Clinical features and determinants of COPD exacerbation in the Hokkaido COPD cohort study

Suzuki, Masaru; Makita, Hironi; Ito, Yoichi M.; Nagai, Katsura; Konno, Satoshi; Nishimura, Masaharu

doi:10.1183/09031936.00110213

Cited by 96 publications

(103 citation statements)

References 28 publications

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“…Although some have suggested a significant excess loss of FEV 1 for each respiratory event (13), or in those with frequent events (15), others have reported minimal (12) or no relationship (18). Such disparate results may result from design differences including sample size, study duration, and exacerbation definitions.…”

Section: Measurements and Main Resultsmentioning

confidence: 82%

“…Previous studies have examined the relationship between acute respiratory illnesses and lung function decline in subjects with established COPD but the findings are not consistent (11)(12)(13)(14)(15)(16)(17)(18). Although some have suggested a significant excess loss of FEV 1 for each respiratory event (13), or in those with frequent events (15), others have reported minimal (12) or no relationship (18).…”

Section: Measurements and Main Resultsmentioning

confidence: 92%

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Acute Exacerbations and Lung Function Loss in Smokers with and without Chronic Obstructive Pulmonary Disease

Dransfield

Kunisaki

Strand

et al. 2017

Am J Respir Crit Care Med

246

193

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Rationale: Acute exacerbations of chronic obstructive pulmonary disease (COPD) increase the risk of death and drive healthcare costs, but whether they accelerate loss of lung function remains controversial. Whether exacerbations in subjects with mild COPD or similar acute respiratory events in smokers without airflow obstruction affect lung function decline is unknown.Objectives: To determine the association between acute exacerbations of COPD (and acute respiratory events in smokers without COPD) and the change in lung function over 5 years of follow-up.Methods: We examined data on the first 2,000 subjects who returned for a second COPDGene visit 5 years after enrollment. Baseline data included demographics, smoking history, and computed tomography emphysema. We defined exacerbations (and acute respiratory events in those without established COPD) as acute respiratory symptoms requiring either antibiotics or systemic steroids, and severe events by the need for hospitalization. Throughout the 5-year follow-up period, we collected self-reported acute respiratory event data at 6-month intervals. We used linear mixed models to fit FEV 1 decline based on reported exacerbations or acute respiratory events. Measurements and Main Results:In subjects with COPD, exacerbations were associated with excess FEV 1 decline, with the greatest effect in Global Initiative for Chronic Obstructive Lung Disease stage 1, where each exacerbation was associated with an additional 23 ml/yr decline (95% confidence interval, 2-44; P = 0.03), and each severe exacerbation with an additional 87 ml/yr decline (95% confidence interval, 23-151; P = 0.008); statistically significant but smaller effects were observed in Global Initiative for Chronic Obstructive Lung Disease stage 2 and 3 subjects. In subjects without airflow obstruction, acute respiratory events were not associated with additional FEV 1 decline.Conclusions: Exacerbations are associated with accelerated lung function loss in subjects with established COPD, particularly those with mild disease. Trials are needed to test existing and novel therapies in subjects with early/mild COPD to potentially reduce the risk of progressing to more advanced lung disease.Clinical trial registered with www.clinicaltrials.gov (NCT 00608764).

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Section: Measurements and Main Resultsmentioning

confidence: 82%

Section: Measurements and Main Resultsmentioning

confidence: 92%

Acute Exacerbations and Lung Function Loss in Smokers with and without Chronic Obstructive Pulmonary Disease

Dransfield

Kunisaki

Strand

et al. 2017

Am J Respir Crit Care Med

246

193

View full text Add to dashboard Cite

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“…In this issue of the European Respiratory Journal, the relationship between exacerbations and lung function decline is addressed in a cohort of 279 Japanese subjects followed over a 5-year period in Hokkaido [11]. The detection rate for exacerbations in this study was 0.78 events per year using a symptom-based definition.…”

Section: @Erspublicationsmentioning

confidence: 99%

“…In a Canadian study, WATERS et al [9] showed that severe cystic fibrosis exacerbations (requiring hospitalisation) were associated with greater FEV1 decline. Although the European Cystic Fibrosis Society study did not report on exacerbations they have reported a link between chronic Pseudomonas aeruginosa infection (a known risk factor for cystic fibrosis exacerbations) and FEV1 decline [10], from which such a relationship may be inferred and this supports the findings of the Canadian study.In this issue of the European Respiratory Journal, the relationship between exacerbations and lung function decline is addressed in a cohort of 279 Japanese subjects followed over a 5-year period in Hokkaido [11]. The detection rate for exacerbations in this study was 0.78 events per year using a symptom-based definition.…”

mentioning

confidence: 99%

Exacerbation frequency and FEV1 decline of COPD: is it geographic?

Seemungal

Wedzicha

2014

European Respiratory Journal

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@ERSpublicationsAll exacerbation data, whether reported, self-managed or untreated, is required to recognise health burdens in COPD http://ow.ly/usGyB Chronic obstructive pulmonary disease (COPD) exacerbations are episodes of symptom worsening that have major impacts on a variety of health outcomes, including quality of life, hospital admission and death [1]. Exacerbation reduction is now a key outcome for pharmacological therapies in COPD and, thus, if exacerbation can be prevented how does this affect disease progression and lung function decline?The issue of the importance of lung function decline in COPD first arose when FLETCHER and PETO [2] explored lung function in a cohort of 792 male British postal workers. These subjects were studied over 8 years and it was found that exacerbations were associated with the ratio of forced expiratory volume in 1 s (FEV1) to the cube of the height, although the exacerbation definition was limited at that time. This work was followed in close succession by a study from Utah in which KANNER et al. [3] showed that exacerbation frequency was related to COPD severity, thus implicating exacerbation frequency as a factor in FEV1 decline. However, detecting the relationship proved elusive until the Lung Health Study showed that in smokers and intermittent quitters each additional exacerbation reported to physicians caused a greater annual decline of 7 mL [4]. The following year, the London COPD cohort study reported that in patients with a history of more frequent exacerbations there was an increased rate of decline of 8 mL per year compared with infrequent exacerbators [5]. The relationship between exacerbation frequency and FEV1 decline in COPD has also been seen in the UPLIFT study [6] and another study from Greece [7]. All of these studies were performed on European or North American subjects with COPD.In diseases other than COPD, an occasional relationship has been reported between exacerbation rates and FEV1 decline. In a study of asthmatics over a period of 11 years, a relationship was seen between exacerbation frequency and FEV1 decline [8]. In a Canadian study, WATERS et al. [9] showed that severe cystic fibrosis exacerbations (requiring hospitalisation) were associated with greater FEV1 decline. Although the European Cystic Fibrosis Society study did not report on exacerbations they have reported a link between chronic Pseudomonas aeruginosa infection (a known risk factor for cystic fibrosis exacerbations) and FEV1 decline [10], from which such a relationship may be inferred and this supports the findings of the Canadian study.In this issue of the European Respiratory Journal, the relationship between exacerbations and lung function decline is addressed in a cohort of 279 Japanese subjects followed over a 5-year period in Hokkaido [11]. The detection rate for exacerbations in this study was 0.78 events per year using a symptom-based definition. The study found no significant relation between exacerbation rate and FEV1 decline. The annual decline in FEV1 in the Hokkaido...

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“…Biomarkers may also be very different between never-smokers and current or former smokers. Secondly, many trials look at very short-term outcomes, given the long duration and variability in the natural history of COPD [7][8][9]. In the study by LEUNG et al [4], the differences between the 1-and 2-year analyses are impressive.…”

mentioning

confidence: 99%

Biomarkers in COPD: the search continues!

Mannino

2015

Eur Respir J

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Clinical features and determinants of COPD exacerbation in the Hokkaido COPD cohort study

Cited by 96 publications

References 28 publications

Acute Exacerbations and Lung Function Loss in Smokers with and without Chronic Obstructive Pulmonary Disease

Acute Exacerbations and Lung Function Loss in Smokers with and without Chronic Obstructive Pulmonary Disease

Exacerbation frequency and FEV1 decline of COPD: is it geographic?

Biomarkers in COPD: the search continues!

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