• 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, and Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints Study Investigators.
• 1 Department of Respiratory Medicine, Odense University Hospital, and Clinical Institute, University of Southern Denmark, Odense, Denmark.
• Am. J. Respir. Crit. Care Med. 2014 May 1; 189 (9): 1022-30.

RationaleChronic obstructive pulmonary disease (COPD) seems to be a heterogeneous disease with a variable course.ObjectivesWe wished to characterize the heterogeneity and variability of COPD longitudinally.MethodsIn 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 ResultsWe 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; club 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.ConclusionsBy 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).

58 keywords...

hide…