Susceptibility to Exacerbation in Chronic Obstructive Pulmonary Disease

  • Locantore N
  • Ph D
  • Müllerova H
 et al. 
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Background Although we know that exacerbations are key events in chronic obstructive pulmo -nary disease (COPD), our understanding of their frequency, determinants, and effects is incomplete. In a large observational cohort, we tested the hypothesis that there is a frequent-exacerbation phenotype of COPD that is independent of disease severity. Methods We analyzed t he frequency and associat ions of exacerbat ion in 2138 pat ients en -rolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End -points (ECLIPSE) study. Exacerbations were defined as events that led a care pro -vider to prescribe antibiotics or corticosteroids (or both) or that led to hospitalization (severe exacerbations). Exacerbation frequency was observed over a period of 3 years. Results Exacerbations became more frequent (and more severe) as the severity of COPD increased; exacerbation rates in the first year of follow-up were 0.85 per person for patients with stage 2 COPD (with stage defined in accordance with Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages), 1.34 for patients with stage 3, and 2.00 for patients with stage 4. Overall, 22% of patients with stage 2 disease, 33% with stage 3, and 47% with stage 4 had frequent exacerbations (two or more in the first year of follow-up). The single best predictor of exacerbations, across all GOLD stages, was a history of exacerbations. The frequent-exacerbation phenotype appeared to be relatively stable over a period of 3 years and could be predicted on the basis of the patient’s recall of previous treated events. In addition to its asso -ciation with more severe disease and prior exacerbations, the phenotype was inde -pendently associated with a history of gastroesophageal reflux or heartburn, poorer quality of life, and elevated white-cell count. Conclusions Although exacerbations become more frequent and more severe as COPD progresses, the rate at which they occur appears to reflect an independent susceptibility pheno -type. This has implications for the targeting of exacerbation-prevention strategies across the spectrum of disease severity

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  • Nicholas Locantore

  • D Ph

  • Hana Müllerova

  • D Ph

  • Ruth Tal-singer

  • D Ph

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