TY - JOUR
T1 - Determinants of exacerbation risk in patients with COPD in the TIOSPIR study
AU - Calverley, Peter M.A.
AU - Tetzlaff, Kay
AU - Dusser, Daniel
AU - Wise, Robert A.
AU - Mueller, Achim
AU - Metzdorf, Norber
AU - Anzueto, Antonio
N1 - Funding Information:
This study was funded by Boehringer Ingelheim. Writing assistance was provided by Sarah J Petit and Jennifer C Fuchs of Parexel and Kristina Standeven of MediTech Media, and was funded by Boehringer Ingelheim.
Funding Information:
PMAC reports receiving consulting fees, lecture fees, and travel support from Novartis, GlaxoSmithKline, Boehringer Ingelheim, and Takeda. DD reports receiving consulting fees, lecture fees, and payment for the development of educational activities from Boehringer Ingelheim, Pfizer, Novartis, Chiesi, Nycomed, and Dey Pharma. RAW reports receiving consulting fees from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, ContraFect, GlaxoSmithKline, Janssen, Mylan, Novartis, Pfizer, Pulmonx, Roche, Spiration, Sunovion, Teva, Theravance, Verona, and Vertex, and grant support from Boehringer Ingelheim, Glaxo-SmithKline, and Pearl Therapeutics. KT, AM, and NM are employees of Boehringer Ingelheim, and ARA reports receiving consulting fees, lecture fees, and travel support from AstraZeneca, Boehringer Ingelheim, Forest Laboratories, GlaxoSmithKline, and Novartis and grant support from GlaxoSmithKline. The authors report no other conflicts of interest in this work.
PY - 2017/11/29
Y1 - 2017/11/29
N2 - Background: Exacerbation history is used to grade the risk of COPD exacerbation, but its reliability and relationship to other risk factors and prior therapy is unclear. To examine these interrelationships, we conducted a post hoc analysis of patients in the TIOSPIR trial with ≥2 years’ follow-up or who died on treatment. Patients and methods: Patients were grouped by their annual exacerbation rate on treatment into nonexacerbators, infrequent, and frequent exacerbators (annual exacerbation rates 0, ≤1, and <1, respectively), and baseline characteristics discriminating among the groups were determined. We used univariate and multivariate analyses to explore the effect of baseline characteristics on risk of exacerbation, hospitalization (severe exacerbation), and death (all causes). Results: Of 13,591 patients, 6,559 (48.3%) were nonexacerbators, 4,568 (33.6%) were infrequent exacerbators, and 2,464 (18.1%) were frequent exacerbators; 45% of patients without exacerbations in the previous year exacerbated on treatment. Multivariate analysis identified baseline pulmonary maintenance medication as a predictive factor of increased exacerbation risk, with inhaled corticosteroid treatment associated with increased exacerbation risk irrespective of exacerbation history. Conclusion: Our data confirm established risk factors for exacerbation, but highlight the limitations of exacerbation history when categorizing patients and the importance of prior treatment when identifying exacerbation risk.
AB - Background: Exacerbation history is used to grade the risk of COPD exacerbation, but its reliability and relationship to other risk factors and prior therapy is unclear. To examine these interrelationships, we conducted a post hoc analysis of patients in the TIOSPIR trial with ≥2 years’ follow-up or who died on treatment. Patients and methods: Patients were grouped by their annual exacerbation rate on treatment into nonexacerbators, infrequent, and frequent exacerbators (annual exacerbation rates 0, ≤1, and <1, respectively), and baseline characteristics discriminating among the groups were determined. We used univariate and multivariate analyses to explore the effect of baseline characteristics on risk of exacerbation, hospitalization (severe exacerbation), and death (all causes). Results: Of 13,591 patients, 6,559 (48.3%) were nonexacerbators, 4,568 (33.6%) were infrequent exacerbators, and 2,464 (18.1%) were frequent exacerbators; 45% of patients without exacerbations in the previous year exacerbated on treatment. Multivariate analysis identified baseline pulmonary maintenance medication as a predictive factor of increased exacerbation risk, with inhaled corticosteroid treatment associated with increased exacerbation risk irrespective of exacerbation history. Conclusion: Our data confirm established risk factors for exacerbation, but highlight the limitations of exacerbation history when categorizing patients and the importance of prior treatment when identifying exacerbation risk.
KW - COPD
KW - Exacerbation
KW - Frequent exacerbators
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UR - http://www.scopus.com/inward/citedby.url?scp=85037718088&partnerID=8YFLogxK
U2 - 10.2147/COPD.S145814
DO - 10.2147/COPD.S145814
M3 - Article
C2 - 29238184
AN - SCOPUS:85037718088
VL - 12
SP - 3391
EP - 3405
JO - International Journal of COPD
JF - International Journal of COPD
SN - 1176-9106
ER -