J Korean Med Sci.  2015 Jan;30(1):54-59. 10.3346/jkms.2015.30.1.54.

Three-month Treatment Response and Exacerbation in Chronic Obstructive Pulmonary Disease

• Lee JS
• Rhee CK
• Yoo KH
• Lee JH
• Yoon HI
• Kim TH
• Kim WJ
• Lee J
• Lim SY
• Park TS
• Lee JS
• Lee SW
• Lee SD
• Oh YM

• KMID: 2155447
• DOI: http://doi.org/10.3346/jkms.2015.30.1.54

Abstract

The aim of this study was to investigate relationships between acute exacerbation and Forced Expiratory Volume 1 second (FEV1) improvement after treatment with combined long-acting beta-agonist (LABA) and inhaled corticosteroid (ICS) in patients with chronic obstructive pulmonary disease (COPD). A total of 137 COPD patients were classified as responders or nonresponders according to FEV1 improvement after 3 months of LABA/ICS treatment in fourteen referral hospitals in Korea. Exacerbation occurrence in these two subgroups was compared over a period of 1 yr. Eighty of the 137 COPD patients (58.4%) were classified as responders and 57 (41.6%) as nonresponders. Acute exacerbations occurred in 25 patients (31.3%) in the responder group and in 26 patients (45.6%) in the nonresponder group (P=0.086). FEV1 improvement after LABA/ICS treatment was a significant prognostic factor for fewer acute exacerbations in a multivariate Cox proportional hazard model adjusted for age, sex, FEV1, smoking history, 6 min walk distance, body mass index, exacerbation history in the previous year, and dyspnea scale.Three-month treatment response to LABA/ICS might be a prognostic factor for the occurrence of acute exacerbation in COPD patients.

Keyword

Pulmonary Disease, Chronic Obstructive; Forced Expiratory Volume; Disease Progression

MeSH Terms

Adrenal Cortex Hormones/*therapeutic use
Adrenergic beta-2 Receptor Agonists/*therapeutic use
Bronchodilator Agents/*therapeutic use
Budesonide/therapeutic use
Drug Therapy, Combination
Female
Fluticasone/therapeutic use
Forced Expiratory Volume/drug effects/*physiology
Formoterol Fumarate/therapeutic use
Humans
Male
Pulmonary Disease, Chronic Obstructive/*drug therapy/physiopathology
Recurrence
Republic of Korea
Salmeterol Xinafoate/therapeutic use
Smoking
Spirometry
Treatment Outcome
Adrenal Cortex Hormones
Adrenergic beta-2 Receptor Agonists
Bronchodilator Agents
Budesonide
Fluticasone
Formoterol Fumarate
Salmeterol Xinafoate

Figure

• 

  Fig. 1 Exacerbation rates according to 3-month treatment response (3MTR). (A) The 3MTR was evaluated with the change of FEV1 in mL after 3-month treatment (P=0.035). A cut-off value of 120 mL was defined by the minimal clinically important difference (MCID)(3, 17).The other cut-off of 300 mL was defined as it was near the upper tertile value. Exacerbation occurrence represents % of COPD patients who experienced exacerbation during the one year of follow-up. (B) The 3MTR was evaluated with the change of FEV1 in % of the predicted reference value after 3-month treatment (P=0.039). According to MCID (3, 17), the responder group was defined when FEV1 improvement was 4% or more of the predicted value after 3-month treatment. We further classified the responder group arbitrarily into two categories based on the change in FEV1, with a cut-off of 8% predicted value.

• 

  Fig. 2 Exacerbation occurrence according to baseline characteristics.

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