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

Peter M.A. Calverley, Antonio R. Anzueto, Daniel Dusser, Achim Mueller, Norbert Metzdorf, Robert A Wise

Research output: Contribution to journalArticle

Abstract

Rationale: Exacerbations of COPD are managed differently, but whether treatment of one exacerbation predicts the likelihood of subsequent events is unknown. Objective: We examined whether the treatment given for exacerbations predicted subsequent outcomes. Methods: This was a post-hoc analysis of 17,135 patients with COPD from TIOtropium Safety and Performance In Respimat® (TIOSPIR®). 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. Results: 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, P=0.0004 and HR: 1.33, P<0.0001, respectively), and a greater risk of having a hospitalized (severe) exacerbation (HR: 1.59 and 1.63, P<0.0001, respectively) or death (HR: 1.50, P=0.0059 and HR: 1.47, P=0.0002, respec-tively) 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, P<0.0001, respectively) or death (all-cause or COPD related, HR: 3.53 and 5.54, P<0.0001, respectively) versus antibiotics alone. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1297-1308
Number of pages12
JournalInternational Journal of COPD
Volume13
DOIs
StatePublished - Apr 23 2018

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Chronic Obstructive Pulmonary Disease
Anti-Bacterial Agents
Hospitalization
Therapeutics
Cause of Death
Adrenal Cortex Hormones
Logistic Models
Steroids
Regression Analysis
Demography
Safety
Tiotropium Bromide

Keywords

  • Exacerbations of COPD
  • Hospitalization
  • Severity
  • TIOSPIR®
  • Tiotropium

ASJC Scopus subject areas

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

Cite this

Treatment of exacerbations as a predictor of subsequent outcomes in patients with COPD. / Calverley, Peter M.A.; Anzueto, Antonio R.; Dusser, Daniel; Mueller, Achim; Metzdorf, Norbert; Wise, Robert A.

In: International Journal of COPD, Vol. 13, 23.04.2018, p. 1297-1308.

Research output: Contribution to journalArticle

Calverley, Peter M.A. ; Anzueto, Antonio R. ; Dusser, Daniel ; Mueller, Achim ; Metzdorf, Norbert ; Wise, Robert A. / Treatment of exacerbations as a predictor of subsequent outcomes in patients with COPD. In: International Journal of COPD. 2018 ; Vol. 13. pp. 1297-1308.
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abstract = "Rationale: Exacerbations of COPD are managed differently, but whether treatment of one exacerbation predicts the likelihood of subsequent events is unknown. Objective: We examined whether the treatment given for exacerbations predicted subsequent outcomes. Methods: This was a post-hoc analysis of 17,135 patients with COPD from TIOtropium Safety and Performance In Respimat{\circledR} (TIOSPIR{\circledR}). 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. Results: 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, P=0.0004 and HR: 1.33, P<0.0001, respectively), and a greater risk of having a hospitalized (severe) exacerbation (HR: 1.59 and 1.63, P<0.0001, respectively) or death (HR: 1.50, P=0.0059 and HR: 1.47, P=0.0002, respec-tively) 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, P<0.0001, respectively) or death (all-cause or COPD related, HR: 3.53 and 5.54, P<0.0001, respectively) versus antibiotics alone. Conclusion: 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.",
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AU - Wise, Robert A

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