Risk factors for future exacerbations in patients with COPD treated with dual LABA/LAMA

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 report revised the combined chronic obstructive pulmonary disease (COPD) assessment. Patients in groups B and E are recommended dual long-acting β₂-agonist (LABA)/long-acting muscarinic antagonist (LAMA) as the initial inhalation therapy. However, some patients still experience exacerbations during treatment. This study aimed to investigate the risk factors for future exacerbations in patients with COPD treated with dual LABA/LAMA.

This was a retrospective cohort study. Baseline data included demographic characteristics, pulmonary function, symptom scores, GOLD grades, GOLD groups, the number of exacerbations and hospitalizations in the past year, LABA/LAMA, and comorbidities were collected. The number of future exacerbations was collected during one year of follow-up.

A total of 1076 patients with COPD were included. There were 284 (26.4%) patients experienced exacerbations during follow-up. Patients who experienced exacerbations were older and had higher clinical COPD questionnaire scores, a great number of exacerbations and hospitalizations in the past year, and a higher proportion of GOLD grades 3-4. Logistic regression analysis showed that GOLD grades 3-4 (odds ratio [OR] = 1.343, 95% confidence intervals [CI] = 1.016-1.776), one exacerbation in the past year (OR = 1.763, 95% CI = 1.248-2.489), and ≥ 2 exacerbations in the past year (OR = 2.514, 95% CI = 1.792-3.525) were independent risk factors for experiencing exacerbations. Furthermore, in group B, logistic regression analysis showed that GOLD grades 3-4 (OR = 1.808, 95% CI = 1.096-2.981) and hypertension (OR = 3.400, 95% CI = 1.712-6.752) were independent risk factors for experiencing exacerbations. In group E, logistic regression analysis showed that ≥ 2 exacerbations in the past year (OR = 1.426, 95% CI = 1.021-1.993) was an independent risk factor for experiencing exacerbations.

Patients with COPD treated with LABA/LAMA remained at high risk of future exacerbations. GOLD grades 3-4 and exacerbations in the past year were associated with future exacerbations and may warrant particular attention from clinicians.