Lung-Function Profile Before and After the First Moderate to Severe Exacerbation During the WISDOM Study
23 February 2017 (online)
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.
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.
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.
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