Frequency and Severity of Exacerbations of COPD Associated with Future Risk of Exacerbations and Mortality: A UK Routine Health Care Data Study

Abstract

Background: Studies have shown that chronic obstructive pulmonary disease (COPD) exacerbation events are related to future events; however, previous literature typically reports frequent vs infrequent exacerbations per patient-year and no studies have investigated increasing number of severe exacerbations in relation to COPD outcomes. Objective: To investigate the association between baseline frequency and severity of exacerbations and subsequent mortality and exacerbation risk in a COPD cohort. Methods: Clinical Practice Research Datalink (CPRD) Aurum and Hospital Episode Statistics data were used to identify patients registered at general practices in the UK, who had a diagnosis of COPD, were over the age of 40 years, were smokers or ex-smokers and had data recorded from 2004 onwards. Frequency and severity of exacerbations in the baseline year were identified as moderate exacerbations (general practice events) and severe exacerbations (hospitalised events). Patients were categorised as having: none, 1 moderate only, 2 moderate only, 3+ moderate only, 1 severe (and any moderate), 2 severe (and any moderate), and 3+ severe (and any moderate exacerbations). Poisson regression was used to investigate the association between baseline exacerbation frequency/severity and exacerbation events and mortality over follow-up. Results: Overall, 340,515 COPD patients were included. Patients had higher rates of future exacerbations with increasing frequency and severity of baseline exacerbations compared to no baseline exacerbations. Adjusted incidence rate ratios (IRR) for patients with 1, 2, and 3+ moderate exacerbations compared to 0 exacerbations were 1.70 (95% CI 1.66-1.74), 2.31 (95% CI 2.24-2.37), and 3.52 (95% CI 3.43-3.62), respectively. Patients with increased frequency of baseline exacerbations were more likely to die from all-cause, COPD-related, and cardiovascular-related mortality in a graduated fashion. Conclusion:Increasing number and severity of exacerbations were associated with increasing risk of subsequent exacerbations, allcause mortality and COPD-related mortality. Even a single moderate event increases the risk of future events, illustrating that every exacerbation counts.

Frequency and severity of respiratory infections prior to COPD diagnosis and risk of subsequent postdiagnosis COPD exacerbations and mortality: EXACOS-UK health care data study

“…The association between exacerbations of COPD and increased risk of future exacerbations is well known 4 9. In addition, recent studies suggest that the presence of moderate exacerbations of COPD during a year, even a single one, are associated with future risk of exacerbations 2–4. Our study expands on this result by highlighting the importance of even a single LRTI requiring antibiotics prior to first COPD diagnosis, in the estimation of the future rate of COPD exacerbations.…”

“…The association between exacerbations of COPD and increased risk of future exacerbations is well known 4 9. In addition, recent studies suggest that the presence of moderate exacerbations of COPD during a year, even a single one, are associated with future risk of exacerbations 2–4.…”

“…Acute exacerbations of chronic obstructive pulmonary disease (COPD) are worsening of COPD symptoms (breathlessness, cough, and sputum volume and purulence) beyond normal day-to-day variation. Approximately 50% to 80% of patients with COPD experience at least one exacerbation in a given year, and even a single moderate exacerbation increases the risk of future multiple exacerbation events 1 2–4. Exacerbations have also been associated with other clinical outcomes including accelerated lung function decline, reduced quality of life,and mortality 5–7…”

Editorial: Toolkits for Prediction and Early Detection of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

“…Chronic obstructive pulmonary disease (COPD) is an inflammatory chronic airway disease with high morbidity and mortality, plus serious social and economic burden ( 1 , 2 ). Acute exacerbations (AECOPD) are periods of worsened symptoms, outside a given patient's day-to-day fluctuations, of dyspnea and cough with increased sputum production, often accompanied by fatigue, sleep disturbance, and sputum purulence.…”

High Flow Nasal Oxygen at Home to Prevent Chronic Obstructive Pulmonary Disease Exacerbations?

“…The natural history of chronic obstructive pulmonary disease (COPD) is characterized by recurrent exacerbations leading to lung function decline and reducing quality of life with an increased risk of early death ( 1 ). Even though there is no strong evidence that long-term oxygen using conventional oxygen therapy is beneficial to reduce mortality and need for hospital admission ( 2 ), a new approach using high-flow nasal cannula oxygen therapy (HFNC) as long-term treatment at home could be beneficial.…”