José M Marín1, Maria Ciudad2, Virginia Moya2, Santiago Carrizo1, Salvador Bello2, Barbara Piras3, Bartolomé R Celli4, Marc Miravitlles5. 1. Respiratory Department, Hospital Universitario Miguel Servet & IIS Aragon, Zaragoza, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Spain. 2. Respiratory Department, Hospital Universitario Miguel Servet & IIS Aragon, Zaragoza, Spain. 3. Institute of Respiratory Diseases, Sassari University, Sassari, Italy. 4. Brigham and Women's Hospital, Boston, USA. 5. Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: mmiravitlles@vhebron.net.
Abstract
BACKGROUND: The forced expiratory volume at first second (FEV(1)) during spirometry reflects the severity of chronic obstructive pulmonary disease (COPD) and is known to be an important prognostic factor. It is uncertain whether the response to short-acting bronchodilators may predict long-term outcomes such as hospitalizations and mortality. METHODS: We retrospectively studied a total of 1203 consecutive COPD patients without significant comorbidities during a mean (±SD) of 69 ± 39 months of follow-up. At baseline the subjects were classified as those with positive or negative bronchodilator test (BDT) and also in quartiles of absolute bronchodilator response to 400 μg of salbutamol. Hospital visits and mortality were the end points. RESULTS: A positive bronchodilator test was observed in 332 (27.6%) of the patients. There were 73 (21.9%) deaths in patients with a positive BDT versus 253 (28.7%) in those with a negative BDT (p = 0.04). In adjusted Cox regression analysis a positive BDT was significantly associated with a prolonged time to first hospitalization. After stratifying the population by quartiles of response to BDT, a dose-response relationship was observed with the best outcomes in the quartile with highest level of airflow reversibility, even after controlling for age, sex, BMI, smoking status and baseline postbronchodilator FEV(1). CONCLUSIONS: In a large population of well characterized COPD patients without significant comorbidities, those demonstrating higher levels of reversibility at baseline presented better long-term outcomes even after controlling for other known prognostic factors.
BACKGROUND: The forced expiratory volume at first second (FEV(1)) during spirometry reflects the severity of chronic obstructive pulmonary disease (COPD) and is known to be an important prognostic factor. It is uncertain whether the response to short-acting bronchodilators may predict long-term outcomes such as hospitalizations and mortality. METHODS: We retrospectively studied a total of 1203 consecutive COPDpatients without significant comorbidities during a mean (±SD) of 69 ± 39 months of follow-up. At baseline the subjects were classified as those with positive or negative bronchodilator test (BDT) and also in quartiles of absolute bronchodilator response to 400 μg of salbutamol. Hospital visits and mortality were the end points. RESULTS: A positive bronchodilator test was observed in 332 (27.6%) of the patients. There were 73 (21.9%) deaths in patients with a positive BDT versus 253 (28.7%) in those with a negative BDT (p = 0.04). In adjusted Cox regression analysis a positive BDT was significantly associated with a prolonged time to first hospitalization. After stratifying the population by quartiles of response to BDT, a dose-response relationship was observed with the best outcomes in the quartile with highest level of airflow reversibility, even after controlling for age, sex, BMI, smoking status and baseline postbronchodilator FEV(1). CONCLUSIONS: In a large population of well characterized COPDpatients without significant comorbidities, those demonstrating higher levels of reversibility at baseline presented better long-term outcomes even after controlling for other known prognostic factors.
Authors: Julio Hernández Vázquez; Ismael Ali García; Rodrigo Jiménez-García; Alejandro Álvaro Meca; Ana López de Andrés; Carmen Matesanz Ruiz; María Jesús Buendía García; Javier de Miguel Díez Journal: Int J Chron Obstruct Pulmon Dis Date: 2018-07-20
Authors: Kanika Jetmalani; Nathan J Brown; Chantale Boustany; Brett G Toelle; Guy B Marks; Michael J Abramson; David P Johns; Alan L James; Michael Hunter; Arthur W Musk; Norbert Berend; Claude S Farah; David G Chapman; Cindy Thamrin; Gregory G King Journal: ERJ Open Res Date: 2021-11-08