Am. J. Respir. Crit. Care Med., Volume 161, Number 4, April 2000, 1201-1205

Relation of FEV₁ to Clinical Outcomes during Exacerbations of Chronic Obstructive Pulmonary Disease

DENNIS E. NIEWOEHNER, DOROTHEA COLLINS, and MARCIA L.ERBLAND for the Department of  Veterans Affairs Cooperative Study Group

Veterans Affairs Medical Centers, Minneapolis, Minnesota and Little Rock, Arkansas; and the Cooperative Studies Program Coordinating Center, West Haven, Connecticut

FEV₁ is an objective measure of airflow obstruction used in clinical practice and in therapeutic trials. The precise relationship of FEV₁ to clinical outcomes is generally uncertain. As part of a randomized trial to assess systemic corticosteroid efficacy, we obtained serial FEV₁ measurements in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). Over the first 14 Study Days at least one FEV₁ value was obtained in 261 subjects. Sixty-four of these subjects experienced treatment failure, defined as death, intubation, readmission for COPD, or intensification of drug therapy, by Study Day 30. After adjustment, both FEV₁ at entry into the study (odds ratio [OR] for a 100-ml increase, 0.87; 95% confidence interval [CI], 0.79 to 0.96) and change in FEV₁ over the first two Study Days (OR for a 100 ml increase, 0.80; 95% CI, 0.69 to 0.92) predicted treatment failure. We identified no baseline characteristic that was significantly related to FEV₁ at entry into the study. Assignment to the systemic corticosteroid treatment arm was associated with a significantly larger FEV₁ at Study Day two (p = 0.01). We conclude that FEV₁ measurements at admission and over the first several days of hospitalization are highly predictive of clinical outcomes during exacerbations of COPD.

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