CHARACTERISTICS OF PATIENTS WITH FREQUENT EXACERBATOR PHENOTYPE OF COPD AND ROLE OF INHALED CORTICOSTEROID THERAPY

Abstract

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) is a chronic pulmonary condition with a progressively increasing burden throughout the world and a high rate of hospitalization. The frequent exacerbator phenotype has been defined as the occurrence of two or more exacerbations per year and has been linked to negative clinical and psychosocial outcomes. We aimed to further characterize patients with frequent exacerbations and evaluate an association between inhaled corticosteroid therapy and the risk of hospital admission. METHODS: In this retrospective cohort study, we reviewed electronic medical records of 120 patients admitted to a hospital for COPD exacerbation at least once between January 1, 2016 and December 31, 2018. Characteristics of the frequent exacerbators were compared to patients with less frequent exacerbations or COPD. Cox proportional hazard model was used to evaluate an association between inhaled corticosteroid therapy and the risk of hospital admission. RESULTS: Patients in the frequent exacerbator cohort (n=69) were significantly younger, with lower percentage of women, compared to the patients with less frequent exacerbations (n=51). The median number of hospital admissions for COPD exacerbation were three and one, respectively. The frequent exacerbator cohort had significantly higher proportion of patients on supplemental oxygen at home and proportion of patients suffering from depression. No significant differences were observed in the disease severity, smoking status, or history of cardiovascular disease. After adjusting for age, sex, GOLD COPD stage and presence of restrictive lung disease, which had significant relationships with hospitalization for COPD in the univariate analysis, Cox proportional hazard regression analysis revealed increased risk for hospital admission associated with inhaled corticosteroid use at the time of admission (HR=1.57, p=0.017). CONCLUSIONS: We described patient characteristics associated with frequent exacerbator phenotype of COPD. Patients on inhaled corticosteroids experienced hospital admissions for COPD at a significantly higher rate. CLINICAL IMPLICATIONS: The knowledge of characteristics of patients with the frequent exacerbator phenotype of COPD may assist in the development of interventions aimed at decreasing the frequency of hospitalizations. The observed association between inhaled corticosteroid use and increased risk of hospital admission adds to the body of conflicting evidence as to the role of inhaled corticosteroids in the treatment of COPD. DISCLOSURES: No relevant relationships by John Chronakos, source=Web Response No relevant relationships by Manish Gupta, source=Web Response No relevant relationships by prajay rathore, source=Web Response No relevant relationships by Sushmita Shrestha, source=Web Response No relevant relationships by Oleg Sostin, source=Web Response No relevant relationships by Uladzislau Valynets, source=Web Response