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Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.

Donaldson, GC; Seemungal, TAR; Bhowmik, A; Wedzicha, JA; (2002) Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax , 57 (10) pp. 847-852. 10.1136/thorax.57.10.847. Green open access

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Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterised by both an accelerated decline in lung function and periods of acute deterioration in symptoms termed exacerbations. The aim of this study was to investigate whether these are related. METHODS: Over 4 years, peak expiratory flow (PEF) and symptoms were measured at home daily by 109 patients with COPD (81 men; median (IQR) age 68.1 (63-74) years; arterial oxygen tension (PaO(2)) 9.00 (8.3-9.5) kPa, forced expiratory volume in 1 second (FEV(1)) 1.00 (0.7-1.3) l, forced vital capacity (FVC) 2.51 (1.9-3.0) l); of these, 32 (29 men) recorded daily FEV(1). Exacerbations were identified from symptoms and the effect of frequent or infrequent exacerbations (> or < 2.92 per year) on lung function decline was examined using cross sectional, random effects models. RESULTS: The 109 patients experienced 757 exacerbations. Patients with frequent exacerbations had a significantly faster decline in FEV(1) and peak expiratory flow (PEF) of -40.1 ml/year (n=16) and -2.9 l/min/year (n=46) than infrequent exacerbators in whom FEV(1) changed by -32.1 ml/year (n=16) and PEF by -0.7 l/min/year (n=63). Frequent exacerbators also had a greater decline in FEV(1) if allowance was made for smoking status. Patients with frequent exacerbations were more often admitted to hospital with longer length of stay. Frequent exacerbations were a consistent feature within a patient, with their number positively correlated (between years 1 and 2, 2 and 3, 3 and 4). CONCLUSIONS: These results suggest that the frequency of exacerbations contributes to long term decline in lung function of patients with moderate to severe COPD.

Type: Article
Title: Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/thorax.57.10.847
Keywords: Administration, Inhalation, Administration, Oral, Aged, Female, Forced Expiratory Volume, Humans, Lung, Male, Middle Aged, Peak Expiratory Flow Rate, Prednisolone, Prognosis, Prospective Studies, Pulmonary Disease, Chronic Obstructive
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/8001
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