Association between COPD exacerbations and lung function decline during maintenance therapy

Three-year study of 12178 pts found COPD exacerbation was associated with greater annual FEV1 decline among COPD pts with elevated blood eosinophils counts (BEC), who were not treated with inhaled corticosteroid (ICS). Those who received ICS had a reduced annual FEV1 decline.

SPS commentary:

To investigate the impact of exacerbations on COPD progression or whether ICS use and BEC (≥350 cells/µL) affect progression, 12178 UK patients with mild to moderate COPD, were followed up for ≥3 years from first to last spirometry recording; 8981 (74%) received ICS.


In patients with BEC ≥350 cells/µL not on ICS, each exacerbation was associated with subsequent acceleration of FEV1 decline of 19.4 mL/year (95% CI 12.0 to 26.7; p<0.0001).


This excess decline was reduced by 15.1 mL/year (6.6 to 23.6) to 4.3 mL/year (1.9 to 6.7; p<0.0001) in those with BEC ≥350 cells/µL treated with ICS.


The authors note that these novel findings suggest that more aggressive prevention of exacerbations using ICS in patients with elevated BEC may prevent excess loss of lung function.