Pharmacotherapy and Lung Function Decline in Patients with Chronic Obstructive Pulmonary Disease A Systematic Review



Celli, Bartolome R, Anderson, Julie A, Cowans, Nicholas J, Crim, Courtney, Hartley, Benjamin F, Martinez, Fernando J, Morris, Andrea N, Quasny, Holly, Yates, Julie, Vestbo, Jorgen
et al (show 1 more authors) (2021) Pharmacotherapy and Lung Function Decline in Patients with Chronic Obstructive Pulmonary Disease A Systematic Review. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 203 (6). pp. 689-698.

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Abstract

<b>Rationale:</b> Whether pharmacological therapy alters decline in FEV<sub>1</sub> in chronic obstructive pulmonary disease remains controversial. Because pharmacotherapy improves health status, exacerbation rate, and symptoms, it may be unethical to complete placebo-controlled long-term studies aimed at modifying FEV<sub>1</sub> decline.<b>Objectives:</b> We conducted a systematic review of placebo-controlled pharmacological trials lasting ≥1 year to address the question of whether therapy alters FEV<sub>1</sub> decline.<b>Methods:</b> A literature search for randomized trials that included repeated spirometry with at least one active and one placebo arm was conducted. Articles were excluded if study duration was <1 year, <3 spirometric measurements, or <100 subjects per arm. Study design was assessed using the Jadad score. To combine studies and find the estimated effect, we used random effects methodology to account for both within-study and between-study variation.<b>Measurements and Main Results:</b> There were 33,051 patients in the analysis (active component, <i>n</i> = 21,941; placebo, <i>n</i> = 11,110 in nine studies). The active treatment arms demonstrated a 5.0 ml/yr reduction (95% confidence interval, 0.8-9.1 ml/yr; <i>P</i> < 0.001) in the rate of FEV<sub>1</sub> decline compared with the placebo arms. The relative FEV<sub>1</sub> differences between active and placebo arms were within the range of differences reported for health status and for the exacerbation rate in the same studies.<b>Conclusions:</b> In chronic obstructive pulmonary disease, pharmacotherapy ameliorates rate of lung function decline. The relative benefit observed is within the range of those reported for health status and exacerbations in the same studies. Guidelines should be adjusted according to these findings.

Item Type: Article
Uncontrolled Keywords: chronic obstructive pulmonary disease, lung function decline, forced expiratory volume, systematic review, spirometry
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 30 Jun 2021 13:56
Last Modified: 17 Mar 2024 09:53
DOI: 10.1164/rccm.202005-1854OC
Open Access URL: https://www.atsjournals.org/doi/10.1164/rccm.20200...
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3128282