Should we view chronic obstructive pulmonary disease differently after ECLIPSE? A clinical perspective from the study team

Jørgen Vestbo, Alvar Agusti, Emiel F.M. Wouters, Per Bakke, Peter M.A. Calverley, Bartolome Celli, Harvey Coxson, Courtney Crim, Lisa D. Edwards, Nicholas Locantore, David A. Lomas, William MacNee, Bruce Miller, Stephen I. Rennard, Edwin K. Silverman, Julie C. Yates, Ruth Tal-Singer

Research output: Contribution to journalReview article

106 Scopus citations

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 stableCOPD, 337smokerswithnormal lung function, and 245 never-smokers, we measured a large number of clinical parameters, lung function, exercise tolerance, biomarkers, andamount ofemphysema 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 conceptof the "frequent exacerbatorphenotype." Disease coursewasvery 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; club cell protein was found to be a potential biomarker for disease activity. For progression ofemphysema, 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. Clinical trial registered with www.clinicaltrials.gov (NCT00292552).

Original languageEnglish (US)
Pages (from-to)1022-1030
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume189
Issue number9
DOIs
StatePublished - May 1 2014

Keywords

  • Chronic obstructive pulmonary disease
  • Comorbidities
  • Computed tomography lung density
  • Exacerbations
  • Lung function

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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    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. (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, 189(9), 1022-1030. https://doi.org/10.1164/rccm.201311-2006PP