Assigning risk stratification categories to patients with COPD who have had 1 or fewer exacerbation in the last year is important for determining future treatment and prevention strategies for these patients, according to study findings presented at the American Thoracic Society (ATS) International Conference 2022, held in San Francisco, CA, May 13 to 18.
Therapeutic recommendations for patients with COPD are based upon severity levels as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) risk stratification framework. Previous studies have ignored the group of patients with low risk of exacerbation (0 or 1 exacerbation in the previous 12 months; GOLD B0 and B1, respectively).
In the current study, researchers sought to investigate risk of future exacerbations, hospitalizations, and death among patients with 0 or 1 COPD exacerbation in the previous 12 months. The investigators conducted a cohort study in Sweden of 45,350 patients with COPD registered in the Swedish National Airway Register (SNAR) from January 2017 to August 2020 who were 30 years of age or older and had a COPD Assessment Test (CAT) score and/or Modified Medical Research Council (mMRC)-dyspnea score and exacerbation/hospitalization within the previous 12 months. Patients were subsequently grouped according to their test scores into GOLD A (29%), GOLD B0 (44%), GOLD B1 (10%), GOLD C (3%), and GOLD D (14%). Follow-up extended from the patient index date (initial interview with CAT/mMRC test score) until January 2021 with the primary endpoints of further exacerbations (need for oral corticosteroid prescription without hospitalization), hospitalization, and death.
Investigators found that a higher risk category was associated with a higher risk of exacerbation, hospitalization, and death. Patients in GOLD cohorts C and B1 exhibited greater risk of exacerbation than those in GOLD cohorts A and B0. Compared with patients in GOLD B0, patients in GOLD B1 showed a significantly greater risk of exacerbation (HR: 2.72; 95% CI, 2.59-2.87), all-cause hospitalization (HR: 1.24; 95% CI, 1.18-1.31), respiratory hospitalizations (HR: 1.69; 95% CI, 1.55-1.85), all-cause mortality (HR: 1.19; 95% CI, 1.08-1.31), and respiratory mortality (HR: 1.62; 95% CI, 1.26-2.07). The B0 cohort exacerbation rate was 0.2 events per patient-year and 0.6 for the B1 cohort (RR: 2.73; 95% CI, 2.57-2.79).
Researchers concluded that, “Stratification of GOLD B patients for one or no exacerbation in the last year provides valuable information on future risk, which should influence treatment recommendations for effective preventive strategies.”
Vanfleteren L, Holmstrand L, Lindberg A, Zhou C, Nyberg F, Stridsman C. Risk for exacerbation, hospitalization and mortality in global initiative for chronic obstructive lung disease group B patients with and without exacerbations: a cohort study. Presented at: the American Thoracic Society (ATS) 2022 International Conference; May 13-18, 2022; San Francisco, CA. Abstract P659.