Quality of life and adherence to inhaled corticosteroids and tiotropium in COPD are related

Huurne, Kirsten Koehorst-ter; Kort, Sharina; Palen, Job van der; Beurden, W.J.C. van; Movig, Kris L. L.; Valk, Paul van der; Brusse-Keizer, Marjolein

doi:10.2147/copd.s107303

Cited by 11 publications

(6 citation statements)

References 28 publications

(29 reference statements)

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“…Approximately 80% of the patients used ICSs. 16 Patients in group 2 had a worse lung function, the duration between the two subsequent AECOPDs was shorter and they had more previous AECOPD.…”

Section: Resultsmentioning

confidence: 90%

Stability in eosinophil categorisation during subsequent severe exacerbations of COPD

et al. 2021

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BackgroundThe blood eosinophil count has been shown to be a promising biomarker for establishing personalised treatment strategies to reduce corticosteroid use, either inhaled or systemic, in chronic obstructive pulmonary disease (COPD). Eosinophil levels seem relatively stable over time in stable state, but little is known whether this is also true in subsequent severe acute exacerbations of COPD (AECOPD).Aims and objectivesTo determine the stability in eosinophil categorisation between two subsequent severe AECOPDs employing frequently used cut-off levels.MethodsDuring two subsequent severe AECOPDs, blood eosinophil counts were determined at admission to the hospital in 237 patients in the Cohort of Mortality and Inflammation in COPD Study. The following four cut-off levels were analysed: absolute counts of eosinophils ≥0.2×10⁹/L (200 cells/µL) and ≥0.3×10⁹/L (300 cells/µL) and relative eosinophil percentage of ≥2% and ≥3% of total leucocyte count. Categorisations were considered stable if during the second AECOPD their blood eosinophil status led to the same classification: eosinophilic or not.ResultsDepending on the used cut-off, the overall stability in eosinophil categorisation varied between 70% and 85% during two subsequent AECOPDs. From patients who were eosinophilic at the first AECOPD, 34%–45% remained eosinophilic at the subsequent AECOPD, while 9%–21% of patients being non-eosinophilic at the first AECOPD became eosinophilic at the subsequent AECOPD.ConclusionsThe eosinophil variability leads to category changes in subsequent AECOPDs, which limits the eosinophil categorisation stability. Therefore, measurement of eosinophils at each new exacerbation seems warranted.

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Section: Resultsmentioning

confidence: 90%

Stability in eosinophil categorisation during subsequent severe exacerbations of COPD

et al. 2021

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“…Previously published main determinants of nonadherence in this cohort were lung function and having more anxiety for dyspnea (measured with the Clinical COPD Questionnaire question 3). 14 An interesting additional outcome measure for future research would be to study the change in morbidity of patients based on longitudinal symptoms and quality of life assessments.…”

Section: Discussionmentioning

confidence: 99%

Association between poor therapy adherence to inhaled corticosteroids and tiotropium and morbidity and mortality in patients with COPD

Huurne¹,

Groothuis-Oudshoorn²,

VanderValk³

et al. 2018

COPD

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AimThe aim of this study was to analyze the association between therapy adherence to inhaled corticosteroids (ICSs) and tiotropium on the one hand and morbidity and mortality in COPD on the other hand.MethodsTherapy adherence to ICSs and tiotropium over a 3-year period of, respectively, 635 and 505 patients was collected from pharmacy records. It was expressed as percentage and deemed optimal at ≥75–≤125%, suboptimal at ≥50%–<75%, and poor at <50% (underuse) or >125% (overuse). The association between adherence and time to first hospital admission for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), community acquired pneumonia (CAP), and mortality was analyzed, with optimal use as the reference category.ResultsSuboptimal use and underuse of ICSs and tiotropium were associated with a substantial increase in mortality risk: hazard ratio (HR) of ICSs was 2.9 (95% CI 1.7–5.1) and 5.3 (95% CI 3.3–8.5) and HR of tiotropium was 3.9 (95% CI 2.1–7.5) and 6.4 (95% CI 3.8–10.8) for suboptimal use and underuse, respectively. Suboptimal use and overuse of tiotropium were also associated with an increased risk of CAP, HR 2.2 (95% CI 1.2–4.0) and HR 2.3 (95% CI 1.2–4.7), respectively. Nonadherence to tiotropium was also associated with an increased risk of severe AECOPD: suboptimal use HR 3.0 (95% CI 2.01–4.5), underuse HR 1.9 (95% CI 1.2–3.1), and overuse HR 1.84 (95% CI 1.1–3.1). Nonadherence to ICSs was not related to time to first AECOPD or first CAP.ConclusionPoor adherence to ICSs and tiotropium was associated with a higher mortality risk. Furthermore, nonadherence to tiotropium was associated with a higher morbidity. The question remains whether improving adherence can reduce morbidity and mortality.

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“…All patients were treated according the current COPD standard. Eighty percent of the patients used inhaled corticosteroids during follow-up (30).…”

Section: Setting and Study Populationmentioning

confidence: 99%

Stable State Proadrenomedullin Level in COPD Patients: A Validation Study

Zuur-Telgen

VanderValk

Palen

et al. 2016

COPD: Journal of Chronic Obstructive Pulmonary Disease

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In patients with stable COPD, proadrenomedullin (MR-proADM) has been shown to be a good predictor for mortality. This study aims to provide an external validation of earlier observed cut-off values used by Zuur-Telgen et al. and Stolz.et al. in COPD patients in stable state and at hospitalization for an acute exacerbation of COPD (AECOPD). From the COMIC cohort study we included 545 COPD patients with a blood sample obtained in stable state (n = 490) and/or at hospitalization for an AECOPD (n = 101). Time to death was compared between patients with MR-proADM cut-off scores 0.71 and 0.75 nmol/L for stable state or 0.79 and 0.84 nmol/l for AECOPD. The predictive value of MR-proADM for survival was represented by the C statistic. Risk ratios were corrected for sex, age, BMI, presence of heart failure, and GOLD stage. Patients above the cut-off of 0.75 nmol/l had a 2-fold higher risk of dying than patient below this cut-off (95% CI: 1.20-3.41). The cut-off of 0.71 nmol/l showed only a borderline significantly higher risk of 1.67 (95% CI: 0.98-2.85). The corrected odds ratios for one-year mortality were 3.15 (95% CI 1.15-8.64) and 3.70 (95% CI 1.18-11.6) in patients with MR-proADM levels above versus below the cut-off of respectively 0.75 and 0.71 nmol/l measured in stable state. MR-proADM levels in samples at hospitalization for an AECOPD were not predictive for mortality in this validation cohort. MR-proADM in stable state is a powerful predictor for mortality.

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Quality of life and adherence to inhaled corticosteroids and tiotropium in COPD are related

Cited by 11 publications

References 28 publications

Stability in eosinophil categorisation during subsequent severe exacerbations of COPD

Stability in eosinophil categorisation during subsequent severe exacerbations of COPD

Association between poor therapy adherence to inhaled corticosteroids and tiotropium and morbidity and mortality in patients with COPD

Stable State Proadrenomedullin Level in COPD Patients: A Validation Study

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