Dynamic hyperinflation is a risk factor for mortality and severe exacerbations in COPD patients - 04/04/24
Abstract |
Objective |
To assess if dynamic hyperinflation is an independent risk factor for mortality and severe exacerbations in COPD patients.
Methods |
A cohort of 141 patients with stable COPD and moderate to very severe airflow limitation, treated according to conventional guidelines, was followed for a median of 9 years. Clinical characteristics were recorded and arterial blood gases, pulmonary function tests, 6-min walk and incremental exercise test with measurement of respiratory pattern and operative lung volumes were performed. Endpoints were all-cause mortality and hospitalization for COPD exacerbation.
Results |
58 patients died during the follow-up period (1228 patients x year). The mortality rate was higher in patients with dynamic hyperinflation (n = 106) than in those without it (n = 35) (14.6; 95% CI, 14.5–14.8 vs. 7.2; 95% CI, 7.1–7.4 per 1000 patients-year). After adjusting for sex, age, body mass index, pack-years and treatment with inhaled corticosteroids, dynamic hyperinflation was associated with a higher mortality risk (adjusted hazard ratio [aHR], 2.725; 95% CI, 1.010–8.161), and in a multivariate model, comorbidity, peak oxygen uptake and dynamic hyperinflation were retained as independent predictors of mortality. The time until first severe exacerbation was shorter for patients with dynamic hyperinflation (aHR, 3.961; 95% CI, 1.385–11.328), and dynamic hyperinflation, FEV1 and diffusing capacity were retained as independent risk factors for severe exacerbation. Moreover, patients with dynamic hyperinflation had a higher hospitalization risk than those without it (adjusted incidence rate ratio, 1.574; 95% CI, 1.087–2.581).
Conclusion |
In stable COPD patients, dynamic hyperinflation is an independent prognostic factor for mortality and severe exacerbations.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Dynamic hyperinflation (DH) has recognized effects on the symptomatic perception and exercise tolerance of COPD patients. |
• | In a cohort of moderate-severe COPD patients, DH has also prognostic relevance at long-term. |
• | In COPD patients, DH is associated with a higher long-term mortality rate and shorter survival time. |
• | DH is an independent risk factor for the development of severe COPD exacerbations. |
KEY WORDS LIST : COPD, Dynamic hyperinflation, Exacerbations, Mortality
Abbreviations : aHR, AT, CI, COPD, DLCO, EELV, EILV, FEV1, FRC, FVC, IC, LABA, LAMA, LTOT, mMRC, PaCO2, PaO2, RV, SABA, SpO2, TLC, VE, VO2, VT, W
Plan
Vol 225
Article 107597- avril 2024 Retour au numéro
Article précédent
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