Abstract

BACKGROUND
Frequent exacerbations induce a high burden to Chronic Obstructive Pulmonary Disease (COPD). We investigated the course of exacerbations in the published COSMIC study that investigated the effects of 1-year withdrawal of fluticasone after a 3-month run-in treatment period with salmeterol/fluticasone in patients with COPD.
METHODS
In 373 patients, we evaluated diary cards for symptoms, Peak Expiratory Flow (PEF), and salbutamol use and assessed their course during exacerbations.
RESULTS
There were 492 exacerbations in 224 patients. The level of symptoms of cough, sputum, dyspnea and nocturnal awakening steadily increased from 2 weeks prior to exacerbation, with a sharp rise during the last week. Symptoms of cough, sputum, and dyspnea reverted to baseline values at different rates (after 4, 4, and 7 weeks respectively), whereas symptoms of nocturnal awakening were still increased after eight weeks. The course of symptoms was similar around a first and second exacerbation. Increases in symptoms and salbutamol use and decreases in PEF were associated with a higher risk to develop an exacerbation, but with moderate predictive values, the areas under the receiver operating curves ranging from 0.63 to 0.70.
CONCLUSIONS
Exacerbations of COPD are associated with increased symptoms that persist for weeks and the course is very similar between a first and second exacerbation. COPD exacerbations are preceded by increased symptoms and salbutamol use and lower PEF, yet predictive values are too low to warrant daily use in clinical practice.

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Authors

van den Berge M, Hop WC, van der Molen T, van Noord JA, Creemers JP, Schreurs AJ, Wouters EF, Postma DS, COSMIC (COPD and Seretide: a Multi-Center Intervention and Characterization) study group

Institution

Department of Respiratory Medicine, University Medical Center Groningen, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands. m.van.den.berge@umcg.nl

Source

Respiratory research 13: 2012 pg 44

MeSH

Aged
Albuterol
Androstadienes
Bronchodilator Agents
Disease Progression
Drug Combinations
Female
Glucocorticoids
Humans
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive
Respiratory Function Tests
Time Factors
Withholding Treatment

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22672621