PRS48 Prognostic Risk Factors of Moderate-to-Severe Exacerbations in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. As COPD exacerbations are associated with a worsening of lung function, increased disease burden and mortality, preventing their occurrence is an important goal of COPD management. This review was conducted to identify the current evidence base regarding risk factors and predictors of moderate-to-severe exacerbations in patients with COPD. A literature review was performed in MEDLINE®, EMBASE®, MEDLINE® In-Process and the Cochrane Central Register of Controlled Trials (CENTRAL). Searches were conducted from January 2015 to July 2019. Eligible publications were journal articles, published in English, which reported risk factors or predictors for the occurrence of moderate-to-severe exacerbations in adult patients (≥40 years of age) with a clinical diagnosis of COPD. The literature review identified 5112 references, of which 134 publications (reporting results for 76 studies) met the eligibility criteria and were included in the review. Among the 76 studies included, 61 were observational and 15 were randomised controlled clinical trials. Exacerbation history was the strongest predictor of future exacerbations, with 34 studies reporting a significant association between history of exacerbations and risk of future moderate or severe exacerbations. Other significant risk factors identified in multiple studies included severe or very severe airflow obstruction (39 studies), comorbidities including respiratory infections (34 studies), symptomatic COPD (17 studies) and blood eosinophil count (16 studies). In this systematic literature review, several demographic and clinical characteristics that predict future risk of COPD exacerbations were identified. These prognostic factors may be useful for clinicians to identify patients at high risk of exacerbations, which are a major driver of the global burden of COPD, including morbidity and mortality.