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

Abstract

BackgroundExacerbations 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.MethodsThe 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%).ResultsCompared 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 second 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).ConclusionBlood eosinophil in the stable period is the factor most correlated with the frequency of severe exacerbations.Trial registrationThe patients in this study was registered retrospectively

Associations of Exercise Tolerance and Clinical Parameters in Japanese Patients With Chronic Obstructive Pulmonary Disease: Impact of Skeletal Muscle

“…For example, low-level physical activity, percent predicted forced expiratory volume in one second (%FEV 1 ), 6-minute walk distance, body mass index (BMI), and a high frequency of exacerbations are significantly associated with mortality in COPD patients 3,4 . We and others have also reported that low-level pulmonary function, exercise tolerance (including 6-minute walk distance and exercise-induced desaturation), and BMI are correlated with a high frequency of exacerbations [5][6][7][8] , indicating that evaluations of exercise tolerance and body composition, in addition to pulmonary function, are important for predicting the clinical course of COPD.…”

Elevated Peripheral Blood Eosinophils during Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…Patients with COPD suffer from exacerbation, reduced quality of life, and increased morbidity and mortality. [1][2][3] Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is mainly associated with neutrophilic inflammation; however, predominant eosinophilic airway inflammation has been reported in a subset of patients with COPD. [4][5][6] Up to 40% of patients with COPD have an eosinophilic phenotype of COPD, defined as peripheral blood eosinophil (PBE) counts ≥ 2%.…”