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Authors Calverley PMA, Anzueto AR, Dusser D, Mueller A, Metzdorf N, Wise RA
Received 10 October 2017
Accepted for publication 19 February 2018
Published 23 April 2018 Volume 2018:13 Pages 1297—1308
DOI https://doi.org/10.2147/COPD.S153631
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Charles Downs
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Rationale: Exacerbations of COPD are managed differently, but whether
treatment of one exacerbation predicts the likelihood of subsequent events is
unknown.
Objective: We examined whether the treatment given for
exacerbations predicted subsequent outcomes.
Methods: This was a post-hoc analysis of 17,135 patients
with COPD from TIOtropium Safety and Performance In Respimat® (TIOSPIR®). Patients
treated with tiotropium with one or more moderate to severe exacerbations on
study were analyzed using descriptive statistics, logistic and Cox regression
analysis, and Kaplan–Meier plots.
Results: Of 8,061 patients with moderate to severe
exacerbation(s), demographics were similar across patients with exacerbations
treated with antibiotics and/or steroids or hospitalization. Exacerbations
treated with systemic corticosteroids alone or in combination with antibiotics
had the highest risk of subsequent exacerbation (HR: 1.21, P =0.0004 and HR: 1.33, P <0.0001, respectively), and a
greater risk of having a hospitalized (severe) exacerbation (HR: 1.59 and
1.63, P <0.0001, respectively) or
death (HR: 1.50, P =0.0059 and HR:
1.47, P =0.0002, respectively) compared
with exacerbations treated with antibiotics alone. Initial hospitalization led
to the highest risk of subsequent hospitalization (all-cause or COPD related
[severe exacerbation], HR: 3.35 and 4.31, P <0.0001,
respectively) or death (all-cause or COPD related, HR: 3.53 and 5.54, P <0.0001, respectively) versus
antibiotics alone.
Conclusion: These data indicate that the way exacerbations
are treated initially is a useful guide to the patient’s subsequent clinical
course. Factors that clinicians consider when making treatment choices require
further clarification.
Keywords: tiotropium,
TIOSPIR®, severity, exacerbations of COPD, hospitalization
摘要视频链接:TIOSPIR®: outcomes by index
exacerbation severity