Chest
Original ResearchCOPDIncreased Systemic Inflammation Is a Risk Factor for COPD Exacerbations
Section snippets
Study Design
This study is a secondary study of the COSMIC study (COPD and Seretide: a Multi-Center Intervention and Characterization), a multicenter trial to investigate the effects of steroid withdrawal in comparison with combination therapy (long-acting β2-agonist salmeterol and inhaled steroid fluticasone) during a 1-year follow-up period.18 The COSMIC study had a multicenter, randomized, double-blind, parallel-group design. All patients received combined salmeterol (50 μg) and fluticasone (500 μg) bid
Results
Patient demographic data and baseline characteristics are summarized in Table 1 . During the 1-year follow-up period, 69 patients withdrew. This occurred after a mean follow-up of 23 weeks. Of the total group of 314 patients, a total of 277 person-years was analyzed (mean follow-up, 0.88 years per patient). Of these 314 patients, 128 patients had neither a moderate nor a severe exacerbation during follow-up; 31 patients had a total of 37 severe exacerbations, with the number per patient ranging
Discussion
We investigated which factors predict acute COPD exacerbations and in particular the role of systemic inflammation in the occurrence of these acute events. We found that higher fibrinogen levels are significantly predictive for the occurrence of severe as well as moderate exacerbations. Further independent predictors for severe acute exacerbations were FEV1, Dlco, and the number of prestudy severe exacerbations, whereas FEV1 and the number of prestudy moderate exacerbations were independent
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Glaxo-Smith-Kline provided funding for this study.
Dr. Groenewegen has no conflict of interest to declare. Dr. Postma has received honoraria for speaking engagements and research funding from AstraZeneca and GlaxoSmithKline. Dr. Hop is a regular biostatistical consultant to GSK. Dr. Wielders' research institute has received grants for research purposes from AstraZeneca and GSK. Dr. Schloesser has no conflict of interest to declare. Dr. Wouters has received honoraria for speaking engagements and research funding from AstraZeneca and GlaxoSmithKline.