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. 2015 Jan;30(1):54-9.
doi: 10.3346/jkms.2015.30.1.54. Epub 2014 Dec 23.

Three-month treatment response and exacerbation in chronic obstructive pulmonary disease

Jung Su Lee  1 , Chin Kook Rhee  2 , Kwang Ha Yoo  3 , Ji-Hyun Lee  4 , Ho Il Yoon  5 , Tae-Hyung Kim  6 , Woo Jin Kim  7 , JinHwa Lee  8 , Seong Yong Lim  9 , Tai Sun Park  1 , Jae Seung Lee  1 , Sei Won Lee  1 , Sang-Do Lee  1 , Yeon-Mok Oh  1
Affiliations

Three-month treatment response and exacerbation in chronic obstructive pulmonary disease

Jung Su Lee et al. J Korean Med Sci. 2015 Jan.

Abstract

The aim of this study was to investigate relationships between acute exacerbation and Forced Expiratory Volume 1 second (FEV1) improvement after treatment with combined long-acting beta-agonist (LABA) and inhaled corticosteroid (ICS) in patients with chronic obstructive pulmonary disease (COPD). A total of 137 COPD patients were classified as responders or nonresponders according to FEV1 improvement after 3 months of LABA/ICS treatment in fourteen referral hospitals in Korea. Exacerbation occurrence in these two subgroups was compared over a period of 1 yr. Eighty of the 137 COPD patients (58.4%) were classified as responders and 57 (41.6%) as nonresponders. Acute exacerbations occurred in 25 patients (31.3%) in the responder group and in 26 patients (45.6%) in the nonresponder group (P=0.086). FEV1 improvement after LABA/ICS treatment was a significant prognostic factor for fewer acute exacerbations in a multivariate Cox proportional hazard model adjusted for age, sex, FEV1, smoking history, 6 min walk distance, body mass index, exacerbation history in the previous year, and dyspnea scale.Three-month treatment response to LABA/ICS might be a prognostic factor for the occurrence of acute exacerbation in COPD patients.

Keywords: Disease Progression; Forced Expiratory Volume; Pulmonary Disease, Chronic Obstructive.

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Conflict of interest statement

No conflicts of interest exist for each author.

Figures

Fig. 1
Fig. 1
Exacerbation rates according to 3-month treatment response (3MTR). (A) The 3MTR was evaluated with the change of FEV1 in mL after 3-month treatment (P=0.035). A cut-off value of 120 mL was defined by the minimal clinically important difference (MCID)(3, 17).The other cut-off of 300 mL was defined as it was near the upper tertile value. Exacerbation occurrence represents % of COPD patients who experienced exacerbation during the one year of follow-up. (B) The 3MTR was evaluated with the change of FEV1 in % of the predicted reference value after 3-month treatment (P=0.039). According to MCID (3, 17), the responder group was defined when FEV1 improvement was 4% or more of the predicted value after 3-month treatment. We further classified the responder group arbitrarily into two categories based on the change in FEV1, with a cut-off of 8% predicted value.
Fig. 2
Fig. 2
Exacerbation occurrence according to baseline characteristics.
See this image and copyright information in PMC

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