Spirometric changes during exacerbations of COPD: a post hoc analysis of the WISDOM trial

Henrik Watz*, Kay Tetzlaff, Helgo Magnussen, Achim Mueller, Roberto Rodriguez-Roisin, Emiel F. M. Wouters, Claus Vogelmeier, Peter M. A. Calverley

*Corresponding author for this work

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Abstract

BackgroundExacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function and poor outcomes for patients. However, there are limited data on the time course of changes in forced expiratory volume in 1s (FEV1) preceding the first reported symptom and after the start of an exacerbation.MethodsWISDOM was a multinational, randomized, double-blind, active-controlled, 52-week study in patients with severe-to-very severe COPD. Patients received triple therapy (long-acting muscarinic antagonist and long-acting (2)-agonist/inhaled corticosteroid [ICS]) for 6weeks, and were randomized to continue triple therapy or stepwise withdrawal of the ICS (dual bronchodilator group). After suitable training, patients performed daily spirometry at home using a portable, battery-operated spirometer. In the present post hoc analysis, patients who continued to perform daily home spirometry and completed at least one measurement per week for a 56-day period before and after the start of a moderate or severe exacerbation were included. Missing values were imputed by linear interpolation (intermittent), backfilling (beginning) or carry forward (end). Exacerbation onset was the first day of a reported symptom of exacerbation.ResultsEight hundred and eighty-eight patients in the WISDOM study had a moderate/severe exacerbation after the complete ICS withdrawal visit; 360 of them contributed at least one FEV1 measure per week for the 8weeks before and after the event and are included in this analysis.Mean daily FEV1 began to decline from approximately 2weeks before the onset of symptoms of an exacerbation, dropping from 0.907L (mean Days -56 to -36 before the exacerbation) to 0.860L on the first day of the exacerbation. After the exacerbation, mean FEV1 improved but did not return to pre-exacerbation levels (mean Days 36-56 after the exacerbation, 0.875L).The pattern of FEV1 changes around exacerbations was similar in the triple therapy and dual bronchodilator groups, and a similar pattern was seen in moderate and severe exacerbations when analysed separately.ConclusionsMean lung function starts to decline prior to the first reported symptoms of an exacerbation, and does not recover to pre-exacerbation levels 8weeks after the event.Trial registrationWISDOM (ClinicalTrials.gov number, NCT00975195).
Original languageEnglish
Article number251
Number of pages7
JournalRespiratory Research
Volume19
DOIs
Publication statusPublished - 13 Dec 2018

Keywords

  • COPD
  • COPD exacerbation
  • Lung function
  • FEV1
  • Home-based spirometry
  • OBSTRUCTIVE PULMONARY-DISEASE
  • BLOOD EOSINOPHILS
  • LUNG-FUNCTION
  • INHALED CORTICOSTEROIDS
  • WITHDRAWAL
  • FREQUENCY
  • RECOVERY
  • DECLINE

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