Mesa 1. Epidemiología, diagnóstico y seguimiento del paciente con EPOC. Congreso A.R.C en EPOC. Madrid Oct. 2016

1. Unidad Médico-Quirúrgica de Enfermedades
Respiratorias
Hospital Universitario Virgen del Rocío - Sevilla
José Luis López-Campos

2. ERS Annual Meeting
Long-term outcome following first clinically important
deterioration in COPD
Ian Naya, Lee Tombs, Hana Mullerova, Chris
Compton, Paul Jones
Mesa 1

3. It is unknown if short-term worsening in COPD is a predictor of long-term poor outcome. We
assessed whether worsening measured using a short-term composite measure (clinically
important deterioration [CID]) would predict adverse outcomes in two large 3-year studies.
A CID was defined as any of:
•a decrease of ≥100mL in FEV1
•increase of ≥4 units in St George’s Respiratory Questionnaire (SGRQ) score from baseline
•a moderate/severe exacerbation
At ≤6 months index date [ID]) in TORCH and ≤12-months ID in ECLIPSE.
Association between presence (+) and absence (-) of CID status at ID and long-term
deterioration in FEV1, health-status, future risk of exacerbations and all-cause mortality was
assessed post hoc from ID until end of follow-up. Only subjects that did not withdraw before
the ID were included in the analysis

4. In total, 2870 of 5292 (54%) and 1442 of 1973 (73%) patients with data post ID were CID+ in
TORCH and ECLIPSE, respectively.
In both studies, CID+ patients had a clinically significant deficit in FEV1 and health-status and
higher exacerbation risk (p<0.001 vs CID- group).
All-cause mortality was also higher (p<0.05 vs CID- patients).
RESULTSRESULTS

5. RESULTSRESULTS

6. CONCLUSIONSCONCLUSIONS
A CID that occurs within 6–12 months of follow-up is associated with sustained loss
of lung function and health-status and increased exacerbation and all-cause
mortality risk.
Funded by GSK (NCT00268216, SCO30003; NCT00292552, SCO104960).

7. ERS Annual Meeting
Rate of FEV1 decline by FEV1 percent predicted in
UPLIFT® and TIOSPIR®
Michael B. Drummond, Donald P. Tashkin,
Antonio Anzueto, Christoph Hallmann, Achim
Mueller, Norbert Metzdorf, Ulrika Hinkel,
Robert A. Wise
Mesa 1

8. Introduction:
Studies suggest that in patients with chronic obstructive pulmonary disease, the rate of
decline in FEV1 accelerates with increasing age. Factors influencing the rate of decline are
poorly understood.
Aims and objectives:
To evaluate the relationship between mean annual rate of FEV1 decline and baseline FEV1 %
predicted in patients from the Understanding Potential Long-term Impacts on Function with
Tiotropium (UPLIFT®
) and TIOtropium Safety and Performance In Respimat®
(TIOSPIR®
) trials.
Methods:
Annual rate of trough FEV1 decline was calculated for patients on treatment >2 years,
stratified by disease severity (baseline FEV1 % predicted). Treatment arms were pooled.

9. RESULTSRESULTS
Overall, decline was calculated for 4295 patients from UPLIFT®
receiving either tiotropium
or placebo.
Demographics did not differ by baseline severity, although GOLD Stage 4 patients
(baseline FEV1 % predicted <30) were slightly younger (60.8 years) with a lower body mass
index (BMI) (24.1) compared with other groups (63.6-64.6 years; BMI 25.9-26.8).
Mean annual rate of trough FEV1 decline was greater in patients with higher baseline FEV1
% predicted and less in patients with more severe disease (Figure). A similar pattern was
observed in patients from TIOSPIR®
.

10. RESULTSRESULTS

11. CONCLUSIONSCONCLUSIONS
In UPLIFT®
and TIOSPIR®
, the annual rate of decline in FEV1 is almost linearly
correlated to the initial disease status (baseline FEV1 % predicted) and probably less
dependent on age.

12. ERS Annual Meeting
In active and former smokers with CT detected emphysema
but without airway obstruction, the presence of an abnormal
DLco is associated with a worse clinical presentation
Jessica Gonzalez Gutierrez, Marta Marin Oto,
Arantza Campo, Javier Zulueta, Ana Belen
Alcaide, Juan Bertó, Juan Pablo De Torres
Mesa 1

13. Rationale:
Little is known about the impact of an abnormal DLco (<80%) and the clinical presentation of
smokers with radiologically detected emphysema but without airway obstruction.
Objective:
To compare clinical and functional characteristics of active or former smokers without
airway obstruction with or without emphysema and/or abnormal DLco.
Methods:
This is an observational study of active or former smokers that underwent a low dose CT
scan (LDCT), pulmonary function tests, COPD assessment test (CAT) and 6 minute walking
distance test (6MWD) .
Patients were classified in 3 groups depending on the presence of visually detected
radiological emphysema and DLco values (no-emphysema; emphysema with DLco>80%;
emphysema with DLco<80%).

14. RESULTSRESULTS
168 patients were analyzed.
Patients with emphysema had a higher CAT score (7.96 vs 5.95 p=0.002) and a greater fall
in SpO2% post-6MWD (22.7% vs 4.2%, p=0,004) .
In those with an abnormal DLco, CAT score are even higher (4.78 vs 9.36, p=0.01) and a
greater % having a fall in the SpO2% (96.3% vs 94.4%, p=0.007).
In this group there were more active smokers (69% vs. 50%, p=0.025), with lower mean
predicted FEV1 (96.7 vs 105.2%, p=0.004) and higher residual volume/total lung capacity
ratio (37.05 vs 32.44, p:0.05).

15. CONCLUSIONSCONCLUSIONS
In active or former smokers with emphysema, the presence of an abnormal DLco
determine a worse clinical and physiological presentation.
The present findings gives value to the determination of DLco in smokers without
airway obstruction