• Jørgen Vestbo, Lisa D Edwards, Paul D Scanlon, Julie C Yates, Alvar Agusti, Per Bakke, Peter M A Calverley, Bartolome Celli, Harvey O Coxson, Courtney Crim, David A Lomas, William MacNee, Bruce E Miller, E... more dwin K Silverman, Ruth Tal-Singer, Emiel Wouters, Stephen I Rennard, and ECLIPSE Investigators. less
• Respiratory Section, Hvidovre Hospital, Hvidovre, Denmark. jvestbo@dadlnet.dk
• N. Engl. J. Med. 2011 Sep 29; 365 (13): 1184-92.

BackgroundA key feature of chronic obstructive pulmonary disease (COPD) is an accelerated rate of decline in forced expiratory volume in 1 second (FEV(1)), but data on the variability and determinants of this change in patients who have established disease are scarce.MethodsWe analyzed the changes in FEV(1) after administration of a bronchodilator over a 3-year period in 2163 patients. A random-coefficient model was used to evaluate possible predictors of both FEV(1) levels and their changes over time.ResultsThe mean (±SE) rate of change in FEV(1) was a decline of 33±2 ml per year, with significant variation among the patients studied. The between-patient standard deviation for the rate of decline was 59 ml per year. Over the 3-year study period, 38% of patients had an estimated decline in FEV(1) of more than 40 ml per year, 31% had a decline of 21 to 40 ml per year, 23% had a change in FEV(1) that ranged from a decrease of 20 ml per year to an increase of 20 ml per year, and 8% had an increase of more than 20 ml per year. The mean rate of decline in FEV(1) was 21±4 ml per year greater in current smokers than in current nonsmokers, 13±4 ml per year greater in patients with emphysema than in those without emphysema, and 17±4 ml per year greater in patients with bronchodilator reversibility than in those without reversibility.ConclusionsThe rate of change in FEV(1) among patients with COPD is highly variable, with increased rates of decline among current smokers, patients with bronchodilator reversibility, and patients with emphysema.

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