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. 2010 Dec 9:5:435-44.
doi: 10.2147/COPD.S13826.

Association between lung function and exacerbation frequency in patients with COPD

Martine Hoogendoorn  1 , Talitha L Feenstra, Rudolf T Hoogenveen, Maiwenn Al, Maureen Rutten-van Mölken
Affiliations

Association between lung function and exacerbation frequency in patients with COPD

Martine Hoogendoorn et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: To quantify the relationship between severity of chronic obstructive pulmonary disease (COPD) as expressed by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage and the annual exacerbation frequency in patients with COPD.

Methods: We performed a systematic literature review to identify randomized controlled trials and cohort studies reporting the exacerbation frequency in COPD patients receiving usual care or placebo. Annual frequencies were determined for total exacerbations defined by an increased use of health care (event-based), total exacerbations defined by an increase of symptoms, and severe exacerbations defined by a hospitalization. The association between the mean forced expiratory volume in one second (FEV(1))% predicted of study populations and the exacerbation frequencies was estimated using weighted log linear regression with random effects. The regression equations were applied to the mean FEV(1)% predicted for each GOLD stage to estimate the frequency per stage.

Results: Thirty-seven relevant studies were found, with 43 reports of total exacerbation frequency (event-based, n = 19; symptom-based, n = 24) and 14 reports of frequency of severe exacerbations. Annual event-based exacerbation frequencies per GOLD stage were estimated at 0.82 (95% confidence interval 0.46-1.49) for mild, 1.17 (0.93-1.50) for moderate, 1.61 (1.51-1.74) for severe, and 2.10 (1.51-2.94) for very severe COPD. Annual symptom-based frequencies were 1.15 (95% confidence interval 0.67-2.07), 1.44 (1.14-1.87), 1.76 (1.70-1.88), and 2.09 (1.57-2.82), respectively. For severe exacerbations, annual frequencies were 0.11 (95% confidence interval 0.02-0.56), 0.16 (0.07-0.33), 0.22 (0.20-0.23), and 0.28 (0.14-0.63), respectively. Study duration or type of study (cohort versus trial) did not significantly affect the outcomes.

Conclusion: This study provides an estimate of the exacerbation frequency per GOLD stage, which can be used for health economic and modeling purposes.

Keywords: COPD; GOLD; disease severity; exacerbations; regression; review.

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Figures

Figure 1
Figure 1
Left graphs: Logarithm of the annual total or severe exacerbation frequency plotted against the mean forced expiratory volume in one second (FEV1)% predicted of the study, line = estimated relationship obtained from the log-linear regression. Right graphs: Annual total or severe exacerbation frequency plotted against the mean FEV1% predicted of the study, line = relationship based on the retransformed exacerbation rates using the smearing factor.
See this image and copyright information in PMC

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