Risk Factors for Progression to Frequent Exacerbators in Stable Patients with Chronic Obstructive Pulmonary Disease

Little is known about the transition to frequent exacerbators in stabilized patients with chronic obstructive pulmonary disease (COPD).

This study utilized data obtained from the Korean COPD Subgroup Study cohort (KOCOSS), including 511 infrequent exacerbators. The outcome for these groups was progression to frequent exacerbators. Multivariable logistic regression analysis was used to investigate the risk factors for progression.

Within 1 year, 40 patients (7.8%) progressed to frequent exacerbators. Among patients with severe airflow limitation and those who used inhaled corticosteroids (ICS), the incidence of progression was significantly higher. The risk factors for this progression were older age (adjusted odds ratio [aOR], 2.01; 95% confidence interval [CI], 1.19 to 3.39 per 10-year increase), decreased percent-predicted post-bronchodilator forced expiratory volume in 1 second (FEV₁ %predicted, aOR, 1.32; 95% CI, 1.05 to 1.66 per 10% predicted decrease), increased blood eosinophil count (aOR, 1.20; 95% CI, 1.07 to 1.35 per 100 cells/μL increase), and use of ICS-containing inhalers (aOR, 3.30; 95% CI, 1.59 to 6.85). In stratified analysis, decreased percent-predicted post-bronchodilator FEV₁ (aOR, 1.39; 95% CI, 1.05 to 1.85 per 10%pred decrease) and ICS-containg inhalers (aOR, 4.01; 95% CI, 1.61 to 9.95) predicted progression among patients with eosinophils <300/μL, while higher eosinophils ≥300/μL showed a nonsignificant trend (aOR, 1.16; 95% CI, 1.00 to 1.36; p=0.058).

Among stable COPD patients, older age, decreased lung function, an increased eosinophil count, and use of ICS-containing inhalers were associated with progression to frequent exacerbators.