Abstract
BackgroundWhether risk of exacerbations of chronic obstructive pulmonary disease (COPD) is influenced by severity of symptoms and maintenance treatment is unclear. ObjectiveWe hypothesized that in addition to history of exacerbations of COPD, the severity of dyspnoea and use of maintenance medications are associated with risk of future exacerbations. MethodsWe included 96,462 adults from the Copenhagen General Population Study and assessed risk of moderate and severe exacerbations from 2003 to 2013 according to exacerbation history, dyspnoea score (mMRC), and presence/absence of maintenance treatment with inhaled long-acting bronchodilators and/or inhaled corticosteroids. FindingsAmong 13,380 individuals with COPD, we observed 1543 moderate and 348 severe exacerbations. In treatment naïve individuals and in those on maintenance treatment, history of previous exacerbations and to a smaller degree also dyspnoea were associated with a higher risk of future exacerbations; 32% of the treatment naïve individuals with mMRC≥2 and a single moderate exacerbation in the previous year experienced a moderate exacerbation during the following year compared with only 3% in the individuals with similar severity of dyspnoea but no exacerbations in the previous year yielding an adjusted hazard ratio of 6.26 (95% confidence interval, 3.70–10.58). InterpretationThis observational study of the general population suggests that in addition to exacerbation history also the severity of dyspnoea predicts the risk of future COPD exacerbations. In subjects with severe dyspnoea, a history of a single moderate exacerbation is associated with a high risk of future exacerbations, suggesting that this subgroup needs special attention in order to prevent these events.
Highlights
Exacerbations, defined as acute worsening of symptoms, are com mon complications of chronic obstructive pulmonary disease (COPD) leading to additional therapy and hospitalizations [1]
Among the 89,099 individuals aged 40 years or older participating in the Copenhagen General Population Study examination from 2003 to 2013 with a valid spirometry, we identified 13,380 participants with COPD, defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)
We present data according to exacerbation history and maintenance treatment in those with severe dyspnoea
Summary
Exacerbations, defined as acute worsening of symptoms, are com mon complications of chronic obstructive pulmonary disease (COPD) leading to additional therapy and hospitalizations [1]. The most recent recommendation from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) suggests that an exacerbation history with at least two mild or moderate exacerbations or at least one severe exacerbation leading to hospitalisation in the preceding year identifies patients that should receive preventive treatment to reduce risk of future exacerba tions [1]. This recommendation is based on studies suggesting “tracking”; i.e., the phenomenon that exacerbations in previous years predict a high risk of future exacerbations [3,4,5,6,7]. In subjects with severe dyspnoea, a history of a single moderate exacerbation is associated with a high risk of future exacerbations, suggesting that this subgroup needs special attention in order to prevent these events
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