Risk factors for COPD exacerbations in inhaled medication users: the COPDGene study biannual longitudinal follow-up prospective cohort

Robert Busch; MeiLan K Han; Russell P Bowler; Mark T Dransfield; J Michael Wells; Elizabeth A Regan; Craig P Hersh; COPDGene Investigators

doi:10.1186/s12890-016-0191-7

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Risk factors for COPD exacerbations in inhaled medication users: the COPDGene study biannual longitudinal follow-up prospective cohort

Journal article

Open access

Peer reviewed

Risk factors for COPD exacerbations in inhaled medication users: the COPDGene study biannual longitudinal follow-up prospective cohort

Robert Busch, MeiLan K Han, Russell P Bowler, Mark T Dransfield, J Michael Wells, Elizabeth A Regan, Craig P Hersh and COPDGene Investigators

BMC pulmonary medicine, Vol.16(1), 28

02/10/2016

DOI: 10.1186/s12890-016-0191-7

PMCID: PMC4748594

PMID: 26861867

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Abstract

Despite inhaled medications that decrease exacerbation risk, some COPD patients experience frequent exacerbations. We determined prospective risk factors for exacerbations among subjects in the COPDGene Study taking inhaled medications. 2113 COPD subjects were categorized into four medication use patterns: triple therapy with tiotropium (TIO) plus long-acting beta-agonist/inhaled-corticosteroid (ICS ± LABA), tiotropium alone, ICS ± LABA, and short-acting bronchodilators. Self-reported exacerbations were recorded in telephone and web-based longitudinal follow-up surveys. Associations with exacerbations were determined within each medication group using four separate logistic regression models. A head-to-head analysis compared exacerbation risk among subjects using tiotropium vs. ICS ± LABA. In separate logistic regression models, the presence of gastroesophageal reflux, female gender, and higher scores on the St. George's Respiratory Questionnaire were significant predictors of exacerbator status within multiple medication groups (reflux: OR 1.62-2.75; female gender: OR 1.53 - OR 1.90; SGRQ: OR 1.02-1.03). Subjects taking either ICS ± LABA or tiotropium had similar baseline characteristics, allowing comparison between these two groups. In the head-to-head comparison, tiotropium users showed a trend towards lower rates of exacerbations (OR = 0.69 [95 % CI 0.45, 1.06], p = 0.09) compared with ICS ± LABA users, especially in subjects without comorbid asthma (OR = 0.56 [95% CI 0.31, 1.00], p = 0.05). Each common COPD medication usage group showed unique risk factor patterns associated with increased risk of exacerbations, which may help clinicians identify subjects at risk. Compared to similar subjects using ICS ± LABA, those taking tiotropium showed a trend towards reduced exacerbation risk, especially in subjects without asthma. ClinicalTrials.gov NCT00608764, first received 1/28/2008.

Comorbidity

Administration, Inhalation

Adrenal Cortex Hormones - therapeutic use

Adrenergic beta-Agonists - therapeutic use

Aged

Asthma - epidemiology

Bronchodilator Agents - therapeutic use

Cohort Studies

Disease Progression

Drug Therapy, Combination

Female

Follow-Up Studies

Gastroesophageal Reflux - epidemiology

Humans

Logistic Models

Longitudinal Studies

Male

Middle Aged

Prospective Studies

Pulmonary Disease, Chronic Obstructive - drug therapy

Pulmonary Disease, Chronic Obstructive - epidemiology

Risk Factors

Sex Factors

Tiotropium Bromide - therapeutic use

Details

Title: Subtitle: Risk factors for COPD exacerbations in inhaled medication users: the COPDGene study biannual longitudinal follow-up prospective cohort
Creators: Robert Busch - Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA. rerbu@channing.harvard.edu
MeiLan K Han - Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA. mrking@med.umich.edu
Russell P Bowler - Department of Medicine, National Jewish Health, Denver, CO, USA. BowlerR@njhealth.org
Mark T Dransfield - Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. mdrans99@uab.edu
J Michael Wells - University of Alabama at Birmingham Hospital
Elizabeth A Regan - Department of Medicine, National Jewish Health, Denver, CO, USA. regane@njhealth.org
Craig P Hersh - Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA. craig.hersh@channing.harvard.edu
COPDGene Investigators
Contributors: Eric A Hoffman (Contributor) - University of Iowa, Radiology
Resource Type: Journal article
Publication Details: BMC pulmonary medicine, Vol.16(1), 28
DOI: 10.1186/s12890-016-0191-7
PMID: 26861867
PMCID: PMC4748594
NLM abbreviation: BMC Pulm Med
ISSN: 1471-2466
eISSN: 1471-2466
Grant note: P30 ES005605 / NIEHS NIH HHS R01HL094635 / NHLBI NIH HHS T32 HL007427 / NHLBI NIH HHS U01 HL089897 / NHLBI NIH HHS R01 HL089856 / NHLBI NIH HHS P01HL105339 / NHLBI NIH HHS U01 HL089856 / NHLBI NIH HHS R01NR013377 / NINR NIH HHS R01HL089897 / NHLBI NIH HHS R01 NR013377 / NINR NIH HHS P01 HL105339 / NHLBI NIH HHS R01 HL089897 / NHLBI NIH HHS R01 HL094635 / NHLBI NIH HHS R01HL089856 / NHLBI NIH HHS
Language: English
Date published: 02/10/2016
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
Record Identifier: 9984240439702771

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