Clinical features of Japanese patients with exacerbations of chronic obstructive pulmonary disease

Abstract

Background Exacerbations are critical events in chronic pulmonary obstructive disease (COPD). The frequency of COPD exacerbations is associated with the prognosis, including mortality, but no useful biomarker has been established. Methods The present retrospective study investigated 481 COPD patients. Clinical features in the stable period were compared between patients who experienced severe exacerbation (n = 88, 18.3%) and those who never experienced severe exacerbation (n = 393, 81.7%). In the patients who experienced exacerbations, clinical features were also compared between frequent exacerbators (exacerbation rate ≥ 2 times/year, n = 27, 30.7%) and infrequent exacerbators (1 time/year, n = 61, 69.3%). Results Compared to COPD patients who never experienced exacerbations, body mass index (BMI), serum albumin, and pulmonary functions were significantly lower, and the cardiovascular disease comorbidity rate, COPD assessment test score, modified Medical Research Council dyspnea scale, and use of long-term oxygen therapy, long-acting β2 adrenergic agonist therapy, inhaled corticosteroid therapy, and macrolide therapy were significantly higher in COPD patients with exacerbations (all p < 0.01). In patients who experienced exacerbations, frequent exacerbators had significantly lower % forced expiratory volume in 1.0 s and a higher risk of critical exacerbations, percentage of blood eosinophils, history of mechanical ventilation use, and use of long-term oxygen therapy and of macrolide therapy than infrequent exacerbators (all p < 0.01). On multivariate analysis, the percentage of blood eosinophils was the parameter most correlated with exacerbation frequency (β value [95% confidence interval] 1.45 [1.12–1.88], p < 0.01). Conclusion Blood eosinophil in the stable period is the factor most correlated with the frequency of severe exacerbations. Trial registration: The patients in this study was registered retrospectively

History of Respiratory Events Prior to a First COPD Diagnosis and Future Exacerbations: A Longitudinal Observational Cohort Database Study in Japan

“…23 From this perspective, respiratory events such as LRTIs may be considered as markers of COPD risk and poorer prognosis. However, it should be noted that other potential confounders such as smoking, exposure to air pollutants or eosinophil count 24 could not be accounted for in our models because data on them are not collected in the JMDC database.…”

Is Blood Eosinophil Count a Biomarker for Chronic Obstructive Pulmonary Disease in a Real-World Clinical Setting? Predictive Property and Longitudinal Stability in Japanese Patients

“…Most cohort studies have continued to pay attention to the association between BEC and AECOPD [21], but they have also provided inconsistent results. While some have reported a positive association between BEC with COPD exacerbation frequency [18,[44][45][46], other cohort studies have reported that there was no evidence of such an association (Table 4) [20,41,43,47]. Although most previous studies were designed to statistically compare the frequency of AECOPD between groups, the period from baseline to the first exacerbation is intended to be analysed using the univariate Cox proportional hazards model.…”

Clinical Impacts of Interventions for Physical Activity and Sedentary Behavior on Patients with Chronic Obstructive Pulmonary Disease

“…Importantly, exercise can exacerbate the phenomena [ 113 ] that might contribute to avoidance of moderate or vigorous physical activity and increase sedentary behavior. Even worse, the sequence of behavior induces a negative feedback cycle leading to poor outcomes for COPD patients, because increasing sedentary time with a reduction in physical activity contributes to skeletal muscle atrophy, especially in antigravity muscles such as the erector spinae muscles and thigh muscles, causing weight loss and decreased exercise capacity [ 59 , 66 , 67 , 114 ]. Consequently, the symptoms of dyspnea and shortness of breath are induced at a low intensity of physical activity, and patients try to avoid movement along with progression of muscle atrophy.…”

“…These data showed that sedentary behavior time was reduced because of improvement of decreased inspiratory capacity, which contributes to shortness of breath and dyspnea, by dual bronchodilator therapy. Recently, inhaled corticosteroid therapy was also found to be effective for patients with COPD, especially in those with frequent exacerbations with elevation of blood eosinophil levels [ 114 , 119 ]. We do not know the impact of inhaled corticosteroid therapy on sedentary behavior in patients with COPD, and further trials are needed to clarify its efficacy.…”