02535nas a2200205   4500000000100000008004100001100001500042700001400057700001500071700001200086700001600098700001600114700001700130245010300147250001500250300000700265490000700272520199900279020005102278       2015                            d1 aJenkins C.1 aPostma D.1 aAnzueto A.1 aMake B.1 aPeterson S.1 aEriksson G.1 aCalverley P.00aReliever salbutamol use as a measure of exacerbation risk in chronic obstructive pulmonary disease  a2015/08/22  a970 v153 a<p>
BACKGROUND: Debate exists regarding which endpoints most sensitively reflect day-to-day variation in chronic obstructive pulmonary disease (COPD) symptoms and are most useful in clinical practice to predict COPD exacerbations. We hypothesized that short-acting beta2-agonist (SABA) reliever use would predict short- and long-term exacerbation risk in COPD patients. METHODS: We performed a retrospective analysis of data from a study (ClinicalTrials.gov registration: NCT00419744) comparing budesonide/formoterol 320/9 mug with formoterol 9 mug (both twice daily) in patients with moderate-to-very-severe COPD; reliever salbutamol 90 mug was provided. First occurrence of reliever use &gt;4 (low), &gt;10 (medium), and &gt;20 (high) inhalations/day was assessed as a predictor of short-term (3-week) exacerbation risk. Mean daily reliever use in the week preceding the 2-month visit was investigated as a predictor of the long-term (10-month) exacerbation risk, using intervals of 2-5, 6-9, and &gt;/=10 inhalations/day. RESULTS: Overall, 810 patients were included (61 % male; mean age 63.2 years; post-bronchodilator forced expiratory volume in 1 s 37.7 % of predicted). First occurrence of low, medium, or high reliever use was predictive of an exacerbation within the following 3 weeks; exacerbation risk increased significantly with increasing reliever use. Mean reliever use over 1 week was predictive of long-term exacerbation risk. Patients with mean use of 2-5, 6-9, and &gt;/=10 inhalations/day exhibited 21 %, 67 %, and 135 % higher exacerbation rates, respectively, in the following 10 months, compared with &lt;2 inhalations/day. Budesonide/formoterol was associated with lower short- and long-term exacerbation risk than formoterol in all reliever-use groups. CONCLUSIONS: SABA reliever use is a predictor of short- and long-term exacerbation risk in moderate-to-very-severe COPD patients with a history of exacerbations receiving budesonide/formoterol or formoterol.
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  a1471-2466 (Electronic)<br/>1471-2466 (Linking)