Please use this identifier to cite or link to this item: http://hdl.handle.net/2445/46327
Title: Susceptibility to exacerbation in chronic obstructive pulmonary disease
Author: Hurst, John R.
Vestbo, Jørgen
Anzueto, Antonio
Locantore, Nicholas
Müllerova, Hana
Tal-Singer, Ruth
Miller, Bruce
Lomas, David A.
Agustí García-Navarro, Àlvar
MacNee, William
Calverley, Peter M.
Rennard, Stephen I.
Wouters, Emiel
Wedzicha, Jadwiga A.
Keywords: Malalties pulmonars obstructives cròniques
Assaigs clínics
Chronic obstructive pulmonary diseases
Clinical trials
Issue Date: 26-Oct-2010
Publisher: Massachusetts Medical Society
Abstract: Background Although we know that exacerbations are key events in chronic obstructive pulmonary disease (COPD), our understanding of their frequency, determinants, and effects is incomplete. In a large observational cohort, we tested the hypothesis that there is a frequent-exacerbation phenotype of COPD that is independent of disease severity. Methods We analyzed the frequency and associations of exacerbation in 2138 patients enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End points (ECLIPSE) study. Exacerbations were defined as events that led a care provider to prescribe antibiotics or corticosteroids (or both)or that led to hospitalization (severe exacerbations). Exacerbation frequency was observed over a period of 3 years. Results Exacerbations became more frequent (and more severe) as the severity of COPD increased; exacerbation rates in the first year of follow-up were 0.85 per person for patients with stage 2 COPD (with stage defined in accordance with Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages), 1.34 for patients with stage 3, and 2.00 for patients with stage 4. Overall, 22% of patients with stage 2 disease, 33% with stage 3, and 47% with stage 4 had frequent exacerbations (two or more in the first year of follow-up). The single best predictor of exacerbations, across all GOLD stages, was a history of exacerbations. The frequent-exacerbation phenotype appeared to be relatively stable over a period of 3 years and could be predicted on the basis of the patient"s recall of previous treated events. In addition to its association with more severe disease and prior exacerbations, the phenotype was independently associated with a history of gastroesophageal reflux or heartburn, poorer quality of life, and elevated white-cell count. Conclusions Although exacerbations become more frequent and more severe as COPD progresses, the rate at which they occur appears to reflect an independent susceptibility phenotype. This has implications for the targeting of exacerbation-prevention strategies across the spectrum of disease severity. (Funded by GlaxoSmithKline; ClinicalTrials .gov number, NCT00292552.)
Note: Reproducció del document publicat a: http://dx.doi.org/10.1056/NEJMoa0909883
It is part of: New England Journal of Medicine, 2010, vol. 363, num. 12, p. 1128-1138
Related resource: http://dx.doi.org/10.1056/NEJMoa0909883
URI: http://hdl.handle.net/2445/46327
ISSN: 0028-4793
Appears in Collections:Articles publicats en revistes (Medicina)

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