Abstract
BACKGROUND: Gastroesophageal reflux is associated with a higher risk of exacerbation, predicting the “frequent exacerbator” phenotype in COPD. We hypothesize that treatment with a proton pump inhibitor normalizes the risk of exacerbation in stable COPD.
METHODS: We prospectively evaluated 638 patients with stable COPD for ≥ 6 weeks, > 10 PY and GOLD II-IV seeking care in pulmonary tertiary hospitals in 8 European countries and included in the PROMISE cohort. Comorbidities including associated medical therapy were assessed at baseline, at exacerbation and at biannual visits. The primary outcome of the study was exacerbation and/or death. Median observation time was 24 months.
RESULTS: 85 (13.3%) of the patients with stable COPD were on anti-GERD therapy. This patient group had higher annual exacerbation and severe exacerbation rates (p=0.009 and p=0.002), decreased QoL (SF-36: activity score p=0.004, SGRQ: physical functioning p=0.013, social functioning p=0.007), higher BODE-index (p=0.033) and MMRC scores (p=0.002), shorter 6 MWD (p=0.0004) and higher adjusted Charlson score (p<0.0001). Anti-GERD therapy was associated with a shorter time to severe exacerbation (HR 2.053 95% CI 1.370-3.075). This association proved independent of adjusted Charlson score and FEV1% pred (HR 1.912 95% CI 1.259-2.905); adjusted Charlson score, BODE index and MMRC (HR 1.623 95% CI 1.038-2.538); as well as adjusted Charlson score, FEV1% pred and 9 classes of medication for comorbidities (HR 1.625 95% CI 10.43-2.531) in 3 multivariable cox-regression models.
CONCLUSION: Patient on anti-GERD therapy remain at higher risk for severe exacerbation of COPD.
- © 2014 ERS