Acute Exacerbations and Lung Function Loss in Smokers with and without Chronic Obstructive Pulmonary Disease

Mark T Dransfield; Ken M Kunisaki; Matthew J Strand; Antonio Anzueto; Surya P Bhatt; Russell P Bowler; Gerard J Criner; Jeffrey L Curtis; Nicola A Hanania; Hrudaya Nath; Nirupama Putcha; Sarah E Roark; Emily S Wan; George R Washko; J Michael Wells; Christine H Wendt; Barry J Make; COPDGene Investigators

doi:10.1164/rccm.201605-1014OC

Back

Acute Exacerbations and Lung Function Loss in Smokers with and without Chronic Obstructive Pulmonary Disease

Journal article

Open access

Peer reviewed

Acute Exacerbations and Lung Function Loss in Smokers with and without Chronic Obstructive Pulmonary Disease

Mark T Dransfield, Ken M Kunisaki, Matthew J Strand, Antonio Anzueto, Surya P Bhatt, Russell P Bowler, Gerard J Criner, Jeffrey L Curtis, Nicola A Hanania, Hrudaya Nath, …

American journal of respiratory and critical care medicine, Vol.195(3), pp.324-330

02/01/2017

DOI: 10.1164/rccm.201605-1014OC

PMCID: PMC5328181

PMID: 27556408

Files and links (1)

url

https://doi.org/10.1164/rccm.201605-1014OCView

Published (Version of record) Open Access

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (COPD) increase the risk of death and drive healthcare costs, but whether they accelerate loss of lung function remains controversial. Whether exacerbations in subjects with mild COPD or similar acute respiratory events in smokers without airflow obstruction affect lung function decline is unknown. To determine the association between acute exacerbations of COPD (and acute respiratory events in smokers without COPD) and the change in lung function over 5 years of follow-up. We examined data on the first 2,000 subjects who returned for a second COPDGene visit 5 years after enrollment. Baseline data included demographics, smoking history, and computed tomography emphysema. We defined exacerbations (and acute respiratory events in those without established COPD) as acute respiratory symptoms requiring either antibiotics or systemic steroids, and severe events by the need for hospitalization. Throughout the 5-year follow-up period, we collected self-reported acute respiratory event data at 6-month intervals. We used linear mixed models to fit FEV decline based on reported exacerbations or acute respiratory events. In subjects with COPD, exacerbations were associated with excess FEV decline, with the greatest effect in Global Initiative for Chronic Obstructive Lung Disease stage 1, where each exacerbation was associated with an additional 23 ml/yr decline (95% confidence interval, 2-44; P = 0.03), and each severe exacerbation with an additional 87 ml/yr decline (95% confidence interval, 23-151; P = 0.008); statistically significant but smaller effects were observed in Global Initiative for Chronic Obstructive Lung Disease stage 2 and 3 subjects. In subjects without airflow obstruction, acute respiratory events were not associated with additional FEV decline. Exacerbations are associated with accelerated lung function loss in subjects with established COPD, particularly those with mild disease. Trials are needed to test existing and novel therapies in subjects with early/mild COPD to potentially reduce the risk of progressing to more advanced lung disease. Clinical trial registered with www.clinicaltrials.gov (NCT 00608764).

Comorbidity

Smoking - adverse effects

Spirometry

Follow-Up Studies

Forced Expiratory Volume - physiology

Humans

Middle Aged

Male

Lung - physiopathology

Pulmonary Disease, Chronic Obstructive - physiopathology

Pulmonary Disease, Chronic Obstructive - epidemiology

Disease Progression

Smoking - epidemiology

Vital Capacity - physiology

Female

Details

Title: Subtitle: Acute Exacerbations and Lung Function Loss in Smokers with and without Chronic Obstructive Pulmonary Disease
Creators: Mark T Dransfield - 2 Birmingham VA Medical Center, Birmingham, Alabama
Ken M Kunisaki - 4 University of Minnesota, Minneapolis, Minnesota
Matthew J Strand - 5 National Jewish Health, Denver, Colorado
Antonio Anzueto - 7 South Texas Veterans Health Care System, San Antonio, Texas
Surya P Bhatt - 1 Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
Russell P Bowler - 5 National Jewish Health, Denver, Colorado
Gerard J Criner - 8 Temple University, Philadelphia, Pennsylvania
Jeffrey L Curtis - 10 VA Ann Arbor Health Care System, Ann Arbor, Michigan
Nicola A Hanania - 11 Baylor College of Medicine, Houston, Texas
Hrudaya Nath - 1 Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
Nirupama Putcha - 12 Johns Hopkins University School of Medicine, Baltimore, Maryland; and
Sarah E Roark - 9 University of Michigan, Ann Arbor, Michigan
Emily S Wan - 13 Brigham and Women's Hospital, Boston, Massachusetts
George R Washko - 13 Brigham and Women's Hospital, Boston, Massachusetts
J Michael Wells - 2 Birmingham VA Medical Center, Birmingham, Alabama
Christine H Wendt - 4 University of Minnesota, Minneapolis, Minnesota
Barry J Make - 5 National Jewish Health, Denver, Colorado
COPDGene Investigators
Contributors: Eric A Hoffman (Contributor) - University of Iowa, Radiology
Resource Type: Journal article
Publication Details: American journal of respiratory and critical care medicine, Vol.195(3), pp.324-330
DOI: 10.1164/rccm.201605-1014OC
PMID: 27556408
PMCID: PMC5328181
NLM abbreviation: Am J Respir Crit Care Med
ISSN: 1073-449X
eISSN: 1535-4970
Publisher: United States
Grant note: U01 HL089856 / NHLBI NIH HHS K08 HL123940 / NHLBI NIH HHS U01 HL089897 / NHLBI NIH HHS R01 HL089856 / NHLBI NIH HHS S10 OD018526 / NIH HHS I01 CX000911 / CSRD VA T32 HL007741 / NHLBI NIH HHS R01 HL089897 / NHLBI NIH HHS K23 HL123594 / NHLBI NIH HHS
Language: English
Date published: 02/01/2017
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
Record Identifier: 9984051576502771

Metrics

30 Record Views

280 Times Cited - Web of Science