Should We View Chronic Obstructive Pulmonary Disease Differently after ECLIPSE? A Clinical Perspective from the Study Team

J. Vestbo, A. Agusti, E. F. M. Wouters, P. Bakke, P. M. A. Calverley, B. Celli, H. Coxson, C. Crim, L. D. Edwards, N. Locantore, D. A. Lomas, W. MacNee, B. Miller, S. I. Rennard, E. K. Silverman, J. C. Yates, R. Tal-Singer, Copd Longitudinally Ide Evaluation

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Abstract

Rationale: Chronic obstructive pulmonary disease (COPD) seems to be a heterogeneous disease with a variable course. Objectives: We wished to characterize the heterogeneity and variability of COPD longitudinally. Methods: In the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study of 2,164 patients with clinically stable COPD, 337 smokers with normal lung function, and 245 never-smokers, we measured a large number of clinical parameters, lung function, exercise tolerance, biomarkers, and amount of emphysema by computed tomography. All three groups were followed for 3 years. Measurements and Main Results: We found a striking heterogeneity among patients with COPD, with poor correlations between FEV1, symptoms, quality of life, functional outcomes, and biomarkers. Presence of systemic inflammation was found in only a limited proportion of patients, and did not relate to baseline characteristics or disease progression, but added prognostic value for predicting mortality. Exacerbations tracked over time and added to the concept of the "frequent exacerbator phenotype." Disease course was very variable, with close to a third of patients not progressing at all. Risk factors for 3-year change in both FEV1 and lung density were assessed. For FEV1 decline, continued smoking and presence of emphysema were the strongest predictors of progression; dub cell protein was found to be a potential biomarker for disease activity. For progression of emphysema, the strongest predictors were continued smoking and female sex. Conclusions: By following a large, well characterized cohort of patients with COPD over 3 years, we have a clearer picture of a heterogeneous disease with clinically important subtypes ("phenotypes") and a variable and not inherently progressive course.
Original languageEnglish
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume189
Issue number9
Pages (from-to)1022-1030
ISSN1073-449X
DOIs
Publication statusPublished - 2014

Cite this

Vestbo, J. ; Agusti, A. ; Wouters, E. F. M. ; Bakke, P. ; Calverley, P. M. A. ; Celli, B. ; Coxson, H. ; Crim, C. ; Edwards, L. D. ; Locantore, N. ; Lomas, D. A. ; MacNee, W. ; Miller, B. ; Rennard, S. I. ; Silverman, E. K. ; Yates, J. C. ; Tal-Singer, R. ; Evaluation, Copd Longitudinally Ide. / Should We View Chronic Obstructive Pulmonary Disease Differently after ECLIPSE? A Clinical Perspective from the Study Team. In: American Journal of Respiratory and Critical Care Medicine. 2014 ; Vol. 189, No. 9. pp. 1022-1030.
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title = "Should We View Chronic Obstructive Pulmonary Disease Differently after ECLIPSE? A Clinical Perspective from the Study Team",
abstract = "Rationale: Chronic obstructive pulmonary disease (COPD) seems to be a heterogeneous disease with a variable course. Objectives: We wished to characterize the heterogeneity and variability of COPD longitudinally. Methods: In the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study of 2,164 patients with clinically stable COPD, 337 smokers with normal lung function, and 245 never-smokers, we measured a large number of clinical parameters, lung function, exercise tolerance, biomarkers, and amount of emphysema by computed tomography. All three groups were followed for 3 years. Measurements and Main Results: We found a striking heterogeneity among patients with COPD, with poor correlations between FEV1, symptoms, quality of life, functional outcomes, and biomarkers. Presence of systemic inflammation was found in only a limited proportion of patients, and did not relate to baseline characteristics or disease progression, but added prognostic value for predicting mortality. Exacerbations tracked over time and added to the concept of the {"}frequent exacerbator phenotype.{"} Disease course was very variable, with close to a third of patients not progressing at all. Risk factors for 3-year change in both FEV1 and lung density were assessed. For FEV1 decline, continued smoking and presence of emphysema were the strongest predictors of progression; dub cell protein was found to be a potential biomarker for disease activity. For progression of emphysema, the strongest predictors were continued smoking and female sex. Conclusions: By following a large, well characterized cohort of patients with COPD over 3 years, we have a clearer picture of a heterogeneous disease with clinically important subtypes ({"}phenotypes{"}) and a variable and not inherently progressive course.",
author = "J. Vestbo and A. Agusti and Wouters, {E. F. M.} and P. Bakke and Calverley, {P. M. A.} and B. Celli and H. Coxson and C. Crim and Edwards, {L. D.} and N. Locantore and Lomas, {D. A.} and W. MacNee and B. Miller and Rennard, {S. I.} and Silverman, {E. K.} and Yates, {J. C.} and R. Tal-Singer and Evaluation, {Copd Longitudinally Ide}",
year = "2014",
doi = "10.1164/rccm.201311-2006PP",
language = "English",
volume = "189",
pages = "1022--1030",
journal = "American Journal of Respiratory and Critical Care Medicine",
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Vestbo, J, Agusti, A, Wouters, EFM, Bakke, P, Calverley, PMA, Celli, B, Coxson, H, Crim, C, Edwards, LD, Locantore, N, Lomas, DA, MacNee, W, Miller, B, Rennard, SI, Silverman, EK, Yates, JC, Tal-Singer, R & Evaluation, CLI 2014, 'Should We View Chronic Obstructive Pulmonary Disease Differently after ECLIPSE? A Clinical Perspective from the Study Team', American Journal of Respiratory and Critical Care Medicine, vol. 189, no. 9, pp. 1022-1030. https://doi.org/10.1164/rccm.201311-2006PP

Should We View Chronic Obstructive Pulmonary Disease Differently after ECLIPSE? A Clinical Perspective from the Study Team. / Vestbo, J.; Agusti, A.; Wouters, E. F. M.; Bakke, P.; Calverley, P. M. A.; Celli, B.; Coxson, H.; Crim, C.; Edwards, L. D.; Locantore, N.; Lomas, D. A.; MacNee, W.; Miller, B.; Rennard, S. I.; Silverman, E. K.; Yates, J. C.; Tal-Singer, R.; Evaluation, Copd Longitudinally Ide.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 189, No. 9, 2014, p. 1022-1030.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Should We View Chronic Obstructive Pulmonary Disease Differently after ECLIPSE? A Clinical Perspective from the Study Team

AU - Vestbo, J.

AU - Agusti, A.

AU - Wouters, E. F. M.

AU - Bakke, P.

AU - Calverley, P. M. A.

AU - Celli, B.

AU - Coxson, H.

AU - Crim, C.

AU - Edwards, L. D.

AU - Locantore, N.

AU - Lomas, D. A.

AU - MacNee, W.

AU - Miller, B.

AU - Rennard, S. I.

AU - Silverman, E. K.

AU - Yates, J. C.

AU - Tal-Singer, R.

AU - Evaluation, Copd Longitudinally Ide

PY - 2014

Y1 - 2014

N2 - Rationale: Chronic obstructive pulmonary disease (COPD) seems to be a heterogeneous disease with a variable course. Objectives: We wished to characterize the heterogeneity and variability of COPD longitudinally. Methods: In the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study of 2,164 patients with clinically stable COPD, 337 smokers with normal lung function, and 245 never-smokers, we measured a large number of clinical parameters, lung function, exercise tolerance, biomarkers, and amount of emphysema by computed tomography. All three groups were followed for 3 years. Measurements and Main Results: We found a striking heterogeneity among patients with COPD, with poor correlations between FEV1, symptoms, quality of life, functional outcomes, and biomarkers. Presence of systemic inflammation was found in only a limited proportion of patients, and did not relate to baseline characteristics or disease progression, but added prognostic value for predicting mortality. Exacerbations tracked over time and added to the concept of the "frequent exacerbator phenotype." Disease course was very variable, with close to a third of patients not progressing at all. Risk factors for 3-year change in both FEV1 and lung density were assessed. For FEV1 decline, continued smoking and presence of emphysema were the strongest predictors of progression; dub cell protein was found to be a potential biomarker for disease activity. For progression of emphysema, the strongest predictors were continued smoking and female sex. Conclusions: By following a large, well characterized cohort of patients with COPD over 3 years, we have a clearer picture of a heterogeneous disease with clinically important subtypes ("phenotypes") and a variable and not inherently progressive course.

AB - Rationale: Chronic obstructive pulmonary disease (COPD) seems to be a heterogeneous disease with a variable course. Objectives: We wished to characterize the heterogeneity and variability of COPD longitudinally. Methods: In the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study of 2,164 patients with clinically stable COPD, 337 smokers with normal lung function, and 245 never-smokers, we measured a large number of clinical parameters, lung function, exercise tolerance, biomarkers, and amount of emphysema by computed tomography. All three groups were followed for 3 years. Measurements and Main Results: We found a striking heterogeneity among patients with COPD, with poor correlations between FEV1, symptoms, quality of life, functional outcomes, and biomarkers. Presence of systemic inflammation was found in only a limited proportion of patients, and did not relate to baseline characteristics or disease progression, but added prognostic value for predicting mortality. Exacerbations tracked over time and added to the concept of the "frequent exacerbator phenotype." Disease course was very variable, with close to a third of patients not progressing at all. Risk factors for 3-year change in both FEV1 and lung density were assessed. For FEV1 decline, continued smoking and presence of emphysema were the strongest predictors of progression; dub cell protein was found to be a potential biomarker for disease activity. For progression of emphysema, the strongest predictors were continued smoking and female sex. Conclusions: By following a large, well characterized cohort of patients with COPD over 3 years, we have a clearer picture of a heterogeneous disease with clinically important subtypes ("phenotypes") and a variable and not inherently progressive course.

U2 - 10.1164/rccm.201311-2006PP

DO - 10.1164/rccm.201311-2006PP

M3 - Journal article

VL - 189

SP - 1022

EP - 1030

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

IS - 9

ER -