Abstract
Exacerbation frequency is central in treatment strategies for chronic obstructive pulmonary disease. However, whether chronic obstructive pulmonary disease patients from the general population with frequent exacerbations continue to have frequent exacerbations over an extended period of time is currently unknown. In this study, we aimed to investigate the stability of the frequent exacerbator in a population-based setting. To this end, we conducted a nationwide register-based descriptive study with a 10-year follow-up period of chronic obstructive pulmonary disease patients with at least one medically treated exacerbation in 2003. Each subsequent year, we divided the population into frequent, infrequent and non-exacerbators and quantified the flow between categories. Further, we estimated the percentage of frequent exacerbators at baseline who stayed in this category each year during a 5-year follow-up. We identified 19,752 patients with chronic obstructive pulmonary disease and an exacerbation in 2003. Thirty percent were frequent exacerbators. Overall, the majority of exacerbators in 2003 were non-exacerbators in the following years (60% in 2004 increasing to 68% in 2012). Approximately half of frequent exacerbators in one year experienced a decrease in exacerbation frequency and had either zero or one exacerbation in the subsequent year. This pattern was stable throughout follow-up. During a 5-year follow-up period, a substantial proportion (42%) of frequent exacerbators in 2003 had no additional years as frequent exacerbators, while the minority (6%) remained in this category each year. In conclusion, the rate of exacerbations shows considerable variation over time among chronic obstructive pulmonary disease patients in the general population. This might hold implications for chronic obstructive pulmonary disease treatment guidelines and their practical application.
Highlights
Chronic obstructive pulmonary disease (COPD) is characterized by recurrent exacerbations, defined as episodes of “worsening of respiratory symptoms that are beyond the normal day-to-day variation and lead to a change in treatment”.1 Exacerbations have considerable impact on patients and result in increased mortality as well as augmented use of medication, rehabilitation and hospitalizations.[2,3,4,5,6,7]Exacerbation frequency is a key component in determining treatment strategies for COPD
The ECLIPSE study showed that the majority of patients without exacerbations remained stable over time, at least within the 3-year study period.[9, 10]
The ECLIPSE study found that the frequent exacerbator was relatively stable over a 2-year follow-up period, the stability was more distinct among non-exacerbators.[9]
Summary
Chronic obstructive pulmonary disease (COPD) is characterized by recurrent exacerbations, defined as episodes of “worsening of respiratory symptoms that are beyond the normal day-to-day variation and lead to a change in treatment”.1 Exacerbations have considerable impact on patients and result in increased mortality as well as augmented use of medication, rehabilitation and hospitalizations.[2,3,4,5,6,7]Exacerbation frequency is a key component in determining treatment strategies for COPD. Chronic obstructive pulmonary disease (COPD) is characterized by recurrent exacerbations, defined as episodes of “worsening of respiratory symptoms that are beyond the normal day-to-day variation and lead to a change in treatment”.1. Exacerbations have considerable impact on patients and result in increased mortality as well as augmented use of medication, rehabilitation and hospitalizations.[2,3,4,5,6,7]. Exacerbation frequency is a key component in determining treatment strategies for COPD.
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