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Transitions to and reversion from a persistent frequent-exacerbator state in COPD.
Delphine Vauterin1, Frauke Van Vaerenbergh1, Lowie E G W Vanfleteren2,3,4
1Department of Bioanalysis, Ghent University, Ghent, Belgium.
ERJ Open Research
|June 24, 2026
Summary
Preventing acute exacerbations in COPD (AECOPDs) is crucial for disease stability. Addressing smoking and inhaler overuse can promote reversion to stable non-exacerbator status, while managing lung cancer and comorbidities reduces worsening.
Area of Science:
- Pulmonary Medicine
- Chronic Obstructive Pulmonary Disease (COPD)
- Epidemiology
Background:
- Acute exacerbations of COPD (AECOPDs) significantly impact disease stability.
- Understanding risk factors for COPD exacerbation phenotypes is key for management.
- Identifying determinants for transitions between non-exacerbator (NE) and frequent-exacerbator (FE) states is crucial.
Purpose of the Study:
- To investigate differential risk factors across COPD exacerbation phenotypes.
- To identify health determinants and comorbidities associated with transitions from NE to persistent FE.
- To analyze factors related to FE to NE reversion and mortality.
Main Methods:
- Nationwide Belgian data from January 2017-February 2018.
- Inclusion of patients aged ≥45 years with obstructive airway diseases or COPD without asthma.
- Multinomial logistic regression used to analyze transitions: NE to FE, FE to NE (reversion), and to death.
Main Results:
- Among 183,762 patients, 11.5% were never exacerbators and 11.6% were frequent exacerbators.
- 4.1% of NE transitioned to persistent FE; 7.3% of FE reverted to stable NE.
- Lung cancer, ever-smoking, and neuropsychiatric/musculoskeletal comorbidities increased NE to FE transition. Overuse of short-acting bronchodilators and ever-smoking decreased reversion odds.
Conclusions:
- Managing smoking and inhaler overuse is vital for promoting reversion to stable non-exacerbator status.
- Addressing lung cancer and specific comorbidities can reduce the risk of disease worsening.
- Cardiovascular comorbidities are linked to increased mortality but not disease worsening.
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