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Which bronchodilator reversibility criteria can predict severe acute exacerbation in chronic obstructive pulmonary disease patients?

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Authors
Kim, Junghyun; Kim, Woo Jin; Lee, Chang-Hoon; Lee, Sang Haak; Lee, Myung-Goo; Shin, Kyeong-Cheol; Yoo, Kwang Ha; Lee, Ji-Hyun; Lim, Seong Yong; Na, Ju Ock; Hwang, Hun-Gyu; Hong, Yoonki; Lim, Myoung Nam; Yoo, Chul-Gyu; Jung, Ki Suck; Lee, Sang-Do
Issue Date
2017-05-30
Publisher
BioMed Central
Citation
Respiratory Research, 18(1):107
Keywords
Bronchodilator reversibilityCOPDSevere acute exacerbatio
Abstract
Background
It is unclear whether various bronchodilator reversibility (BDR) criteria affect the prognosis of chronic obstructive pulmonary disease (COPD). The aim of this study is to evaluate the impact of positive BDR defined according to various BDR criteria on the risk of severe acute exacerbation (AE) in COPD patients.

Methods
Patients from four prospective COPD cohorts in South Korea who underwent follow-up for at least 1 year were enrolled in this study. The assessed BDR criteria included the Global Initiative for Chronic Obstructive Lung Disease (GOLD), American Thoracic Society (ATS), American College of Chest Physicians, (ACCP), major criteria of the Spanish definition of asthma-COPD overlap syndrome (ACOS), criteria compatible with ACOS in the Global Initiative for Asthma (GINA), and European Respiratory Society (ERS). The rate of patients with severe AE who required hospitalization within 1 year due to BDR results according to each set of criteria was analyzed using logistic regression models.

Results
Among a total of 854 patients, the BDR-positive cases varied according to the criteria used. There was a 3.5% positive BDR rate according to GINA and a 29.9% rate according to the ATS criteria. Positive BDR according to the GOLD criteria was significantly associated with a decreased risk of severe AE (adjusted odds ratio (aOR) = 0.38; 95% Confidence interval (CI) = 0.15–0.93). This result remained statistically significant even in a sensitivity analysis that included only participants with a smoking history of at least 10 pack-years and in the analysis for the propensity score-matched participants.

Conclusions
Among different criteria for positive BDR, the use of the GOLD ones was significantly associated with a decreased risk of severe AE in COPD patients. Increase use of ICS/LABA may have affected this relationship.
Language
English
URI
https://doi.org/10.1186/s12931-017-0587-9

http://hdl.handle.net/10371/117665
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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