Increased mortality associated with frequent exacerbations in COPD patients with mild-to-moderate lung function impairment, and smokers with normal spirometry

Spyridon Fortis; Emily S. Wan; Ken Kunisaki; Patrick Tel Eyck; Zuhair K. Ballas; Russell P. Bowler; James D. Crapo; John E. Hokanson; Chris Wendt; Edwin K. Silverman; Alejandro P. Comellas

doi:10.1016/j.yrmex.2020.100025

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Increased mortality associated with frequent exacerbations in COPD patients with mild-to-moderate lung function impairment, and smokers with normal spirometry

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Increased mortality associated with frequent exacerbations in COPD patients with mild-to-moderate lung function impairment, and smokers with normal spirometry

Spyridon Fortis, Emily S. Wan, Ken Kunisaki, Patrick Tel Eyck, Zuhair K. Ballas, Russell P. Bowler, James D. Crapo, John E. Hokanson, Chris Wendt, Edwin K. Silverman, …

Respiratory medicine: X, Vol.3, 100025

12/29/2020

DOI: 10.1016/j.yrmex.2020.100025

PMCID: PMC9333066

PMID: 35911870

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Abstract

Background: The burden of frequent respiratory exacerbations in COPD patients with mild-to-moderate spirometric impairment and smokers with preserved lung function is unknown. Methods: We categorized COPD participants in COPDGene with post-bronchodilator FEV1%predicted≥50% by the annual exacerbation frequency into three groups: i)frequent exacerbators (top 5%; n = 109), ii)exacerbators (>0 but less than frequent exacerbators; n = 1,009), and iii)No exacerbation (n = 981). Exacerbations were defined as respiratory episodes requiring antibiotics and/or systemic steroids. We performed a Cox proportional hazards regression analysis to examine the association with mortality. We repeated the same process in current/former smokers with preserved spirometry (FEV1≥80%predicted and FEV1/FVC≥0.7). Results: Among 2,099 COPD participants, frequent exacerbators had ≥1.8 exacerbations/year and were responsible for 34.3% of the total exacerbations. There were 102 (10.4%) deaths in the group with no exacerbations, 119 (11.8%) in the exacerbator group, and 24 (22%) in the frequent exacerbators. Adjusted mortality in frequent exacerbators was higher relative to individuals with no exacerbations (hazard ratio (HR) = 1.98; 95%CI = 1.25–3.13). An increase in frequency of exacerbations by one exacerbation/year was associated with increased mortality (HR = 1.40,95%CI = 1.21–1.62). Among 3,143 participants with preserved spirometry, frequent exacerbators had ≥0.8 exacerbations/year and were responsible for more than half of the exacerbations. There were 93 (4.2%) deaths in the group with no exacerbations, 28 (3.8%) in the exacerbator group, and 14 (7.6%) in the frequent exacerbators. The adjusted mortality was increased in frequent exacerbators with preserved spirometry relative to those with no exacerbations (HR = 2.25; 95%CI = 1.26–4.01). Conclusions: In COPD participants with mild-to-moderate spirometric impairment and smokers with preserved spirometry, the frequent exacerbator phenotype is responsible for a large proportion of total exacerbations and associated with high mortality.

Chronic obstructive pulmonary disease

Exacerbations

Mortality

Details

Title: Subtitle: Increased mortality associated with frequent exacerbations in COPD patients with mild-to-moderate lung function impairment, and smokers with normal spirometry
Creators: Spyridon Fortis - University of Iowa Hospitals and Clinics
Emily S. Wan - Brigham and Women's Hospital
Ken Kunisaki - Minneapolis VA Health Care System
Patrick Tel Eyck - University of Iowa Hospitals and Clinics
Zuhair K. Ballas - University of Iowa
Russell P. Bowler - National Jewish Health
James D. Crapo - National Jewish Health
John E. Hokanson - Colorado School of Public Health
Chris Wendt - University of Minnesota
Edwin K. Silverman - Brigham and Women's Hospital
Alejandro P. Comellas - University of Iowa
Resource Type: Journal article
Publication Details: Respiratory medicine: X, Vol.3, 100025
DOI: 10.1016/j.yrmex.2020.100025
PMID: 35911870
PMCID: PMC9333066
NLM abbreviation: Respir Med X
ISSN: 2590-1435
eISSN: 2590-1435
Grant note: DOI: 10.13039/100000050, name: National Heart, Lung, and Blood Institute; DOI: 10.13039/100008184, name: COPD Foundation; DOI: 10.13039/100004325, name: AstraZeneca; DOI: 10.13039/100004328, name: Genentech; DOI: 10.13039/100004330, name: GlaxoSmithKline; DOI: 10.13039/100004336, name: Novartis; DOI: 10.13039/100004319, name: Pfizer; DOI: 10.13039/501100004830, name: Siemens; DOI: 10.13039/100009655, name: Sunovion; name: SF; DOI: 10.13039/100000738, name: Department of Veterans Affairs; DOI: 10.13039/501100002346, name: CIN; DOI: 10.13039/100001465, name: American Thoracic Society; DOI: 10.13039/100001465, name: American Thoracic Society; DOI: 10.13039/100001818, name: RPB; DOI: 10.13039/100001003, name: Boehringer Ingelheim; DOI: 10.13039/100004325, name: AstraZeneca; DOI: 10.13039/100004330, name: GlaxoSmithKline
Language: English
Date published: 12/29/2020
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; ICTS; Biostatistics; Immunology; Internal Medicine; Design Biostat and Ethics
Record Identifier: 9984359804902771

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