COPD: prognosis worsens with number and severity of exacerbations

  • Çolak Y & al.
  • Respir Med
  • 25 Jul 2019

  • International Clinical Digest
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Takeaway

  • COPD prognosis depends on the number and severity of previous exacerbations, with the worst prognosis reserved for individuals with a history of exacerbation requiring hospitalization (severe exacerbation).
  • Even a single exacerbation in the preceding year is associated with elevated risk for future exacerbation.

Why this matters

  • Patients should strive to avoid even a single exacerbation.

Study design

  • Population-based cohort of 98,614 adults in the Copenhagen General Population Study.
  • Funding: Lundbeck Foundation.

Key results

  • Compared with individuals without previous exacerbation, the likelihood of future moderate exacerbation (a medically treated exacerbation) adjusted for lung function and symptoms is:
    • HR, 4.68 (95% CI, 3.31-6.62) for having 1 previous moderate exacerbation.
    • HR, 21 (95% CI, 13-33) for having ≥2 previous moderate exacerbations.
    • HR, 5.30 (95% CI, 3.44-8.15) for having ≥1 previous severe exacerbation.
  • Compared with individuals without previous exacerbation, the likelihood of future severe exacerbation adjusted for lung function and symptoms is:
    • HR, 1.62 (95% CI, 0.78-3.34) for having 1 previous moderate exacerbation.
    • HR, 1.29 (95% CI, 0.57-2.89) for having ≥2 previous moderate exacerbations.
    • HR, 5.43 (95% CI, 2.56-12) for having ≥1 previous severe exacerbation.
  • Mean survival time was shortest (5.93 years; 95% CI, 4.04-7.83 years) for individuals with ≥1 severe exacerbation.

Limitations

  • Observational design.