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Observational Study
. 2017 Mar 10:12:839-848.
doi: 10.2147/COPD.S127146. eCollection 2017.

Colds as predictors of the onset and severity of COPD exacerbations

Neil W Johnston  1 , Marita Olsson  2 , Staffan Edsbäcker  3 , Maria Gerhardsson de Verdier  4 , Per Gustafson  5 , Christopher McCrae  3 , Peter V Coyle  6 , R Andrew McIvor  1
Affiliations
Observational Study

Colds as predictors of the onset and severity of COPD exacerbations

Neil W Johnston et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Rationale: Common colds are associated with acute respiratory symptom exacerbations in COPD patients.

Objective: To determine exacerbation risk and severity in COPD patients with/without coincident self-reported colds.

Methods: Global initiative for chronic Obstructive Lung Disease stage I-IV COPD patients electronically transmitted respiratory symptom diaries to research staff daily between December 2006 and April 2009. Respiratory symptom worsening prompted contact by a study nurse and patient assessment to determine if a cold was present or an exacerbation underway. A composite daily symptom score was derived for each subject from diarized symptom data. The exacerbation/cold/virus relation was examined using a Poisson regression model, the relation of colds to respiratory symptom severity using generalized estimating equation models.

Results: Daily diary transmission compliance of >97% enabled detection of all possible exacerbations. Among 262 exacerbations meeting Anthonisen criteria, 218 (83%) had cold-like symptoms present at their inception, but respiratory viruses were detected in only 106 (40%). Within-subject exacerbation risk was 30 times (95% confidence interval [CI]: 20, 47; P<0.001) greater with colds present. Compared to cold- and virus-negative exacerbations (n=57), the mean increase in composite symptom score in those cold and virus positive (n=79) was 0.93 (95% CI: 0.61, 1.25; P<0.001), cold-positive and virus-negative exacerbations (n=100) 0.51 (95% CI: 0.21, 0.81; P<0.001), cold-negative and virus-positive exacerbations (n=26) 0.58 (95% CI: 0.23, 0.94; P<0.001).

Conclusion: This study emphasizes the importance of colds in COPD exacerbation risk and severity, even in the absence of virus detection. COPD patients should act promptly when cold symptoms appear to facilitate early intervention for exacerbation prevention or management.

Keywords: COPD epidemiology; COPD exacerbations; common cold; respiratory infection; respiratory viruses.

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Conflict of interest statement

Disclosure Mr Johnston has received research funding and/or honoraria from Merck Canada, Inc., GlaxoSmithKline Canada, and AstraZeneca PLC. Dr McIvor has received honoraria from pharmaceutical companies, including AstraZeneca, Boehringer Ingelheim, Takeda, Pfizer, Merck, and GlaxoSmithKline for educational events, advisory boards, and Phase 3 clinical trials. Authors Gerhardsson de Verdier, Gustafson, McCrae, Edsbäcker, and Olsson are employed by AstraZeneca and own shares in the company. Professor Coyle has received honoraria from pharmaceutical companies (Roche, Randox, and Abbott) for educational events, advisory boards, and is a founding director of the start-up company Hibergene. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
The distributions of composite respiratory symptom scores and their medians and quartiles within four study periods. Notes: Scores are grouped in four categories of chronic obstructive pulmonary disease exacerbation: those with colds being virus positive (VC), those with virus present but no apparent cold (VNC), those with no virus present but a cold reported (NVC), and those with neither virus nor cold present (NVNC).
Figure 2
Figure 2
The adjusted mean composite respiratory symptom scores and their 95% confidence intervals across all four periods of the study. Notes: Scores are grouped in four categories of chronic obstructive pulmonary disease exacerbation: those with colds being virus positive (VC), those with virus present but no apparent cold (VNC), those with no virus present but a cold reported (NVC), and those with neither virus nor cold present (NVNC).
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