COPD Exacerbations and Lung Function Decline During Maintenance Therapy

Sarfaroj Khan 

June 19, 2020


  • Exacerbations are associated with a rapid lung function decline among patients with mild to moderate chronic obstructive pulmonary disease (COPD) with elevated blood eosinophil count (BEC; ≥350 cells/μL), not treated with inhaled corticosteroid (ICS).

  • ICS use may mitigate lung function decline in these patients.

Why this matters

  • Findings highlight the importance of recognising the need for ICS treatment to prevent rapid lung function loss related to exacerbations in COPD patients with high BECs in daily clinical practice.

Study design

  • This prospective observational study included 25,560 patients with mild to moderate COPD (aged ≥35 years), with a history of tobacco smoking, and with at least 3 years of follow-up, using data from the UK Clinical Practice Research Datalink (CPRD) and Optimum Patient Care Research Database (OPCRD).

  • Funding: AstraZeneca.

Key results

  • Of 12,178 patients included, 8,981 (74%) received ICS.

  • Overall, each exacerbation/year increase was associated with 5.8 mL/year (95% CI, 4.9-6.6) and 5.7 mL/year (95% CI, 3.6-7.7) faster forced expiratory volume 1 (FEV1) decline after initiation of ICS and non-ICS containing therapy, respectively.

  • In patients with BEC ≥350 cells/μL not treated with ICS, a substantial excess FEVdecline of 19.4 mL/year (95% CI, 12.0-26.7; P<.0001) was observed with every increase of one exacerbation per year.

  • This excess decline associated with increasing exacerbation rate was reduced by 15.1 mL/year (95% CI, 6.6-23.6) to 4.3 mL/year (95% CI, 1.9-6.7; P<.0001) in patients with BEC ≥350 cells/μL treated with ICS.


  • Risk of bias.

Kerkhof M, Voorham J, Dorinsky P, Cabrera C, Darken P, Kocks JW, Sadatsafavi M, Sin DD, Carter V, Price DB. Association between COPD exacerbations and lung function decline during maintenance therapy. Thorax. 2020 Jun 12 [Epub ahead of print]. doi: 10.1136/thoraxjnl-2019-214457. PMID: 32532852 Full text.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.


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