Treatment of exacerbations as a predictor of subsequent outcomes in patients with COPD



Calverley, Peter MA, Anzueto, Antonio R, Dusser, Daniel, Mueller, Achim, Metzdorf, Norbert and Wise, Robert A
(2018) Treatment of exacerbations as a predictor of subsequent outcomes in patients with COPD. INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, 13. pp. 1297-1308.

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Abstract

<h4>Rationale</h4>Exacerbations of COPD are managed differently, but whether treatment of one exacerbation predicts the likelihood of subsequent events is unknown.<h4>Objective</h4>We examined whether the treatment given for exacerbations predicted subsequent outcomes.<h4>Methods</h4>This was a post-hoc analysis of 17,135 patients with COPD from TIOtropium Safety and Performance In Respimat<sup>®</sup> (TIOSPIR<sup>®</sup>). Patients treated with tiotropium with one or more moderate to severe exacerbations on study were analyzed using descriptive statistics, logistic and Cox regression analysis, and Kaplan-Meier plots.<h4>Results</h4>Of 8,061 patients with moderate to severe exacerbation(s), demographics were similar across patients with exacerbations treated with antibiotics and/or steroids or hospitalization. Exacerbations treated with systemic corticosteroids alone or in combination with antibiotics had the highest risk of subsequent exacerbation (HR: 1.21, <i>P</i>=0.0004 and HR: 1.33, <i>P</i><0.0001, respectively), and a greater risk of having a hospitalized (severe) exacerbation (HR: 1.59 and 1.63, <i>P</i><0.0001, respectively) or death (HR: 1.50, <i>P</i>=0.0059 and HR: 1.47, <i>P</i>=0.0002, respectively) compared with exacerbations treated with antibiotics alone. Initial hospitalization led to the highest risk of subsequent hospitalization (all-cause or COPD related [severe exacerbation], HR: 3.35 and 4.31, <i>P</i><0.0001, respectively) or death (all-cause or COPD related, HR: 3.53 and 5.54, <i>P</i><0.0001, respectively) versus antibiotics alone.<h4>Conclusion</h4>These data indicate that the way exacerbations are treated initially is a useful guide to the patient's subsequent clinical course. Factors that clinicians consider when making treatment choices require further clarification.

Item Type: Article
Uncontrolled Keywords: tiotropium, TIOSPIR (R), severity, exacerbations of COPD, hospitalization
Depositing User: Symplectic Admin
Date Deposited: 13 Aug 2019 09:09
Last Modified: 19 Jan 2023 00:31
DOI: 10.2147/COPD.S153631
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3051534