Pneumologie 2017; 71(S 01): S1-S125
DOI: 10.1055/s-0037-1598314
Posterbegehung – Sektion Klinische Pneumologie
COPD I – Andreas Rembert Koczulla/Marburg, Henrik Watz/Großhansdorf
Georg Thieme Verlag KG Stuttgart · New York

Lung-Function Profile Before and After the First Moderate to Severe Exacerbation During the WISDOM Study

EFM Wouters
1  Department of Respiratory Medicine, University of Maastricht
,
H Magnussen
2  Pulmonary Research Institute at Lung Clinic Großhansdorf, Airway Research Center North, Member of the German Center for Lung Research
,
R Rodríguez-Roisin
3  Servei de Pneumologia, Hospital Clínic Idibaps-Ciberes, Universitat de Barcelona
,
K Tetzlaff
4  Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim; Department of Sports Medicine, Medical Clinic V, University of Tübingen
,
S Bell
5  Department of Biostatistics and Data Sciences, Boehringer Ingelheim
,
PMA Calverley
6  Institute of Ageing and Chronic Disease, Aintree University Hospital
› Author Affiliations
Further Information

Publication History

Publication Date:
23 February 2017 (online)

 

Rationale:

In the WISDOM study (NCT00975195), daily home spirometry measured the time course of lung-function changes throughout the study. The aim of this post-hoc analysis was to address the lung-function profile leading up to, during, and following the first moderate-to-severe exacerbation.

Methods:

Patients with severe to very severe COPD entered a 6-week run-in with LABA+LAMA+ICS (tiotropium 18 µg once daily; salmeterol 50 µg twice daily; and fluticasone propionate 500 µg twice daily), and were randomized to continue LABA+LAMA+ICS or salmeterol/tiotropium for 52 weeks while discontinuing ICS in a stepwise manner over 12 weeks. In this post-hoc analysis, we included patients who experienced a moderate to severe exacerbation after the ICS-withdrawal visit, did not have an exacerbation in the 8 weeks before or after the exacerbation, and had daily home-measured FEV1 data available for every week analyzed.

Results:

Of 2488 patients, 262 experienced a moderate-to-severe exacerbation after the ICS-withdrawal visit and had lung-function data for every week. For all patients combined (ICS and ICS withdrawal), change in FEV1 remained relatively stable 56 – 14 days before the first moderate-to-severe exacerbation (mean FEV1 change from baseline values: -0,04 to -0,07 L). There was a decline in lung function starting 2 – 3 weeks before exacerbation (FEV1 change value of -0,12 L from baseline), followed by a moderate improvement over ˜ 14 days. Post-exacerbation lung function did not reach pre-exacerbation levels.

Conclusions:

Lung function was relatively stable in both treatment groups. Home spirometry measurements showed a marked decline in FEV1 prior to moderate-to-severe exacerbation with improvements seen post-exacerbation, although not to pre-exacerbation levels. These findings support the usefulness of home spirometry to predict exacerbations and to indicate subsequent worsening of lung function resulting from a previous COPD exacerbation.

Content already presented at ATS congress 2016