Unidad Médico-Quirúrgica de Enfermedades Respiratorias

Hospital Universitario Virgen del Rocío - Sevilla

José Luis López-Campos

ERS Annual MeetingLong-term outcome following first clinically important

deterioration in COPD

Ian Naya, Lee Tombs, Hana Mullerova, Chris Compton, Paul Jones

Mesa 1

It is unknown if short-term worsening in COPD is a predictor of long-term poor outcome. We assessed whether worsening measured using a short-term composite measure (clinically important deterioration [CID]) would predict adverse outcomes in two large 3-year studies.

A CID was defined as any of: •a decrease of ≥100mL in FEV1

•increase of ≥4 units in St George’s Respiratory Questionnaire (SGRQ) score from baseline •a moderate/severe exacerbation

At ≤6 months index date [ID]) in TORCH and ≤12-months ID in ECLIPSE.

Association between presence (+) and absence (-) of CID status at ID and long-term deterioration in FEV1, health-status, future risk of exacerbations and all-cause mortality was assessed post hoc from ID until end of follow-up. Only subjects that did not withdraw before the ID were included in the analysis

In total, 2870 of 5292 (54%) and 1442 of 1973 (73%) patients with data post ID were CID+ in TORCH and ECLIPSE, respectively.

In both studies, CID+ patients had a clinically significant deficit in FEV1 and health-status and higher exacerbation risk (p<0.001 vs CID- group).

All-cause mortality was also higher (p<0.05 vs CID- patients).

RESULTSRESULTS

RESULTSRESULTS

CONCLUSIONSCONCLUSIONS

A CID that occurs within 6–12 months of follow-up is associated with sustained loss of lung function and health-status and increased exacerbation and all-cause mortality risk.

Funded by GSK (NCT00268216, SCO30003; NCT00292552, SCO104960).

ERS Annual MeetingRate of FEV1 decline by FEV1 percent predicted in

UPLIFT® and TIOSPIR®

Michael B. Drummond, Donald P. Tashkin, Antonio Anzueto, Christoph Hallmann, Achim

Mueller, Norbert Metzdorf, Ulrika Hinkel, Robert A. Wise

Mesa 1

Introduction:Studies suggest that in patients with chronic obstructive pulmonary disease, the rate of decline in FEV1 accelerates with increasing age. Factors influencing the rate of decline are poorly understood.

Aims and objectives: To evaluate the relationship between mean annual rate of FEV1 decline and baseline FEV1 % predicted in patients from the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT®) and TIOtropium Safety and Performance In Respimat® (TIOSPIR®) trials.

Methods: Annual rate of trough FEV1 decline was calculated for patients on treatment >2 years, stratified by disease severity (baseline FEV1 % predicted). Treatment arms were pooled.

RESULTSRESULTS

Overall, decline was calculated for 4295 patients from UPLIFT® receiving either tiotropium or placebo.

Demographics did not differ by baseline severity, although GOLD Stage 4 patients (baseline FEV1 % predicted <30) were slightly younger (60.8 years) with a lower body mass index (BMI) (24.1) compared with other groups (63.6-64.6 years; BMI 25.9-26.8).

Mean annual rate of trough FEV1 decline was greater in patients with higher baseline FEV1 % predicted and less in patients with more severe disease (Figure). A similar pattern was observed in patients from TIOSPIR®.

RESULTSRESULTS

CONCLUSIONSCONCLUSIONS

In UPLIFT® and TIOSPIR®, the annual rate of decline in FEV1 is almost linearly correlated to the initial disease status (baseline FEV1 % predicted) and probably less dependent on age.

ERS Annual MeetingIn active and former smokers with CT detected emphysema but without airway obstruction, the presence of an abnormal

DLco is associated with a worse clinical presentation

Jessica Gonzalez Gutierrez, Marta Marin Oto, Arantza Campo, Javier Zulueta, Ana Belen Alcaide, Juan Bertó, Juan Pablo De Torres

Mesa 1

Rationale: Little is known about the impact of an abnormal DLco (<80%) and the clinical presentation of smokers with radiologically detected emphysema but without airway obstruction.

Objective: To compare clinical and functional characteristics of active or former smokers without airway obstruction with or without emphysema and/or abnormal DLco.

Methods: This is an observational study of active or former smokers that underwent a low dose CT scan (LDCT), pulmonary function tests, COPD assessment test (CAT) and 6 minute walking distance test (6MWD) . Patients were classified in 3 groups depending on the presence of visually detected radiological emphysema and DLco values (no-emphysema; emphysema with DLco>80%; emphysema with DLco<80%).

RESULTSRESULTS

168 patients were analyzed.

Patients with emphysema had a higher CAT score (7.96 vs 5.95 p=0.002) and a greater fall in SpO2% post-6MWD (22.7% vs 4.2%, p=0,004) .

In those with an abnormal DLco, CAT score are even higher (4.78 vs 9.36, p=0.01) and a greater % having a fall in the SpO2% (96.3% vs 94.4%, p=0.007).

In this group there were more active smokers (69% vs. 50%, p=0.025), with lower mean predicted FEV1 (96.7 vs 105.2%, p=0.004) and higher residual volume/total lung capacity ratio (37.05 vs 32.44, p:0.05).

CONCLUSIONSCONCLUSIONS

In active or former smokers with emphysema, the presence of an abnormal DLco determine a worse clinical and physiological presentation.

The present findings gives value to the determination of DLco in smokers without airway obstruction