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Natural history of COPD exacerbations in a general practice based COPD population

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Title: Natural history of COPD exacerbations in a general practice based COPD population
Authors: Rothnie, K
Quint, JK
Mullerova, H
Smeeth, L
Item Type: Journal Article
Abstract: Rationale: Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) are important adverse events in the natural history of chronic obstructive pulmonary disease (COPD). Objectives: To investigate the natural history of AECOPDs over 10 years of follow-up. Methods: We identified 99,574 patients with COPD from January 1, 2004, to March 31, 2015, from the UK Clinical Practice Research Datalink. We defined moderate AECOPDs as those managed outside hospital and severe as those requiring hospitalization. During the baseline period (first year of follow-up), patients were grouped according to the number and severity of AECOPDs and then followed for a maximum of 10 years (mean, 4.9 yr). We investigated the effect of baseline AECOPD number and severity on risk of further events and death. Measurements and Main Results: Around one-quarter of the patients with COPD did not exacerbate during follow-up. Compared with no AECOPDs in the baseline period, AECOPD number predicted the future long-term rate of AECOPDs in a graduated fashion, ranging from hazard ratio (HR) of 1.71 (1.66–1.77) for one event to HR of 3.41 (3.27–3.56) for five or more events. Two or more moderate AECOPDs were also associated with an increased risk of death in a graduated fashion, ranging from HR of 1.10 (1.03–1.18) for two moderate AECOPDs to HR of 1.57 (1.45–1.70) for five or more moderate AECOPDs, compared with those with no AECOPDs at baseline. Severe AECOPDs were associated with an even higher risk of death (HR, 1.79; 1.65–1.94). Conclusions: A large proportion of patients with COPD 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 AECOPDs is associated with risk of death and highlights the importance of preventing AECOPDs.
Issue Date: 15-Aug-2018
Date of Acceptance: 13-Feb-2018
URI: http://hdl.handle.net/10044/1/57084
DOI: https://dx.doi.org/10.1164/rccm.201710-2029OC
ISSN: 1073-449X
Publisher: American Thoracic Society
Start Page: 464
End Page: 471
Journal / Book Title: American Journal of Respiratory and Critical Care Medicine
Volume: 198
Issue: 4
Copyright Statement: © 2018 by the American Thoracic Soci ety
Sponsor/Funder: GlaxoSmithKline Services Unlimited
Funder's Grant Number: PO #3000793769
Keywords: Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
Respiratory System
General & Internal Medicine
epidemiology
cohort studies
case-control studies
COPD
FREQUENCY
CARE
case–control studies
11 Medical And Health Sciences
Publication Status: Published
Online Publication Date: 2018-02-23
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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