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Association between...
Association between COPD exacerbations and lung function decline during maintenance therapy
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Kerkhof, M (författare)
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Voorham, J (författare)
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Dorinsky, P (författare)
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Cabrera, C (författare)
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Darken, P (författare)
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Kocks, JWH (författare)
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Sadatsafavi, M (författare)
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Sin, DD (författare)
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Carter, V (författare)
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Price, DB (författare)
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- 2020-06-12
- 2020
- Engelska.
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Ingår i: Thorax. - : BMJ. - 1468-3296 .- 0040-6376. ; 75:9, s. 744-753
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https://thorax.bmj.c...
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http://kipublication...
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https://doi.org/10.1...
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Abstract
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- Little is known about the impact of exacerbations on COPD progression or whether inhaled corticosteroid (ICS) use and blood eosinophil count (BEC) affect progression. We aimed to assess this in a prospective observational study.MethodsThe study population included patients with mild to moderate COPD, aged ≥35 years, with a smoking history, who were followed up for ≥3 years from first to last spirometry recording using two large UK electronic medical record databases: Clinical Practice Research Datalink (CPRD) and Optimum Patient Care Research Database (OPCRD). Multilevel mixed-effects linear regression models were used to determine the relationship between annual exacerbation rate following initiation of therapy (ICS vs non-ICS) and FEV1decline. Effect modification by blood eosinophils was studied through interaction terms.ResultsOf 12178 patients included (mean age 66 years; 48% female), 8981 (74%) received ICS. In patients with BEC ≥350 cells/µL not on ICS, each exacerbation was associated with subsequent acceleration of FEV1decline of 19.4 mL/year (95% CI 12.0 to 26.7, p<0.0001). This excess decline was reduced by 15.1 mL/year (6.6 to 23.6) to 4.3 mL/year (1.9 to 6.7, p<0.0001) in those with BEC ≥350 cells/µL treated with ICS.ConclusionExacerbations are associated with a more rapid loss of lung function among COPD patients with elevated blood eosinophils, defined as ≥350 cells/µL, not treated with ICS. More aggressive prevention of exacerbations using ICS in such patients may prevent excess loss of lung function.
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Thorax
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Kerkhof, M
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Voorham, J
-
Dorinsky, P
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Cabrera, C
-
Darken, P
-
Kocks, JWH
-
visa fler...
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Sadatsafavi, M
-
Sin, DD
-
Carter, V
-
Price, DB
-
visa färre...
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Thorax
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Karolinska Institutet