| アブストラクト | BACKGROUND: Little is known about the impact of exacerbations on COPD progression or whether inhaled corticosteroid (ICS) use and blood eosinophil count (BEC) affect progression. We aimed to assess this in a prospective observational study. METHODS: The study population included patients with mild to moderate COPD, aged >/=35 years, with a smoking history, who were followed up for >/=3 years from first to last spirometry recording using two large UK electronic medical record databases: Clinical Practice Research Datalink (CPRD) and Optimum Patient Care Research Database (OPCRD). Multilevel mixed-effects linear regression models were used to determine the relationship between annual exacerbation rate following initiation of therapy (ICS vs non-ICS) and FEV1 decline. Effect modification by blood eosinophils was studied through interaction terms. RESULTS: Of 12178 patients included (mean age 66 years; 48% female), 8981 (74%) received ICS. In patients with BEC >/=350 cells/microL not on ICS, each exacerbation was associated with subsequent acceleration of FEV1 decline of 19.4 mL/year (95% CI 12.0 to 26.7, p<0.0001). This excess decline was reduced by 15.1 mL/year (6.6 to 23.6) to 4.3 mL/year (1.9 to 6.7, p<0.0001) in those with BEC >/=350 cells/microL treated with ICS. CONCLUSION: Exacerbations are associated with a more rapid loss of lung function among COPD patients with elevated blood eosinophils, defined as >/=350 cells/microL, not treated with ICS. More aggressive prevention of exacerbations using ICS in such patients may prevent excess loss of lung function. |
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| 投稿者 | Kerkhof, Marjan; Voorham, Jaco; Dorinsky, Paul; Cabrera, Claudia; Darken, Patrick; Kocks, Janwillem Wh; Sadatsafavi, Mohsen; Sin, Don D; Carter, Victoria; Price, David B |
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| 組織名 | Observational and Pragmatic Research Institute, Singapore.;AstraZeneca, Durham, North Carolina, USA.;AstraZeneca, Gothenburg, Sweden.;Department of Medical Epidemiology and Biostatistics, Karolinska Institute,;Stockholm, Sweden.;AstraZeneca, 280 Headquarters Plaza, East Tower, Morristown, NJ 07960, USA.;General Practitioners Research Institute, Groningen, The Netherlands.;Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences,;University of British Columbia, Vancouver, British Columbia, Canada.;Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British;Columbia, Canada.;Observational and Pragmatic Research Institute, Singapore dprice@opri.sg.;Centre of Academic Primary Care, Division of Applied Health Sciences, University;of Aberdeen, Aberdeen, UK. |
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