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

Robert A Wise, Peter M.A. Calverley, Kerstine Carter, Emmanuelle Clerisme-Beaty, Norbert Metzdorf, Antonio Anzueto

Research output: Contribution to journalArticle

Abstract

Background: 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® (TIOSPIR®) trial. Patients and methods: TIOSPIR was a large-scale, multicenter trial, which assessed the safety and efficacy of tiotropium delivered via HandiHaler® (18 μg once daily) or Respimat® 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. Results: 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. Conclusion: 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. Trial registration number: NCT01126437.

Original languageEnglish (US)
Pages (from-to)605-616
Number of pages12
JournalInternational Journal of COPD
Volume13
DOIs
StatePublished - Feb 14 2018

Fingerprint

Chronic Obstructive Pulmonary Disease
Safety
Forced Expiratory Volume
Mortality
Hospitalization
Nebulizers and Vaporizers
Bronchodilator Agents
Vital Capacity
Multicenter Studies
Tiotropium Bromide
Smoking
History
Morbidity
Therapeutics

Keywords

  • Exacerbations
  • HandiHaler
  • Preventive treatment
  • Respimat Soft Mist inhaler
  • Seasonality
  • TIOSPIR
  • Tiotropium

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Seasonal variations in exacerbations and deaths in patients with COPD during the TIOSPIR® trial. / Wise, Robert A; Calverley, Peter M.A.; Carter, Kerstine; Clerisme-Beaty, Emmanuelle; Metzdorf, Norbert; Anzueto, Antonio.

In: International Journal of COPD, Vol. 13, 14.02.2018, p. 605-616.

Research output: Contribution to journalArticle

Wise, Robert A ; Calverley, Peter M.A. ; Carter, Kerstine ; Clerisme-Beaty, Emmanuelle ; Metzdorf, Norbert ; Anzueto, Antonio. / Seasonal variations in exacerbations and deaths in patients with COPD during the TIOSPIR® trial. In: International Journal of COPD. 2018 ; Vol. 13. pp. 605-616.
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AU - Calverley, Peter M.A.

AU - Carter, Kerstine

AU - Clerisme-Beaty, Emmanuelle

AU - Metzdorf, Norbert

AU - Anzueto, Antonio

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