Elsevier

Respiratory Medicine

Volume 105, Issue 4, April 2011, Pages 588-594
Respiratory Medicine

Clinical predictors of frequent exacerbations in subjects with severe chronic obstructive pulmonary disease (COPD)

https://doi.org/10.1016/j.rmed.2010.11.015Get rights and content
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Summary

Background

Acute exacerbations are a significant source of morbidity and mortality associated with chronic obstructive pulmonary disease. Among individuals with COPD, some patients suffer an inordinate number of exacerbations while others remain relatively protected. We undertook a study to determine the clinical factors associated with "frequent exacerbator" status within a population of subjects with severe COPD.

Methods

Case-control cohort recruited from two Boston-area practices. All subjects had GOLD stage 3 or 4 (FEV1 ≤ 50% predicted) COPD. "Frequent exacerbators" (n = 192) had an average of ≥2 moderate-to-severe exacerbations per year while "non-exacerbators" (n = 153) had no exacerbations in the preceding 12 months. Multivariate logistic regression was performed to determine the significant clinical predictors of "frequent exacerbator" status.

Results

Physician-diagnosed asthma was a significant predictor of frequent exacerbations. Within a subset of our cohort, the modified Medical Research Council dyspnea score and FEF 25–75% predicted were also significant clinical predictors of frequent exacerbator status (p < 0.05). Differences in exacerbation frequency were not found to be due to increased current tobacco use or decreased rates of maintenance medication use.

Conclusions

Within our severe COPD cohort, a history of physician-diagnosed asthma was found to be a significant clinical predictor of frequent exacerbations. Although traditional risk factors such as decreased FEV1% predicted were not significantly associated with frequent exacerbator status, lower mid-expiratory flow rates, as assessed by FEF 25–75% predicted, were significantly associated with frequent exacerbations in a subset of our cohort.

Keywords

COPD acute exacerbations
COPD epidemiology
Risk factors for acute exacerbations of COPD

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Institution at which the work was performed.