Capturing exacerbations of chronic obstructive pulmonary disease with EXACT: A sub-analysis of FLAME

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Title: Capturing exacerbations of chronic obstructive pulmonary disease with EXACT: A sub-analysis of FLAME
Authors: Frent, SM
Chapman, KR
Larbig, M
Mackay, A
Fogel, R
Gutzwiller, FS
Shen, S
Patalano, F
Banerji, D
Kostikas, K
Wedzicha, JA
Item Type: Journal Article
Abstract: Rationale: Chronic obstructive pulmonary disease (COPD) exacerbations accelerate lung function decline, reduce quality of life, and increase mortality. A subset of patients (n=457) from the FLAME study used the EXAcerbations of COPD Tool (EXACT®) to capture symptom-defined exacerbations. Objectives: To evaluate the effect of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/fluticasone (SFC) on symptom-defined exacerbations measured using EXACT, and to assess differences between these events and exacerbations requiring healthcare resource use (HCRU). Methods: All patients in FLAME used an e-Diary to record and detect symptom deteriorations; HCRU-related exacerbations were confirmed by investigators. In patients using the EXACT questionnaire, the onset, recovery and magnitude of symptom-defined exacerbations were identified by changes in total scores relative to baseline. We analyzed the annualized rate and time-to-first symptom-defined (EXACT) exacerbation, and assessed differences between symptom-defined and HCRU events in terms of number, severity and concordance. Measurements and Main Results: A non-significant 17% reduction in the annualized rate of symptom-defined (EXACT) exacerbations (rate ratio: 0.83, 95% CI: 0.60, 1.14, P = 0.242) and a numerically longer time to first symptom-defined exacerbation were observed with IND/GLY versus SFC (HR 0.76, 95% CI: 0.56, 1.03, P = 0.075). These results were consistent with data from the overall FLAME population. 23.5% of symptom-defined (EXACT) events corresponded to HCRU events, and 22.2% of HRCU events were captured by EXACT (kappa index 0.24, 95% CI: 0.15, 0.33). Conclusions: Regardless of the exacerbation definition used, our findings support the use of LABA/LAMAs as the preferred treatment option for patients at risk of future exacerbations.
Issue Date: 1-Jan-2019
Date of Acceptance: 17-Jul-2018
URI: http://hdl.handle.net/10044/1/61289
DOI: https://doi.org/10.1164/rccm.201801-0038OC
ISSN: 1073-449X
Publisher: American Thoracic Society
Start Page: 43
End Page: 51
Journal / Book Title: American Journal of Respiratory and Critical Care Medicine
Volume: 199
Issue: 1
Copyright Statement: © 2018 by the American Thoracic Society
Keywords: Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
Respiratory System
General & Internal Medicine
defined symptom
exacerbation
concordance
treatment
QUALITY-OF-LIFE
COPD EXACERBATIONS
LUNG-FUNCTION
SYMPTOMS
BECLOMETHASONE/FORMOTEROL
GLYCOPYRRONIUM
FLUTICASONE
MANAGEMENT
FREQUENCY
THERAPY
concordance
defined symptom
exacerbation
treatment
Respiratory System
11 Medical and Health Sciences
Publication Status: Published
Online Publication Date: 2018-07-18
Appears in Collections:National Heart and Lung Institute
Airway Disease
Faculty of Medicine



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