Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by intermittent exacerbations, which leads to substantial morbidity and mortality. Chronic cough and sputum production are significant but variable symptoms in COPD, but their effects on exacerbation frequency have not been well described. Methods: We analyzed 52 stable outpatients in Phase II of the Pennsylvania Study of COPD Exacerbations (PA−SCOPE) with severe airflow obstruction (FEV1 <50%). Patients documented daily symptoms of cough, wheeze, breathlessness, sputum quantity, color, and consistency, and upper respiratory tract infectious symptoms in semiquantitative scales, as well as peak flow for up to 2 years. Exacerbation presence and severity was defined based on a daily index of symptoms. Patients were divided into tertiles based on their average sputum symptom indices. Percent emphysema in a subset of these patients (n=23, 8 in tertile 1, 6 in tertile 2, 9 in tertile 3) was analyzed using 3D Slicer v2.8. Data were analyzed using ANOVA and Chi−square test.

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