Risk factors for COPD exacerbations in inhaled medication users: The COPDGene study biannual longitudinal follow-up prospective cohort

The COPDGene Investigators

doi:10.1186/s12890-016-0191-7

Risk factors for COPD exacerbations in inhaled medication users: The COPDGene study biannual longitudinal follow-up prospective cohort

The COPDGene Investigators

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Background: Despite inhaled medications that decrease exacerbation risk, some COPD patients experience frequent exacerbations. We determined prospective risk factors for exacerbations among subjects in the COPDGene Study taking inhaled medications. Methods: 2113 COPD subjects were categorized into four medication use patterns: triple therapy with tiotropium (TIO) plus long-acting beta-agonist/inhaled-corticosteroid (ICS ± LABA), tiotropium alone, ICS ± LABA, and short-acting bronchodilators. Self-reported exacerbations were recorded in telephone and web-based longitudinal follow-up surveys. Associations with exacerbations were determined within each medication group using four separate logistic regression models. A head-to-head analysis compared exacerbation risk among subjects using tiotropium vs. ICS ± LABA. Results: In separate logistic regression models, the presence of gastroesophageal reflux, female gender, and higher scores on the St. George's Respiratory Questionnaire were significant predictors of exacerbator status within multiple medication groups (reflux: OR 1.62-2.75; female gender: OR 1.53 - OR 1.90; SGRQ: OR 1.02-1.03). Subjects taking either ICS ± LABA or tiotropium had similar baseline characteristics, allowing comparison between these two groups. In the head-to-head comparison, tiotropium users showed a trend towards lower rates of exacerbations (OR = 0.69 [95 % CI 0.45, 1.06], p = 0.09) compared with ICS ± LABA users, especially in subjects without comorbid asthma (OR = 0.56 [95 % CI 0.31, 1.00], p = 0.05). Conclusions: Each common COPD medication usage group showed unique risk factor patterns associated with increased risk of exacerbations, which may help clinicians identify subjects at risk. Compared to similar subjects using ICS ± LABA, those taking tiotropium showed a trend towards reduced exacerbation risk, especially in subjects without asthma. Trial registration: ClinicalTrials.gov NCT00608764 , first received 1/28/2008.

Original language	English (US)
Article number	28
Journal	BMC Pulmonary Medicine
Volume	16
Issue number	1
DOIs	https://doi.org/10.1186/s12890-016-0191-7
State	Published - Feb 10 2016

Bibliographical note

Funding Information:
The authors (RB, MKH, RPB, MTD, JMW, EAR, CPH) assert that they have no conflicts of interest to disclose directly pertaining to the content of this study. Robert Busch, and Elizabeth Regan declare that they have no conflicts of interest. Russell Bowler has served on the Advisory Board to Boehringer-Ingelheim. MeiLan Han has served as a consultant for Regenerson, Glaxo-Smith-Kline, and Boehringer-Ingelheim. Mark Dransfield has served as a consultant for Glaxo-Smith-Kline, Boehringer-Ingelheim, and Ikaria. J Michael Wells and Mark Dransfield both declare that their institution has received research grant support from the American Heart Association, National Heart Lung and Blood Institute, Glaxo-Smith-Kline, and Forest and has received contracted support for enrollment in clinical trials from Aeris, AstraZeneca, Boehringer-Ingelheim, Boston Scientific, Centocor, Glaxo-Smith-Kline, Forest, Otsuka, Pearl, Pfizer, PneumRx, and Pulmonx. Craig Hersh has received lecture fees from Novartis and consulting fees from CSL Behring.

Funding Information:
This study was supported by NIH grants T32 HL007427, R01HL094635, R01NR013377, P01HL105339, R01HL089897 and R01HL089856. The COPDGene Study is also supported by the COPD Foundation through contributions made to an Industry Advisory Board comprised of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Pfizer, Siemens and Sunovion.

Publisher Copyright:
© 2016 Busch et al.

Keywords

Adrenergic beta-agonists
COPD exacerbation
Chronic obstructive pulmonary disease
Inhaled corticosteroid
Inhaled medications
Long-acting beta-agonist
Prospective cohort study
Tiotropium

Publisher link

10.1186/s12890-016-0191-7

Find It

Find It at U of M Libraries

Cite this

@article{66d9b8de6d7f452e991878557cf8c9d9,

title = "Risk factors for COPD exacerbations in inhaled medication users: The COPDGene study biannual longitudinal follow-up prospective cohort",

abstract = "Background: Despite inhaled medications that decrease exacerbation risk, some COPD patients experience frequent exacerbations. We determined prospective risk factors for exacerbations among subjects in the COPDGene Study taking inhaled medications. Methods: 2113 COPD subjects were categorized into four medication use patterns: triple therapy with tiotropium (TIO) plus long-acting beta-agonist/inhaled-corticosteroid (ICS ± LABA), tiotropium alone, ICS ± LABA, and short-acting bronchodilators. Self-reported exacerbations were recorded in telephone and web-based longitudinal follow-up surveys. Associations with exacerbations were determined within each medication group using four separate logistic regression models. A head-to-head analysis compared exacerbation risk among subjects using tiotropium vs. ICS ± LABA. Results: In separate logistic regression models, the presence of gastroesophageal reflux, female gender, and higher scores on the St. George's Respiratory Questionnaire were significant predictors of exacerbator status within multiple medication groups (reflux: OR 1.62-2.75; female gender: OR 1.53 - OR 1.90; SGRQ: OR 1.02-1.03). Subjects taking either ICS ± LABA or tiotropium had similar baseline characteristics, allowing comparison between these two groups. In the head-to-head comparison, tiotropium users showed a trend towards lower rates of exacerbations (OR = 0.69 [95 % CI 0.45, 1.06], p = 0.09) compared with ICS ± LABA users, especially in subjects without comorbid asthma (OR = 0.56 [95 % CI 0.31, 1.00], p = 0.05). Conclusions: Each common COPD medication usage group showed unique risk factor patterns associated with increased risk of exacerbations, which may help clinicians identify subjects at risk. Compared to similar subjects using ICS ± LABA, those taking tiotropium showed a trend towards reduced exacerbation risk, especially in subjects without asthma. Trial registration: ClinicalTrials.gov NCT00608764 , first received 1/28/2008.",

keywords = "Adrenergic beta-agonists, COPD exacerbation, Chronic obstructive pulmonary disease, Inhaled corticosteroid, Inhaled medications, Long-acting beta-agonist, Prospective cohort study, Tiotropium",

author = "{The COPDGene Investigators} and Robert Busch and Han, {Meilan K.} and Bowler, {Russell P.} and Dransfield, {Mark T.} and Wells, {J. Michael} and Regan, {Elizabeth A.} and Hersh, {Craig P.} and James Crapo and Edwin Silverman and Barry Make and Terri Beaty and Nan Laird and Christoph Lange and Michael Cho and Stephanie Santorico and Peter Castaldi and McDonald, {Merry Lynn} and Emily Wan and Megan Hardin and Jacqueline Hetmanski and Margaret Parker and Brian Hobbs and Adel El-Boueiz and Dandi Qiao and Eitan Halper-Stromberg and Ferdouse Begum and Sungho Won and Coxson, {Harvey O.} and Hoffman, {Eric A.} and Stephen Humphries and Judy, {Philip F.} and Newell, {John D.} and Ross, {James C.} and Estepar, {Raul San Jose} and Stoel, {Berend C.} and Juerg Tschirren and {van Rikxoort}, Eva and {van Ginneken}, Bram and {Al Qaisi}, Mustafa and Teresa Gray and Alex Kluiber and Tanya Mann and Jered Sieren and Douglas Stinson and Joyce Schroeder and Charlene McEvoy and Joseph Tashjian and Christine Wendt and Joanne Billings and Tadashi Allen",

note = "Funding Information: The authors (RB, MKH, RPB, MTD, JMW, EAR, CPH) assert that they have no conflicts of interest to disclose directly pertaining to the content of this study. Robert Busch, and Elizabeth Regan declare that they have no conflicts of interest. Russell Bowler has served on the Advisory Board to Boehringer-Ingelheim. MeiLan Han has served as a consultant for Regenerson, Glaxo-Smith-Kline, and Boehringer-Ingelheim. Mark Dransfield has served as a consultant for Glaxo-Smith-Kline, Boehringer-Ingelheim, and Ikaria. J Michael Wells and Mark Dransfield both declare that their institution has received research grant support from the American Heart Association, National Heart Lung and Blood Institute, Glaxo-Smith-Kline, and Forest and has received contracted support for enrollment in clinical trials from Aeris, AstraZeneca, Boehringer-Ingelheim, Boston Scientific, Centocor, Glaxo-Smith-Kline, Forest, Otsuka, Pearl, Pfizer, PneumRx, and Pulmonx. Craig Hersh has received lecture fees from Novartis and consulting fees from CSL Behring. Funding Information: This study was supported by NIH grants T32 HL007427, R01HL094635, R01NR013377, P01HL105339, R01HL089897 and R01HL089856. The COPDGene Study is also supported by the COPD Foundation through contributions made to an Industry Advisory Board comprised of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Pfizer, Siemens and Sunovion. Publisher Copyright: {\textcopyright} 2016 Busch et al.",

year = "2016",

month = feb,

day = "10",

doi = "10.1186/s12890-016-0191-7",

language = "English (US)",

volume = "16",

journal = "BMC Pulmonary Medicine",

issn = "1471-2466",

publisher = "BioMed Central",

number = "1",

}

TY - JOUR

T1 - Risk factors for COPD exacerbations in inhaled medication users

T2 - The COPDGene study biannual longitudinal follow-up prospective cohort

AU - The COPDGene Investigators

AU - Busch, Robert

AU - Han, Meilan K.

AU - Bowler, Russell P.

AU - Dransfield, Mark T.

AU - Wells, J. Michael

AU - Regan, Elizabeth A.

AU - Hersh, Craig P.

AU - Crapo, James

AU - Silverman, Edwin

AU - Make, Barry

AU - Beaty, Terri

AU - Laird, Nan

AU - Lange, Christoph

AU - Cho, Michael

AU - Santorico, Stephanie

AU - Castaldi, Peter

AU - McDonald, Merry Lynn

AU - Wan, Emily

AU - Hardin, Megan

AU - Hetmanski, Jacqueline

AU - Parker, Margaret

AU - Hobbs, Brian

AU - El-Boueiz, Adel

AU - Qiao, Dandi

AU - Halper-Stromberg, Eitan

AU - Begum, Ferdouse

AU - Won, Sungho

AU - Coxson, Harvey O.

AU - Hoffman, Eric A.

AU - Humphries, Stephen

AU - Judy, Philip F.

AU - Newell, John D.

AU - Ross, James C.

AU - Estepar, Raul San Jose

AU - Stoel, Berend C.

AU - Tschirren, Juerg

AU - van Rikxoort, Eva

AU - van Ginneken, Bram

AU - Al Qaisi, Mustafa

AU - Gray, Teresa

AU - Kluiber, Alex

AU - Mann, Tanya

AU - Sieren, Jered

AU - Stinson, Douglas

AU - Schroeder, Joyce

AU - McEvoy, Charlene

AU - Tashjian, Joseph

AU - Wendt, Christine

AU - Billings, Joanne

AU - Allen, Tadashi

N1 - Funding Information: The authors (RB, MKH, RPB, MTD, JMW, EAR, CPH) assert that they have no conflicts of interest to disclose directly pertaining to the content of this study. Robert Busch, and Elizabeth Regan declare that they have no conflicts of interest. Russell Bowler has served on the Advisory Board to Boehringer-Ingelheim. MeiLan Han has served as a consultant for Regenerson, Glaxo-Smith-Kline, and Boehringer-Ingelheim. Mark Dransfield has served as a consultant for Glaxo-Smith-Kline, Boehringer-Ingelheim, and Ikaria. J Michael Wells and Mark Dransfield both declare that their institution has received research grant support from the American Heart Association, National Heart Lung and Blood Institute, Glaxo-Smith-Kline, and Forest and has received contracted support for enrollment in clinical trials from Aeris, AstraZeneca, Boehringer-Ingelheim, Boston Scientific, Centocor, Glaxo-Smith-Kline, Forest, Otsuka, Pearl, Pfizer, PneumRx, and Pulmonx. Craig Hersh has received lecture fees from Novartis and consulting fees from CSL Behring. Funding Information: This study was supported by NIH grants T32 HL007427, R01HL094635, R01NR013377, P01HL105339, R01HL089897 and R01HL089856. The COPDGene Study is also supported by the COPD Foundation through contributions made to an Industry Advisory Board comprised of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Pfizer, Siemens and Sunovion. Publisher Copyright: © 2016 Busch et al.

PY - 2016/2/10

Y1 - 2016/2/10

N2 - Background: Despite inhaled medications that decrease exacerbation risk, some COPD patients experience frequent exacerbations. We determined prospective risk factors for exacerbations among subjects in the COPDGene Study taking inhaled medications. Methods: 2113 COPD subjects were categorized into four medication use patterns: triple therapy with tiotropium (TIO) plus long-acting beta-agonist/inhaled-corticosteroid (ICS ± LABA), tiotropium alone, ICS ± LABA, and short-acting bronchodilators. Self-reported exacerbations were recorded in telephone and web-based longitudinal follow-up surveys. Associations with exacerbations were determined within each medication group using four separate logistic regression models. A head-to-head analysis compared exacerbation risk among subjects using tiotropium vs. ICS ± LABA. Results: In separate logistic regression models, the presence of gastroesophageal reflux, female gender, and higher scores on the St. George's Respiratory Questionnaire were significant predictors of exacerbator status within multiple medication groups (reflux: OR 1.62-2.75; female gender: OR 1.53 - OR 1.90; SGRQ: OR 1.02-1.03). Subjects taking either ICS ± LABA or tiotropium had similar baseline characteristics, allowing comparison between these two groups. In the head-to-head comparison, tiotropium users showed a trend towards lower rates of exacerbations (OR = 0.69 [95 % CI 0.45, 1.06], p = 0.09) compared with ICS ± LABA users, especially in subjects without comorbid asthma (OR = 0.56 [95 % CI 0.31, 1.00], p = 0.05). Conclusions: Each common COPD medication usage group showed unique risk factor patterns associated with increased risk of exacerbations, which may help clinicians identify subjects at risk. Compared to similar subjects using ICS ± LABA, those taking tiotropium showed a trend towards reduced exacerbation risk, especially in subjects without asthma. Trial registration: ClinicalTrials.gov NCT00608764 , first received 1/28/2008.

AB - Background: Despite inhaled medications that decrease exacerbation risk, some COPD patients experience frequent exacerbations. We determined prospective risk factors for exacerbations among subjects in the COPDGene Study taking inhaled medications. Methods: 2113 COPD subjects were categorized into four medication use patterns: triple therapy with tiotropium (TIO) plus long-acting beta-agonist/inhaled-corticosteroid (ICS ± LABA), tiotropium alone, ICS ± LABA, and short-acting bronchodilators. Self-reported exacerbations were recorded in telephone and web-based longitudinal follow-up surveys. Associations with exacerbations were determined within each medication group using four separate logistic regression models. A head-to-head analysis compared exacerbation risk among subjects using tiotropium vs. ICS ± LABA. Results: In separate logistic regression models, the presence of gastroesophageal reflux, female gender, and higher scores on the St. George's Respiratory Questionnaire were significant predictors of exacerbator status within multiple medication groups (reflux: OR 1.62-2.75; female gender: OR 1.53 - OR 1.90; SGRQ: OR 1.02-1.03). Subjects taking either ICS ± LABA or tiotropium had similar baseline characteristics, allowing comparison between these two groups. In the head-to-head comparison, tiotropium users showed a trend towards lower rates of exacerbations (OR = 0.69 [95 % CI 0.45, 1.06], p = 0.09) compared with ICS ± LABA users, especially in subjects without comorbid asthma (OR = 0.56 [95 % CI 0.31, 1.00], p = 0.05). Conclusions: Each common COPD medication usage group showed unique risk factor patterns associated with increased risk of exacerbations, which may help clinicians identify subjects at risk. Compared to similar subjects using ICS ± LABA, those taking tiotropium showed a trend towards reduced exacerbation risk, especially in subjects without asthma. Trial registration: ClinicalTrials.gov NCT00608764 , first received 1/28/2008.

KW - Adrenergic beta-agonists

KW - COPD exacerbation

KW - Chronic obstructive pulmonary disease

KW - Inhaled corticosteroid

KW - Inhaled medications

KW - Long-acting beta-agonist

KW - Prospective cohort study

KW - Tiotropium

UR - http://www.scopus.com/inward/record.url?scp=84957553849&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84957553849&partnerID=8YFLogxK

U2 - 10.1186/s12890-016-0191-7

DO - 10.1186/s12890-016-0191-7

M3 - Article

C2 - 26861867

AN - SCOPUS:84957553849

VL - 16

JO - BMC Pulmonary Medicine

JF - BMC Pulmonary Medicine

SN - 1471-2466

IS - 1

M1 - 28

ER -

Risk factors for COPD exacerbations in inhaled medication users: The COPDGene study biannual longitudinal follow-up prospective cohort

Abstract

Bibliographical note

Keywords

Publisher link

Find It

Other files and links

Fingerprint

Cite this