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. 2024 Oct 3;64(4):2302240.
doi: 10.1183/13993003.02240-2023. Print 2024 Oct.

Exacerbation history and blood eosinophil count prior to diagnosis of COPD and risk of subsequent exacerbations

David M G Halpin  1   2 , Heath Healey  3 , Derek Skinner  3 , Victoria Carter  3 , Rachel Pullen  2 , David Price  4   3   5
Affiliations

Exacerbation history and blood eosinophil count prior to diagnosis of COPD and risk of subsequent exacerbations

David M G Halpin et al. Eur Respir J. .

Abstract

Background: Prior exacerbation history is used to guide initial maintenance therapy in COPD; however, the recommendations were derived from patients already diagnosed and treated.

Methods: We assessed the rates of moderate (i.e. treated with antibiotics and/or systemic corticosteroids) and severe (i.e. hospitalised) exacerbations in the year following diagnosis in patients newly diagnosed with COPD according to their prior history of exacerbations, blood eosinophil count (BEC) and whether maintenance therapy was started. Data were extracted from the Optimum Patient Care Research Database.

Results: 73 189 patients were included. 61.9% had no exacerbations prior to diagnosis, 21.5% had 1 moderate, 16.5% had ≥2 moderate and 0.3% had ≥1 severe. 50% were started on maintenance therapy. In patients not started on maintenance therapy the rates of moderate exacerbations in the year after diagnosis in patients with no, 1 moderate, ≥2 moderate and ≥1 severe prior exacerbations were 0.34 (95% CI 0.33-0.35), 0.59 (95% CI 0.56-0.61), 1.18 (95% CI 1.14-1.23) and 1.21 (95% CI 0.73-1.69), respectively. Similar results were seen in patients started on maintenance therapy. BEC did not add significantly to the prediction of future exacerbation risk.

Conclusions: A single moderate exacerbation in the year prior to diagnosis increases the risk of subsequent exacerbations, and more frequent or severe exacerbations prior to diagnosis are associated with a higher risk.

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Conflict of interest statement

Conflict of interest: D.M.G. Halpin has received sponsorship to attend international meetings, and honoraria for lecturing, attending advisory boards and preparing educational materials from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Inogen, Meanrini, Novartis and Sanofi. H. Healey, D. Skinner, V. Carter and R. Pullen are employees of the Observational and Pragmatic Research Institute. D. Price has advisory board membership with AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme and Thermo Fisher, consultancy agreements with Airway Vista Secretariat, AstraZeneca, Boehringer Ingelheim, Chiesi, EPG Communication Holdings Ltd, FIECON Ltd, Fieldwork International, GlaxoSmithKline, Mylan, Mundipharma, Novartis, OM Pharma SA, PeerVoice, Phadia AB, Spirosure Inc., Strategic North Limited, Synapse Research Management Partners SL, Talos Health Solutions, Theravance and WebMD Global LLC, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Novartis, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi Genzyme, Theravance and UK National Health Service, payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals and Sanofi Genzyme, payment for travel, accommodation and/or meeting expenses from AstraZeneca, Boehringer Ingelheim, Mundipharma, Mylan, Novartis and Thermo Fisher, stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals, 74% ownership of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 92.61% of Observational and Pragmatic Research Institute Pte Ltd (Singapore), 5% shareholding in Timestamp which develops adherence monitoring technology, is peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation programme, and Health Technology Assessment, and was an expert witness for GlaxoSmithKline.

Figures

None
Overview of the study. BEC: blood eosinophil count.
FIGURE 1
FIGURE 1
Patient flow. OPCRD: Optimum Patient Care Research Database; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity.
FIGURE 2
FIGURE 2
Rates of moderate or severe exacerbations in the 12 months after diagnosis with 95% confidence intervals, according to exacerbation history in the 12 months prior to diagnosis and whether maintenance therapy was started.
See this image and copyright information in PMC

Comment in

References

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