Patients With COPD Exacerbation Have Increased Odds of Having More, Study Finds

The odds of subsequent exacerbations and death within 3 years is higher in patients with chronic obstructive pulmonary disease (COPD) who had a moderate exacerbation, according to a study published in International Journal of Chronic Obstructive Pulmonary Disease.

The aim of the study was to investigate the impact of a moderate exacerbation on the odds of subsequent exacerbations and death in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) B COPD. Patients in the GOLD B grouping have a significant symptom burden and either 0 exacerbations or 1 moderate exacerbation in the previous year, according to the authors.

The researchers carried out a population-based cohort study using 5 Danish health registries. All participants in this study were 40 years and older who had a visit to a specialized hospital-based clinic for COPD between 2008 and 2014. Patients were excluded because of missing information, incomplete registration, and diagnosis of other conditions for which oral corticosteroids (OCS) were prescribed.

Patients were identified as part of GOLD B by using the available data in the registry on the number and severity of COPD exacerbations. Moderate exacerbations were defined as short-term use of OCS, severe exacerbations as hospitalizations or emergency department visits. For patients with both moderate and severe exacerbations, only their severe exacerbation was considered.

The modified Medical Research Council (mMRC) dyspnea scale was used to evaluate breathlessness, with a 0 indicating no breathlessness and a 4 indicating breathlessness doing menial tasks. Patients identified as part of the GOLD B group were split into 2 groups: B0 with zero baseline exacerbations and B1 with 1 moderate baseline exacerbation.

There were 4545 GOLD B0 patients with a mean age of 70.1 years and 51.1% male and 3908 GOLD B1 patients with a mean age of 69.9 years and 49.9% male. The mMRC scores of both groups were similar, with more than half of the patients having a score of 2. Approximately 30% of GOLD B0 and 14% of GOLD B1 had scores of 3 and 4.

There were 30.3% and 24.7% of patients in GOLD B0 and B1, respectively, who were not prescribed respiratory medication in the 4 months prior to their index in the registry; 15.1% and 15.9% in GOLD B0 and B1, respectively, were treated with only 1 type of medication.

The proportion of B0 patients without exacerbations ranged from 32.5% to 43.9%; during the entire study period, 15% of B0 patients were exacerbation free. For B1 patients, the proportion of patients without exacerbations in the first 3 years was lower, between 24.9% and 32.9%, with only 8% remaining without exacerbations for all 3 years.

During the 3-year follow-up, 34.1% of B0 patients and 24.9% of B1 patients had 0 exacerbations or 1 moderate exacerbation. The mean (SD) number of exacerbations were 3.01 (2.6) in GOLD B0 and 3.97 (2.9) in GOLD B1, and 61.9% and 71.2%, respectively, had 2 or more moderate exacerbations or 1 or more severe exacerbations or death.

In addition, B1 patients had more than double the odds for 2 or more moderate or severe exacerbations during the 3-year period vs B0 patients. During the 3-year period, B1 patients also had a 58% greater chance (odds ratio [OR], 1.58; 95% CI, 1.33-1.87) of a new moderate exacerbation.

Patients in the B1 group had an increased risk of any exacerbation compared with the B0 group (HR, 1.21; 95% CI, 1.18-1.25). Approximately 10% of all patients died overall, and 28.7% died during follow-up.

Overall, the risk of death increased 85% (OR, 1.85; 95% CI, 1.57-2.17) after 3 years in the B1 group compared with the B0 group. The most common cause of death was COPD (B0, 43.8%; B1, 42.8%).

There were some limitations to this study. All patients were identified in a hospital setting, which means the participants were a more symptomatic GOLD B population compared with other patients followed only in primary care. There were also differences in collection of medication for B0 and B1 patients, which may reflect disease severity differences between the 2 groups.

The researchers concluded that their study determined that a moderate exacerbation in GOLD B patients with COPD increased the odds of other exacerbations and death. “To improve the current management of COPD, a better risk assessment and a more individualized approach is required,” they wrote.

Reference

Lokke A, Hilberg O, Lange P, et al. Disease trajectories and impact of one moderate exacerbation in gold B COPD patients. Int J Chron Obstruct Pulmon Dis. 2022;17:569-578. doi:10.2147/COPD.S344669