Four risk factors namely gastroesophageal reflux disease (GERD), chronic bronchitis, high symptom burden, and impaired lung function (as shown by decreased FEV₁ percent predicted) increase the risk of exacerbation among patients with chronic pulmonary obstructive disease (COPD) without no recent exacerbations in a study published in The Annals of the American Thoracic Society.1

The main objective of this study was to determine factors associated with increased rates of exacerbations in participants in the Genetic Epidemiology of COPD Study (COPDGene) who had not experienced an exacerbation in the preceding year. Their median age was 69 years with male preponderance (58.1%). One-third were former smokers. The inclusion criteria were COPD patients with a history of smoking, who had not experienced any exacerbation in the year prior to their second study site visit. Nearly half (46.7%) of them had grade 2 COPD, 27.4% had grade 1 COPD, 20.4% had grade 3 COPD, while less than 6% had grade 4 COPD. Additionally, they were required to fill out at least one follow-up questionnaire within the subsequent 36 months.

Out of the 1528 participants included in the present study, 508 participants (33.2%) experienced at least one episode of moderate or severe exacerbation during the 36 months follow-up period.

Factors that were associated with increased risk of exacerbation were high symptom burden (as measured by Modified Medical Research Council [mMRC] Dyspnea Scale and COPD Assessment Test), lower FEV1% predicted, chronic bronchitis and GERD.

After adjusting or age, sex and smoking status, the rate ratio of moderate or severe exacerbations was significantly high; it was 1.3 for GERD, 1.62 for chronic bronchitis, 1.39 for mMRC dyspnea score of 2 and 2.16 for for mMRC dyspnea score >2. COPD Assessment Test (CAT) score ≥10 and reduced FEV1 percent predicted were also found to be significantly associated with higher exacerbation rate with RRs of 1.59 and 1.25 respectively. For every 1-point increase in the graduated risk score, there was a 25-30% rise in the rate of exacerbations over the 36-month follow-up period.

This study has helped to identify potential predictors of future exacerbations, which will aid in the early diagnosis and treatment of COPD patients who are at risk. This approach can improve patient outcomes and lessen the overall burden of COPD exacerbations by offering insightful information on preventive measures.

Reference

1.   Michael C Ferrera, et al. Risk factors for chronic obstructive pulmonary disease exacerbations among individuals without a history of recent exacerbations: a COPDGene analysis. Ann Am Thorac Soc. 2024 Mar;21(3):421-427. doi: 10.1513/AnnalsATS.202209-751OC.