Tags

Type your tag names separated by a space and hit enter

Spirometric changes during exacerbations of COPD: a post hoc analysis of the WISDOM trial.
Respir Res. 2018 Dec 13; 19(1):251.RR

Abstract

BACKGROUND

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function and poor outcomes for patients. However, there are limited data on the time course of changes in forced expiratory volume in 1 s (FEV1) preceding the first reported symptom and after the start of an exacerbation.

METHODS

WISDOM was a multinational, randomized, double-blind, active-controlled, 52-week study in patients with severe-to-very severe COPD. Patients received triple therapy (long-acting muscarinic antagonist and long-acting β2-agonist/inhaled corticosteroid [ICS]) for 6 weeks, and were randomized to continue triple therapy or stepwise withdrawal of the ICS (dual bronchodilator group). After suitable training, patients performed daily spirometry at home using a portable, battery-operated spirometer. In the present post hoc analysis, patients who continued to perform daily home spirometry and completed at least one measurement per week for a 56-day period before and after the start of a moderate or severe exacerbation were included. Missing values were imputed by linear interpolation (intermittent), backfilling (beginning) or carry forward (end). Exacerbation onset was the first day of a reported symptom of exacerbation.

RESULTS

Eight hundred and eighty-eight patients in the WISDOM study had a moderate/severe exacerbation after the complete ICS withdrawal visit; 360 of them contributed at least one FEV1 measure per week for the 8 weeks before and after the event and are included in this analysis. Mean daily FEV1 began to decline from approximately 2 weeks before the onset of symptoms of an exacerbation, dropping from 0.907 L (mean Days - 56 to - 36 before the exacerbation) to 0.860 L on the first day of the exacerbation. After the exacerbation, mean FEV1 improved but did not return to pre-exacerbation levels (mean Days 36-56 after the exacerbation, 0.875 L). The pattern of FEV1 changes around exacerbations was similar in the triple therapy and dual bronchodilator groups, and a similar pattern was seen in moderate and severe exacerbations when analysed separately.

CONCLUSIONS

Mean lung function starts to decline prior to the first reported symptoms of an exacerbation, and does not recover to pre-exacerbation levels 8 weeks after the event.

TRIAL REGISTRATION

WISDOM (ClinicalTrials.gov number, NCT00975195).

Authors+Show Affiliations

Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany. H.Watz@pulmoresearch.de.Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany. Department of Sports Medicine, University of Tübingen, Tübingen, Germany.Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany.Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany.Hospital Clínic IDIBAPS-CIBERES, Universitat de Barcelona, Barcelona, Spain.Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands.Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany.Institute of Ageing and Chronic Disease, Clinical Science Centre, University Hospital Aintree, Liverpool, UK.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

30545350

Citation

Watz, Henrik, et al. "Spirometric Changes During Exacerbations of COPD: a Post Hoc Analysis of the WISDOM Trial." Respiratory Research, vol. 19, no. 1, 2018, p. 251.
Watz H, Tetzlaff K, Magnussen H, et al. Spirometric changes during exacerbations of COPD: a post hoc analysis of the WISDOM trial. Respir Res. 2018;19(1):251.
Watz, H., Tetzlaff, K., Magnussen, H., Mueller, A., Rodriguez-Roisin, R., Wouters, E. F. M., Vogelmeier, C., & Calverley, P. M. A. (2018). Spirometric changes during exacerbations of COPD: a post hoc analysis of the WISDOM trial. Respiratory Research, 19(1), 251. https://doi.org/10.1186/s12931-018-0944-3
Watz H, et al. Spirometric Changes During Exacerbations of COPD: a Post Hoc Analysis of the WISDOM Trial. Respir Res. 2018 Dec 13;19(1):251. PubMed PMID: 30545350.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spirometric changes during exacerbations of COPD: a post hoc analysis of the WISDOM trial. AU - Watz,Henrik, AU - Tetzlaff,Kay, AU - Magnussen,Helgo, AU - Mueller,Achim, AU - Rodriguez-Roisin,Roberto, AU - Wouters,Emiel F M, AU - Vogelmeier,Claus, AU - Calverley,Peter M A, Y1 - 2018/12/13/ PY - 2018/08/20/received PY - 2018/11/20/accepted PY - 2018/12/15/entrez PY - 2018/12/14/pubmed PY - 2019/1/10/medline KW - COPD KW - COPD exacerbation KW - FEV1 KW - Home-based spirometry KW - Lung function SP - 251 EP - 251 JF - Respiratory research JO - Respir Res VL - 19 IS - 1 N2 - BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function and poor outcomes for patients. However, there are limited data on the time course of changes in forced expiratory volume in 1 s (FEV1) preceding the first reported symptom and after the start of an exacerbation. METHODS: WISDOM was a multinational, randomized, double-blind, active-controlled, 52-week study in patients with severe-to-very severe COPD. Patients received triple therapy (long-acting muscarinic antagonist and long-acting β2-agonist/inhaled corticosteroid [ICS]) for 6 weeks, and were randomized to continue triple therapy or stepwise withdrawal of the ICS (dual bronchodilator group). After suitable training, patients performed daily spirometry at home using a portable, battery-operated spirometer. In the present post hoc analysis, patients who continued to perform daily home spirometry and completed at least one measurement per week for a 56-day period before and after the start of a moderate or severe exacerbation were included. Missing values were imputed by linear interpolation (intermittent), backfilling (beginning) or carry forward (end). Exacerbation onset was the first day of a reported symptom of exacerbation. RESULTS: Eight hundred and eighty-eight patients in the WISDOM study had a moderate/severe exacerbation after the complete ICS withdrawal visit; 360 of them contributed at least one FEV1 measure per week for the 8 weeks before and after the event and are included in this analysis. Mean daily FEV1 began to decline from approximately 2 weeks before the onset of symptoms of an exacerbation, dropping from 0.907 L (mean Days - 56 to - 36 before the exacerbation) to 0.860 L on the first day of the exacerbation. After the exacerbation, mean FEV1 improved but did not return to pre-exacerbation levels (mean Days 36-56 after the exacerbation, 0.875 L). The pattern of FEV1 changes around exacerbations was similar in the triple therapy and dual bronchodilator groups, and a similar pattern was seen in moderate and severe exacerbations when analysed separately. CONCLUSIONS: Mean lung function starts to decline prior to the first reported symptoms of an exacerbation, and does not recover to pre-exacerbation levels 8 weeks after the event. TRIAL REGISTRATION: WISDOM (ClinicalTrials.gov number, NCT00975195). SN - 1465-993X UR - https://www.unboundmedicine.com/medline/citation/30545350/Spirometric_changes_during_exacerbations_of_COPD:_a_post_hoc_analysis_of_the_WISDOM_trial_ L2 - https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-018-0944-3 DB - PRIME DP - Unbound Medicine ER -