Among patients with COPD without a recent history of exacerbations, having chronic bronchitis, gastroesophageal reflux disease (GERD), or shortness of breath were all associated with a significantly increased risk for exacerbations over three years of follow-up in a first-of-its-kind analysis.
Researchers from the University of Michigan, National Jewish Health and GlaxoSmithKline presented their model for predicting future exacerbation risk in patients without frequent exacerbations this week at the virtual meeting of the American Thoracic Society, ATS 2021.
The study was one of several presented at the meeting exploring COPD burden and outcomes.
A modeling study exploring the future burden of COPD projected a 75% increase in cases in the U.S., Canada, and Central and South America by 2050.
And a real-world evaluation of patients hospitalized with COPD found a diagnosis of pneumonia to be associated with a significantly increased risk for exacerbation within a year.
MeiLan Han, MD, of the University of Michigan, was a co-investigator for the study exploring clinical features associated with COPD exacerbations among patients without recent exacerbations, which involved data from the COPDGene Analysis.
In an interview with BreakingMED, Han said identifying risk factors associated with exacerbation among patients without a recent history of exacerbations is important because most patients with COPD do not have multiple events every year.
“People vary a lot from year to year, and only a small faction of patients consistently have, for instance, 2 or more exacerbations every single year over a 2 or 3 year time period,” she said.
COPDGene participants with no exacerbations in the year prior to a five-year study visit, and at least one longitudinal follow-up in the subsequent three years, were included in the analysis.
Exacerbation data were collected every six months based on telephone or web-based follow-up, and univariable and post-hoc multivariable zero-inflated negative binomial regression modeling was used to evaluate factors associated with exacerbations.
A total of 1,528 study participants were included in the analysis (mean age, 69.0 years; 58.1% male and 66.3% former smokers). Mean FEV % predicted was 65.5% and 33.2% of participants (n=508) had at least one moderate or severe exacerbation during follow-up.
In univariable analysis, history of GERD (rate ratio (RR) 1.26; 95% CI, 1.02-1.56; P=0.03), chronic bronchitis (RR 1.64; 95% CI, 1.30-2.08; P<0.001), and Modified Medical Research Council Dyspnea Score (mMRC) ≥2 (RR 1.99; 95% CI, 1.62-2.46; P<0.001) were associated with a significantly increased rate of exacerbations over three years.
All three remained significant in a multivariable model controlling for age, sex, smoking status, and FEV % predicted (GERD, RR 1.33; 95% CI [1.07-1.65; P=0.009: chronic bronchitis, RR 1.68; 95% CI, 1.32-2.15; P<0.001: mMRC ≥2, RR 1.67; 95% CI, 1.34, 2.09; P<0.001).
Han said GERD, chronic bronchitis and dyspnea score were all strongly and independently predictive of exacerbation risk in the patient population.
“These are some of the symptoms that we would probably be targeting anyway,” she said. “Exacerbation history is important. We’ve seen so much focus on the frequent exacerbator phenotype. I think one message is we shouldn’t forget about patients who don’t have frequent exacerbations.”
In a separate retrospective analysis involving data from more than 3 million Medicare and Medicaid recipients with a COPD diagnosis, half (50.8%) of patients diagnosed with pneumonia had a COPD exacerbation within the next 12 months, compared to 30.7% of patients without a pneumonia diagnosis (OR, 2.33; 95% CI, 6.22-6.34).
Roughly one-in-five (21.3%) pneumonia patients had post-index COPD exacerbations overlapping with a pneumonia episode.
In a study which utilized modeling to predict the prevalence of COPD in North and South America by 2050, Daniela Tellez of ResMed, and colleagues, used time-in-state modeling to make projections using publicly available data from the World Bank population projections and Global Burden of Disease data for COPD.
The researchers generated an estimated count of COPD patients by country, age, sex, and year strata from 2020 to 2050.
“We assumed the change in the number of people living with COPD over time to be a function of the aging of the population and projected population growth, but assumed no change in COPD risk factors during this time period,” Tellez said when presenting the findings by video at ATS 2021.
The researchers found that roughly 37.3 million people live with COPD in North and South America in 2020, corresponding to a population prevalence of 5.8%.
“We estimate that in 2050, 65.5 million people will have COPD in the Americas, which corresponds to a 7.8% projected prevalence,” she said.
This equates to a 75.6% relative increase in the total number of people with COPD in this 30-year period.
“These numbers highlight the dire need for coordinated efforts in COPD care, as COPD risk factors are expected to worsen over time,” Tellez said.
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Among patients with COPD without a recent history of exacerbations, having chronic bronchitis, gastroesophageal reflux disease (GERD), or shortness of breath were all associated with a significantly increased risk for exacerbations over three years of follow-up.
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Results from a modeling study which predicted the future burden of COPD projected a 75% increase in cases in the U.S., Canada, and Central and South America by 2050.
Salynn Boyles, Contributing Writer, BreakingMED™
Funding for the study by Ferrera et al was provided by GlaxoSmithKline. Funding for the study by Tellez et al was provided byResMed.
Cat ID: 154
Topic ID: 89,154,730,192,154,195,925,198
