Seasonal variations in exacerbations and deaths in patients with COPD during the TIOSPIR® trial



Wise, Robert A, Calverley, Peter MA, Carter, Kerstine, Clerisme-Beaty, Emmanuelle, Metzdorf, Norbert and Anzueto, Antonio
(2018) Seasonal variations in exacerbations and deaths in patients with COPD during the TIOSPIR® trial. INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, 13. pp. 605-616.

[img] Text
Seasonal variations in exacerbations and deaths in patients with COPD during the TIOSPIR® trial.pdf - Published version

Download (924kB) | Preview

Abstract

<h4>Background</h4>Although COPD exacerbations are known to occur more frequently in winter, there is little information on hospitalizations and cause-specific mortality. This study aimed to examine seasonal variations in mortality and exacerbations in patients with COPD during the TIOtropium Safety and Performance In Respimat<sup>®</sup> (TIOSPIR<sup>®</sup>) trial.<h4>Patients and methods</h4>TIOSPIR was a large-scale, multicenter trial, which assessed the safety and efficacy of tiotropium delivered via HandiHaler<sup>®</sup> (18 μg once daily) or Respimat<sup>®</sup> Soft Mist™ (2.5 or 5 μg once daily) inhaler in patients with COPD. Patients were aged ≥40 years, with a smoking history ≥10 pack-years, and post-bronchodilator forced expiratory volume in 1 second ≤70% and forced expiratory volume in 1 second/forced vital capacity ≤0.70. COPD exacerbations and deaths were monitored throughout the trial. The data were pooled to examine seasonal patterns. Southern hemisphere data were shifted by 6 months to align with northern hemisphere seasons.<h4>Results</h4>TIOSPIR was conducted in 43 northern (n=15,968) and 7 southern (n=1,148) hemisphere (n=1,148) countries. The median duration of treatment was 835 days, with a mean follow-up of 2.3 years. Among 19,494 exacerbations, there were clear seasonal differences (winter, 6,646 [34.1%]; spring, 4,515 [23.2%]; summer, 3,198 [16.4%]; autumn, 5,135 [26.3%]). Exacerbations peaked in early winter (December in the northern hemisphere and June in the southern hemisphere), respiratory hospitalizations in midwinter, and respiratory deaths in early spring.<h4>Conclusion</h4>Although winter poses a 2-fold hazard for COPD exacerbations vs summer, respiratory deaths peak in early spring. These data suggest that seasonal intensification of preventive treatments may impact COPD morbidity and mortality.<h4>Trial registration number</h4>NCT01126437.

Item Type: Article
Uncontrolled Keywords: TIOSPIR, tiotropium, HandiHaler, Respimat Soft Mist inhaler, seasonality, preventive treatment, exacerbations
Depositing User: Symplectic Admin
Date Deposited: 12 Aug 2019 10:49
Last Modified: 13 Oct 2023 09:10
DOI: 10.2147/COPD.S148393
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3051358