Susceptibility to exacerbation in chronic obstructive pulmonary disease

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 C...

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Autores: Hurst, John R., Vestbo, Jørgen, Anzueto, Antonio, Locantore, Nicholas, Müllerova, Hana, Tal-Singer, Ruth, Miller, Bruce E., Lomas, David A., Agustí García-Navarro, Àlvar, MacNee, William, Calverley, Peter M., Rennard, Stephen I., Wouters, Emiel, Wedzicha, Jadwiga A.
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2010
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/46327
Acceso en línea:https://hdl.handle.net/2445/46327
Access Level:acceso abierto
Palabra clave:Malalties pulmonars obstructives cròniques
Assaigs clínics
Chronic obstructive pulmonary diseases
Clinical trials
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spelling Susceptibility to exacerbation in chronic obstructive pulmonary diseaseHurst, John R.Vestbo, JørgenAnzueto, AntonioLocantore, NicholasMüllerova, HanaTal-Singer, RuthMiller, Bruce E.Lomas, David A.Agustí García-Navarro, ÀlvarMacNee, WilliamCalverley, Peter M.Rennard, Stephen I.Wouters, EmielWedzicha, Jadwiga A.Malalties pulmonars obstructives cròniquesAssaigs clínicsChronic obstructive pulmonary diseasesClinical trialsBackground 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.)Massachusetts Medical Society2010info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/46327Articles publicats en revistes (Medicina)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: http://dx.doi.org/10.1056/NEJMoa0909883New England Journal of Medicine, 2010, vol. 363, num. 12, p. 1128-1138http://dx.doi.org/10.1056/NEJMoa0909883(c) Massachusetts Medical Society, 2010info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/463272026-05-27T06:46:51Z
dc.title.none.fl_str_mv Susceptibility to exacerbation in chronic obstructive pulmonary disease
title Susceptibility to exacerbation in chronic obstructive pulmonary disease
spellingShingle Susceptibility to exacerbation in chronic obstructive pulmonary disease
Hurst, John R.
Malalties pulmonars obstructives cròniques
Assaigs clínics
Chronic obstructive pulmonary diseases
Clinical trials
title_short Susceptibility to exacerbation in chronic obstructive pulmonary disease
title_full Susceptibility to exacerbation in chronic obstructive pulmonary disease
title_fullStr Susceptibility to exacerbation in chronic obstructive pulmonary disease
title_full_unstemmed Susceptibility to exacerbation in chronic obstructive pulmonary disease
title_sort Susceptibility to exacerbation in chronic obstructive pulmonary disease
dc.creator.none.fl_str_mv Hurst, John R.
Vestbo, Jørgen
Anzueto, Antonio
Locantore, Nicholas
Müllerova, Hana
Tal-Singer, Ruth
Miller, Bruce E.
Lomas, David A.
Agustí García-Navarro, Àlvar
MacNee, William
Calverley, Peter M.
Rennard, Stephen I.
Wouters, Emiel
Wedzicha, Jadwiga A.
author Hurst, John R.
author_facet Hurst, John R.
Vestbo, Jørgen
Anzueto, Antonio
Locantore, Nicholas
Müllerova, Hana
Tal-Singer, Ruth
Miller, Bruce E.
Lomas, David A.
Agustí García-Navarro, Àlvar
MacNee, William
Calverley, Peter M.
Rennard, Stephen I.
Wouters, Emiel
Wedzicha, Jadwiga A.
author_role author
author2 Vestbo, Jørgen
Anzueto, Antonio
Locantore, Nicholas
Müllerova, Hana
Tal-Singer, Ruth
Miller, Bruce E.
Lomas, David A.
Agustí García-Navarro, Àlvar
MacNee, William
Calverley, Peter M.
Rennard, Stephen I.
Wouters, Emiel
Wedzicha, Jadwiga A.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Malalties pulmonars obstructives cròniques
Assaigs clínics
Chronic obstructive pulmonary diseases
Clinical trials
topic Malalties pulmonars obstructives cròniques
Assaigs clínics
Chronic obstructive pulmonary diseases
Clinical trials
description 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.)
publishDate 2010
dc.date.none.fl_str_mv 2010
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/46327
url https://hdl.handle.net/2445/46327
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: http://dx.doi.org/10.1056/NEJMoa0909883
New England Journal of Medicine, 2010, vol. 363, num. 12, p. 1128-1138
http://dx.doi.org/10.1056/NEJMoa0909883
dc.rights.none.fl_str_mv (c) Massachusetts Medical Society, 2010
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) Massachusetts Medical Society, 2010
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Massachusetts Medical Society
publisher.none.fl_str_mv Massachusetts Medical Society
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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