Natural History of COPD Exacerbations in a General Practice Based COPD Population.
Rothnie, KJ; Müllerová, H; Smeeth, L; Quint, JK; (2018) Natural History of COPD Exacerbations in a General Practice Based COPD Population. American journal of respiratory and critical care medicine. ISSN 1073-449X DOI: https://doi.org/10.1164/rccm.201710-2029OC
Abstract
Rationale Acute exacerbations (AECOPD) are important adverse events in the natural history of COPD. Objectives To investigate the natural history of AECOPD over 10-years of follow-up. Methods and Results We identified 99,574 patients with COPD 01/Jan/04-31/March/15 from the UK Clinical Practice Research Datalink. We defined moderate AECOPD as those managed outside hospital and severe as those requiring hospitalisation. During the baseline period (first year of follow-up), patients were grouped according to the number and severity of AECOPD and then followed for a maximum of 10 years (mean 4.9 years). We investigated the effect of baseline AECOPD number and severity on risk of further events and death. Around one-quarter of the COPD patients did not exacerbate during follow-up. Compared to no AECOPD in the baseline period, AECOPD number predicted the future long-term rate of AECOPD in a graduated fashion, ranging from HR 1.71(1.66-1.77) for one to HR 3.41(3.27-3.56) for 5+ events. Two or more moderate AECOPD were also associated with an increased risk of death in a graduated fashion, ranging from HR 1.10(1.03-1.18) for 2 moderate AECOPD to HR 1.57(1.45-1.70) for 5+ moderate AECOPD, compared to those with no AECOPD at baseline. Severe AECOPD were associated with an even higher risk of death (HR 1.79,1.65-1.94). Conclusions A large proportion of COPD patients do not exacerbate over a maximum 10 years of follow-up. AECOPD frequency in a single year predicts long-term AECOPD rate. Increasing frequency and severity of AECOPD is associated with risk of death, and highlights the importance of preventing AECOPD.
| Item Type: | Article |
|---|---|
| Faculty and Department: | Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology |
| Research Centre: | EHR Research Group |
| PubMed ID: | 29474094 |
| URI: | http://researchonline.lshtm.ac.uk/id/eprint/4646793 |
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