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Exacerbation history is a reliable predictor of future exacerbations

Presented by
Prof. Claus Vogelmeier, Philipps University of Marburg, Germany
ERS 2020
Cohort study, AvoidEx
Previous exacerbations proved an important risk factor for future exacerbations. This real-world data from a large cohort study supports the need for improved management and treatment of COPD patients [1].

In the registry-based, cohort study AvoidEx, data was collected from German healthcare insurance claims and Swedish medical records of COPD patients ≥40 years. All participants had their first COPD diagnosis during 2010-2017. Overall, 250,723 COPD patient from Germany and 27,178 COPD patients from Sweden were included. Patients were divided into 4 groups (i.e. none, 1 moderate, 1 severe, ≥ 2 moderate to severe) according to the baseline exacerbation 12 months pre-index (which is based on the exacerbation classification). The follow-up period lasted up to 9 years.

In German patients without baseline exacerbations, 19.0% (18.9-19.2%) had exacerbations after 1-year follow-up and 35.9% (35.7-36.1%) after 3 years. In Sweden, corresponding numbers were 22.5% (21.9-23.1%) and 39.4% (38.7-40.1%), respectively. After 3 years, cumulative exacerbation risk was 59.1% (58.5-59.7%), 58.1% (56.1-60.1%), and 84.1% (83.6-84.5%) in German patients with 1 moderate, 1 severe, and ≥2 moderate-to-severe exacerbations at baseline, respectively. Corresponding numbers in the Swedish population were 53.6% (51.7-55.5%), 66.6% (62.6-70.7%), and 84.1% (82.8-85.4%), respectively (see Figure). “As you can see, there is a stepwise increase: patients who had a lower exacerbation rate in the past had a lower risk of exacerbations in the future and the risk goes up depending on the exacerbation history,” explained Prof. Claus Vogelmeier (University Clinic Giessen and Marburg, Germany).

Figure: Results show that patients with previous exacerbations have a much higher risk of future exacerbations [1]

In total, more than 1 out of 3 patients without baseline COPD exacerbation experienced exacerbation(s) during the 3-year follow up. In addition, more than half of those with 1 moderate baseline exacerbation experienced subsequent exacerbation(s), with an even higher risk in patients with frequent or severe baseline exacerbations. Yet, even patients with only 1 moderate baseline exacerbation had more subsequent exacerbations compared with those without baseline exacerbations. Patients with no history of exacerbations had also a much longer time until the next subsequent exacerbation during follow-up.

“I think this data very nicely supports earlier data under very different circumstances, because this data used medical data and insurance data from a very big cohort. But all this information stresses that exacerbation history is a self-fulfilling prophecy for future events,” Prof. Vogelmeier concluded.


    1. Vogelmeier C. Risk of future exacerbations among COPD patients – A real-world register-based cohort study (AvoidEx). Abstract 4189, ERS International Virtual Congress 2020, 7-9 Sept.


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