First chronic obstructive pulmonary disease exacerbation predicts risk of more

Exacerbation history, along with the presence of severe dyspnoea and maintenance treatment use, is associated with an increased risk of future exacerbation episodes in patients with chronic obstructive pulmonary disease (COPD), a study has found.

The analysis included 96,462 adults from the Copenhagen General Population Study. All of them completed a comprehensive questionnaire and underwent a physical examination including spirometry with measurements of prebronchodilatory forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC).

Of the 13,380 individuals found to have COPD, 1,543 developed moderate and 348 developed severe exacerbations. The median follow-up time for these exacerbations was 3.6 years.

Individuals with frequent exacerbations, severe dyspnoea, and/or dyspnoea score (mMRC) ≥2 had a higher prevalence of treatment with maintenance inhaled medications. Individuals with less dyspnoea accordingly had a higher FEV1 than those with severe dyspnoea.

Among treatment-naïve individuals and those on maintenance treatment, history of previous exacerbations and, to a smaller degree, dyspnoea contributed to a heightened risk of future exacerbations.

A total of 32 percent treatment-naïve individuals with mMRC≥2 and a single moderate exacerbation in the previous year experienced a moderate exacerbation during the following year. This was higher than the 3 percent documented among individuals with similar severity of dyspnoea but no exacerbations in the previous year. The corresponding hazard ratio for future exacerbations was 6.26 (95 percent confidence interval, 3.70–10.58).

The findings highlight the need to closely monitor patients with severe dyspnoea and a history of a single moderate exacerbation in order to minimize the risk of future exacerbations.