Differences in outcomes between GOLD groups in patients with COPD in the TIOSPIR® trial

被引:6
作者
Dusser, Daniel [1 ]
Wise, Robert A. [2 ]
Dahl, Ronald [3 ]
Anzueto, Antonio [4 ,5 ]
Carter, Kerstine [6 ]
Fowler, Andy [7 ]
Calverley, Peter M. [8 ]
机构
[1] Univ Paris 05, AP HP, Hop Cochin, Sorbonne Paris Cite,Serv Pneumol, 27 Rue Faubourg St Jacques, F-75679 Paris 14, France
[2] Johns Hopkins Univ, Sch Med, Asthma & Allergy Ctr, Baltimore, MD USA
[3] Odense Univ Hosp, Allergy Ctr, DK-5000 Odense C, Denmark
[4] Univ Texas San Antonio, Pulm Crit Care, San Antonio, TX USA
[5] South Texas Vet Hlth Care Syst, San Antonio, TX USA
[6] Boehringer Ingelheim Pharmaceut Inc, 90 E Ridge POB 368, Ridgefield, CT 06877 USA
[7] Boehringer Ingelheim Pharma Ltd, Bracknell, Berks, England
[8] Univ Liverpool, Inst Ageing & Chron Dis, Liverpool L69 3BX, Merseyside, England
关键词
TIOSPIR (R); GOLD; cardiovascular comorbidity; mortality; respiratory death; cardiovascular death; OBSTRUCTION; DYSPNEA; DISEASE; DEATH;
D O I
10.2147/COPD.S97924
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background: The aim of this study was to evaluate whether Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification could predict mortality risk factors and whether baseline treatment intensity would relate to mortality within each group, using data from TIOSPIR (R), the largest randomized clinical trial in COPD performed to date. Methods: A total of 17,135 patients from TIOSPIR (R) were pooled and grouped by GOLD grading (A-D) according to baseline Medical Research Council breathlessness score, exacerbation history, and spirometry. All-cause mortality and adjudicated cardiovascular (CV) and respiratory mortality were assessed. Results: Of the 16,326 patients classified, 1,248 died on treatment. Group B patients received proportionally more CV treatment at baseline. CV mortality risk, but not all-cause mortality risk, was significantly higher in Group B than Group C patients (CV mortality - hazard ratio [HR] = 1.74, P = 0.004; all-cause mortality - HR = 1.18, P = 0.11). Group D patients had a higher incidence of all-cause mortality than Group B patients (10.9% vs 6.6%). Similar trends were observed regardless of respiratory or CV medication at baseline. In contrast, respiratory deaths increased consistently from Groups A-D (0.3%, 0.8%, 1.6%, and 4.2% of patients, respectively). Conclusion: The data obtained from the TIOSPIR (R) trial, supporting earlier studies, suggest that proportionally more CV medication and CV deaths occur in GOLD Group B COPD patients, although deaths attributed to respiratory causes are more prevalent in Groups C and D.
引用
收藏
页码:133 / 145
页数:13
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