration: SCO104960, clinicaltrials.gov identifier NCT00292552.

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Related in: MedlinePlus

Timing of assessment and patient exacerbation categorization during the initial two years of the ECLIPSE study.
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Figure 1: Timing of assessment and patient exacerbation categorization during the initial two years of the ECLIPSE study.

Mentions: All patients completing at least 2 years of observation are included in this study. Patients underwent comprehensive medical reviews at baseline and then at the end of each 12 months of observation (see Figure 1). Data recorded at the 3, 6 and 18 month visits have not been analysed in this study as data on some patient characteristics were not available at these time points. Patients underwent standard spirometry testing after the administration of 400 μg of inhaled albuterol, completed a modified Medical Research Council dyspnoea scale (mMRC) and a St. Georges Respiratory Questionnaire (SGRQ). Co-morbidities were assessed from questions in the American Thoracic Society–Division of Lung Diseases (ATS-DLD) questionnaire and symptoms of depression by the Center for Epidemiologic Studies of Depression (CES-D) questionnaire. A venous blood sample was taken and a medical history including start/stop dates of medications and smoking history recorded. The patients underwent a six minute walking test (6MWD) according to ATS guidelines [15], with distance expressed as a percentage of predicted [16] which was used in calculating the patient’s BODE index [17]. Patients also underwent computed tomographic (CT) scanning, at baseline and year 1, to evaluate the severity of emphysema as the percentage of low attenuation areas (LAA%) [18].


Factors associated with change in exacerbation frequency in COPD.

Donaldson GC, Müllerova H, Locantore N, Hurst JR, Calverley PM, Vestbo J, Anzueto A, Wedzicha JA - Respir. Res. (2013)

Timing of assessment and patient exacerbation categorization during the initial two years of the ECLIPSE study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3733814&req=5

Figure 1: Timing of assessment and patient exacerbation categorization during the initial two years of the ECLIPSE study.
Mentions: All patients completing at least 2 years of observation are included in this study. Patients underwent comprehensive medical reviews at baseline and then at the end of each 12 months of observation (see Figure 1). Data recorded at the 3, 6 and 18 month visits have not been analysed in this study as data on some patient characteristics were not available at these time points. Patients underwent standard spirometry testing after the administration of 400 μg of inhaled albuterol, completed a modified Medical Research Council dyspnoea scale (mMRC) and a St. Georges Respiratory Questionnaire (SGRQ). Co-morbidities were assessed from questions in the American Thoracic Society–Division of Lung Diseases (ATS-DLD) questionnaire and symptoms of depression by the Center for Epidemiologic Studies of Depression (CES-D) questionnaire. A venous blood sample was taken and a medical history including start/stop dates of medications and smoking history recorded. The patients underwent a six minute walking test (6MWD) according to ATS guidelines [15], with distance expressed as a percentage of predicted [16] which was used in calculating the patient’s BODE index [17]. Patients also underwent computed tomographic (CT) scanning, at baseline and year 1, to evaluate the severity of emphysema as the percentage of low attenuation areas (LAA%) [18].

Bottom Line: Patient characteristics compared between those patients who did or did not change exacerbation category from year 1 to year 2.More severe disease was associated with changing from IE to FE and less severe disease from FE to IE.Over the preceding year, small falls in FEV1 and 6-minute walking distance were associated with changing from IE to FE, and small falls in platelet count associated with changing from FE to IE.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Respiratory Medicine, UCL Medical School, Royal Free Campus, Rowland Hill Street Hampstead, London NW3 2PF, UK. g.donaldson@ucl.ac.uk

ABSTRACT

Background: Patients with chronic obstructive pulmonary disease (COPD) can be categorized as having frequent (FE) or infrequent (IE) exacerbations depending on whether they respectively experience two or more, or one or zero exacerbations per year. Although most patients do not change category from year to year, some will, and the factors associated with this behaviour have not been examined.

Methods: 1832 patients completing two year follow-up in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) study were examined at baseline and then yearly. Exacerbations were defined by health care utilisation. Patient characteristics compared between those patients who did or did not change exacerbation category from year 1 to year 2.

Findings: Between years 1 and 2, 221 patients (17%) changed from IE to FE and 210 patients (39%) from FE to IE. More severe disease was associated with changing from IE to FE and less severe disease from FE to IE. Over the preceding year, small falls in FEV1 and 6-minute walking distance were associated with changing from IE to FE, and small falls in platelet count associated with changing from FE to IE.

Conclusion: No parameter clearly predicts an imminent change in exacerbation frequency category.

Trial registration: SCO104960, clinicaltrials.gov identifier NCT00292552.

Show MeSH
Related in: MedlinePlus