Significant predictors of future re-exacerbations in patients with chronic obstructive pulmonary disease (COPD) include impaired lung function, poorer respiratory-related quality of life (ie, greater disease burden), history of exacerbations, and season of the index exacerbation, according to results of an analysis published in the International Journal of Chronic Obstructive Pulmonary Disease. Researchers re-analyzed data obtained from the large-scale, multicenter, international Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) prospective study (ClinicalTrials.gov Identifier: NCT00292552).
The investigators sought to identify factors that are predictive of re-exacerbations and are associated with prolonged acute exacerbations of COPD (AECOPDs). A re-exacerbation was defined as any new exacerbation event that took place after the index date, regardless of the number of days between the end date of 1 exacerbation and the start date of any subsequent exacerbation. Study enrollees included those from the ECLIPSE study with moderate to severe AECOPDs.
In the current study, the index date was defined as the end date of the first moderate or severe AECOPD event that occurred during follow-up in ECLIPSE. The timing of re-exacerbation risk was evaluated among those individuals with 180 days’ post-index-date follow-up data. Factors were divided into those predictive of early (1 to 90 days) re-exacerbations, late (91-180 days) re-exacerbations, and no re-exacerbations.
Among the 2163 patients from ECLIPSE who were available for re-analysis, 1554 fulfilled the eligibility criteria for inclusion in the final analytical group for evaluating duration of exacerbation (cohort A), with a total of 1420 of them who had 180 days’ of follow-up data available after their index exacerbation included in the final analytical group for evaluating risk for re-exacerbation (cohort B). More of these individuals experienced early (30.9%) vs late re-exacerbations (18.7%), with 50.4% of patients experiencing no re-exacerbations within 180 days.
Significant predictors of early, compared with late or no, risk for re-exacerbation within 180 days included lower postbronchodilator FEV1 (P =.0019), higher St. George’s Respiratory Questionnaire total score (P =.0035), higher number of moderate or severe exacerbations on or before the index date (P <.0001), and season of the year in which the index exacerbation occurred (autumn vs winter; P =.00164). These factors were all also predictive of any vs no risk for re-exacerbation within 180 days.
The median duration of moderate or severe COPD exacerbations was 12 days. Overall, 22.7% (353 of 1554) of the participants in cohort A experienced a prolonged AECOPD (77.1% moderate; 22.9% severe), and 77.3% (1201 of 1554) of them experienced a nonprolonged AECOPD (83.3% moderate; 16.7% severe). The likelihood of experiencing a prolonged AECOPD was greater for patients who had experienced severe vs moderate AECOPDs (adjusted odds ratio [aOR], 1.917; 95% CI, 1.269-2.896; P =.002) and lower for spring compared with winter AECOPDs (aOR, 0.578; 95% CI, 0.368-0.906; P =.017).
The researchers concluded that although the risk for re-exacerbation is dynamic and likely to be impacted by many factors, optimizing medication regimens for those individuals with COPD who are more likely to experience an early re-exacerbation may help to improve patient outcomes.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Meeraus WH, Mullerova H, El Baou C, Fahey M, Hessel EM, Fahy WA. Predicting re-exacerbation timing and understanding prolonged exacerbations: an analysis of patients with COPD in the ECLIPSE cohort. Int J Chron Obstruct Pulmon Dis. 2021;16:225-244.