期刊
NEW ENGLAND JOURNAL OF MEDICINE
卷 365, 期 13, 页码 1184-1192出版社
MASSACHUSETTS MEDICAL SOC
DOI: 10.1056/NEJMoa1105482
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资金
- GlaxoSmithKline
- AstraZeneca
- Boehringer Ingelheim
- Chiesi
- Novartis
- Nycomed
- Pfizer
- Forest Laboratories
- Almirall
- Esteve
- Roche
- Merck and Novartis
- Aeris
- Rox Medical
- GlaxoSmithKline and Spiration
- Able Associates
- Adelphi Research
- APT Pharma/Britnall
- Aradigm
- CommonHealth
- Consult Complete
- COPDforum
- Datamonitor
- Decision Resources
- Defined Health
- Dey
- Dunn Group
- Easton Associates
- Equinox
- Forest
- Gerson
- InfoMed
- KOL Connection
- M. Pankove
- MedaCorp
- MDRx Financial
- Mpex
- Oriel Therapeutics
- Otsuka
- Pennside
- Parma Ventures
- Pearl
- Pharmaxis
- Price Waterhouse
- Propagate
- Pulmatrix
- Reckner Associates
- Recruiting Resources
- Sankyo
- Schlesinger Medical
- Scimed
- Sudler and Hennessey
- TargeGen
- Theravance
- United BioSource
- Uptake Medical
- VantagePoint Management
- Convergent Health Solutions for Reviews and Trends in COPD
- COPD Foundation
- Creative Educational Concepts
- France Foundation
- Information TV
- Network for Continuing Education (CHARM)
- Novartis (Horsham)
- Biomarck
- Centocor
- Nabi
- MRC [G0901697, G0901786] Funding Source: UKRI
- Medical Research Council [G0901697, G0901786] Funding Source: researchfish
BACKGROUND A key feature of chronic obstructive pulmonary disease (COPD) is an accelerated rate of decline in forced expiratory volume in 1 second (FEV(1)), but data on the variability and determinants of this change in patients who have established disease are scarce. METHODS We analyzed the changes in FEV1 after administration of a bronchodilator over a 3-year period in 2163 patients. A random-coefficient model was used to evaluate possible predictors of both FEV1 levels and their changes over time. RESULTS The mean (+/- SE) rate of change in FEV1 was a decline of 33 +/- 2 ml per year, with significant variation among the patients studied. The between-patient standard deviation for the rate of decline was 59 ml per year. Over the 3-year study period, 38% of patients had an estimated decline in FEV1 of more than 40 ml per year, 31% had a decline of 21 to 40 ml per year, 23% had a change in FEV1 that ranged from a decrease of 20 ml per year to an increase of 20 ml per year, and 8% had an increase of more than 20 ml per year. The mean rate of decline in FEV1 was 21 +/- 4 ml per year greater in current smokers than in current nonsmokers, 13 +/- 4 ml per year greater in patients with emphysema than in those without emphysema, and 17 +/- 4 ml per year greater in patients with bronchodilator reversibility than in those without reversibility. CONCLUSIONS The rate of change in FEV1 among patients with COPD is highly variable, with increased rates of decline among current smokers, patients with bronchodilator reversibility, and patients with emphysema. (Funded by GlaxoSmithKline; ECLIPSE-ClinicalTrials.gov number, NCT00292552.)
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