AimThe aim of this study was to analyze the association between therapy adherence to inhaled corticosteroids (ICSs) and tiotropium on the one hand and morbidity and mortality in COPD on the other hand.MethodsTherapy adherence to ICSs and tiotropium over a 3-year period of, respectively, 635 and 505 patients was collected from pharmacy records. It was expressed as percentage and deemed optimal at ≥75–≤125%, suboptimal at ≥50%–<75%, and poor at <50% (underuse) or >125% (overuse). The association between adherence and time to first hospital admission for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), community acquired pneumonia (CAP), and mortality was analyzed, with optimal use as the reference category.ResultsSuboptimal use and underuse of ICSs and tiotropium were associated with a substantial increase in mortality risk: hazard ratio (HR) of ICSs was 2.9 (95% CI 1.7–5.1) and 5.3 (95% CI 3.3–8.5) and HR of tiotropium was 3.9 (95% CI 2.1–7.5) and 6.4 (95% CI 3.8–10.8) for suboptimal use and underuse, respectively. Suboptimal use and overuse of tiotropium were also associated with an increased risk of CAP, HR 2.2 (95% CI 1.2–4.0) and HR 2.3 (95% CI 1.2–4.7), respectively. Nonadherence to tiotropium was also associated with an increased risk of severe AECOPD: suboptimal use HR 3.0 (95% CI 2.01–4.5), underuse HR 1.9 (95% CI 1.2–3.1), and overuse HR 1.84 (95% CI 1.1–3.1). Nonadherence to ICSs was not related to time to first AECOPD or first CAP.ConclusionPoor adherence to ICSs and tiotropium was associated with a higher mortality risk. Furthermore, nonadherence to tiotropium was associated with a higher morbidity. The question remains whether improving adherence can reduce morbidity and mortality.

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Adding MR-proADM increased the predictive power of BOD, ADO and updated ADO index.

BackgroundThe effectiveness of antibiotics in chronic obstructive pulmonary disease (COPD) exacerbations is still a matter of debate, especially in outpatients with an intermediate probability of bacterial infection.MethodsIn this study, 35 COPD outpatients diagnosed by their chest physician with moderately severe COPD exacerbation, but without pneumonia, were randomised in a double blind, placebo-controlled study. Patients had one or two of the following characteristics: a positive Gram's stain of the sputum, 2 or more exacerbations in the previous year, a decrease in lung function of >200 mL and >12%. Patients received amoxicillin clavulanic acid (500/125 mg three times daily) or placebo for 7 days, always combined with a course of prednisolone (30 mg/day) for 7 days. Primary outcome was duration of the exacerbation. Additionally, we measured severity of the exacerbation, health-related quality of life, sputum parameters, number of relapses within 28 days and the number of re-exacerbations within 4 months after the study.ResultsThere was no difference observed in time to resolution of the exacerbation between the two groups (HR=1.12; (95% CI 0.5 to 2.3; p=0.77)), nor in any other treatment parameter.ConclusionsWe detected no evidence for the effectiveness of addition of antibiotics to prednisolone for COPD exacerbations of moderate severity and with intermediate probability of bacterial infection in this underpowered study. More placebo-controlled studies are needed to properly define subgroups of COPD outpatients in which antibiotics are of additional value.Trials registration numberclinical trial registered with http://www.trialregister.nl/(NTR351).

To better classify patients with chronic obstructive pulmonary disease (COPD) for prognostic purposes and to tailor treatment, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2007 classification was revised in 2011. The primary aim of the current data analyses was to evaluate the accuracy of the GOLD 2007 and 2011 GOLD classifications to predict all-cause mortality and morbidity in a well-described COPD cohort. The prognostic values of both GOLD classifications, expressed as the C-statistic, were assessed in the Cohort of Mortality and Inflammation in COPD (COMIC) study of 795 COPD patients, with a follow-up of 3 years. Outcomes were all-cause mortality and morbidity. Morbidity was defined as time until first COPD-related hospitalisation and time until first community-acquired pneumonia (CAP). The prognostic value of the GOLD 2011 classification was compared between symptom classification based on the modified Medical Research Council (mMRC) score and the Clinical COPD Questionnaire (CCQ) scores with two different thresholds. Although the GOLD 2011 CCQ classification had the highest accuracy to predict mortality and morbidity in our study, the C-statistics differed only numerically. Furthermore, our study showed that the instrument used to determine the level of symptoms in the GOLD 2011 classification has not only important consequences on the mortality prognosis, but also affects the morbidity prognosis in COPD. Therefore, patients' estimated prognosis could alter when different types of tools are used to evaluate the prognosis.