Adverse health consequences in COPD patients with rapid decline in FEV(1 )- evidence from the UPLIFT trial

BACKGROUND: The rate of decline in forced expiratory volume in 1 second (FEV(1)) is representative of the natural history of COPD. Sparse information exists regarding the associations between the magnitude of annualised loss of FEV(1 )with other endpoints. METHODS: Retrospective analysis of UPLIFT(® )trial (four-year, randomized, double-blind, placebo-controlled trial of tiotropium 18 μg daily in chronic obstructive pulmonary disease [COPD], n = 5993). Decline of FEV(1 )was analysed with random co-efficient regression. Patients were categorised according to quartiles based on the rate of decline (RoD) in post-bronchodilator FEV(1. )The St George's Respiratory Questionnaire (SGRQ) total score, exacerbations and mortality were assessed within each quartile. RESULTS: Mean (standard error [SE]) post-bronchodilator FEV(1 )increased in the first quartile (Q1) by 37 (1) mL/year. The other quartiles showed annualised declines in FEV(1 )(mL/year) as follows: Q2 = 24 (1), Q3 = 59 (1) and Q4 = 125 (2). Age, gender, respiratory medication use at baseline and SGRQ did not distinguish groups. The patient subgroup with the largest RoD had less severe lung disease at baseline and contained a higher proportion of current smokers. The percentage of patients with ≥ 1 exacerbation showed a minimal difference from the lowest to the largest RoD, but exacerbation rates increased with increasing RoD. The highest proportion of patients with ≥ 1 hospitalised exacerbation was in Q4 (Q1 = 19.5% [tiotropium], 26% [control]; Q4 = 33.8% [tiotropium] and 33.1% [control]). Time to first exacerbation and hospitalised exacerbation was shorter with increasing RoD. Rate of decline in SGRQ increased in direct proportion to each quartile. The group with the largest RoD had the highest mortality. CONCLUSION: Patients can be grouped into different RoD quartiles with the observation of different clinical outcomes indicating that specific (or more aggressive) approaches to management may be needed. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00144339