Exacerbation history, dyspnea severity predict future COPD events

History of exacerbations, as well as severity of dyspnea, may predict future exacerbations in patients with COPD, according to results of an observational study published in Respiratory Medicine.

Researchers conducted an observational study that included 96,462 adults from the Copenhagen General Population Study; of those, 13,380 adults had COPD. The researchers evaluated the risk for moderate and severe exacerbations from 2003 to 2013 based on COPD exacerbation history, dyspnea score, and the presence or absence of maintenance treatment with inhaled long-acting bronchodilators and/or inhaled corticosteroids.

During follow-up, those with COPD had 1,543 moderate exacerbations and 348 severe exacerbations.

In both treatment-naive individuals and those on maintenance treatment, history of exacerbations and dyspnea, though to a smaller degree, were associated with increased risk for future exacerbations. A moderate exacerbation in the following year occurred in 32% of treatment-naive individuals with a dyspnea score of at least 2 and a single moderate exacerbation in the previous year compared with 3% of individuals with a similar dyspnea severity but no previous exacerbations (HR = 6.26; 95% CI, 3.7-10.58).

“As this is an observational study, the comparison of the treatment-naive groups with those on maintenance treatment is difficult. We have no information on whether maintenance treatment was started because of daily symptoms or because of earlier exacerbations. Therefore, the individuals on maintenance treatment in the [no exacerbations in the previous year] or [one moderate exacerbation in the previous year] groups could have been frequent exacerbators in the past before initiating maintenance medication and enrollment in our study cohort,” Jacob Louis Marott, MD, from the Copenhagen General Population Study at Copenhagen University Hospital of Herlev and Gentofte and Frederiksberg and Bispebjerg in Copenhagen, Denmark, and colleagues wrote.

According to the researchers, the small number of participants and number of outcomes and lack of information on previous treatment history are limitations of the current study.

“... [T]he present observational study of individuals with COPD from the general population shows that exacerbation history is the main driver of the future exacerbation risk, but severe dyspnea also predicts future exacerbations. In particular, in treatment-naive individuals with severe dyspnea, corresponding to GOLD B, a single moderate exacerbation in the preceding year is associated with a relative high risk of future exacerbation, suggesting that this subgroup needs special attention in order to prevent these events,” Marott and colleagues researchers wrote.