Characteristics Associated with Accelerated Lung Function Decline in a Primary Care Population with Chronic Obstructive Pulmonary Disease

Abstract

Background

Estimates for lung function decline in chronic obstructive pulmonary disease (COPD) have differed by study setting and have not been described in a UK primary care population.

Purpose

To describe rates of FEV ₁ and FVC decline in COPD and investigate characteristics associated with accelerated decline.

Patients and Methods

Current/ex-smoking COPD patients (35 years+) who had at least 2 FEV ₁ or FVC measurements ≥6 months apart were included using Clinical Practice Research Datalink. Patients were followed up for a maximum of 13 years. Accelerated rate of lung function decline was defined as the fastest quartile of decline using mixed linear regression, and association with baseline characteristics was investigated using logistic regression.

Results

A total of 72,683 and 50,649 COPD patients had at least 2 FEV ₁ or FVC measurements, respectively. Median rates of FEV ₁ and FVC changes or decline were −18.1mL/year (IQR: −31.6 to −6.0) and −22.7mL/year (IQR: −39.9 to −6.7), respectively. Older age, high socioeconomic status, being underweight, high mMRC dyspnoea and frequent AECOPD or severe AECOPD were associated with an accelerated rate of FEV ₁ and FVC decline. Current smoking, mild airflow obstruction and inhaled corticosteroid treatment were additionally associated with accelerated FEV ₁ decline whilst women, sputum production and severe airflow obstruction were associated with accelerated FVC decline.

Conclusion

Rate of FEV ₁ and FVC decline was similar and showed similar heterogeneity. Whilst FEV ₁ and FVC shared associations with baseline characteristics, a few differences highlighted the importance of both lung function measures in COPD progression. We identified important characteristics that should be monitored for disease progression.