Susceptibility to frequent exacerbation in COPD patients: Impact of the exacerbations history, vaccinations and comorbidities?

Exacerbations are key events in the natural history of COPD, but our understanding of their longitudinal determinants remains unclear. We used data from a large observational study to test the hypothesis that vaccination status and comorbidities could be associated with the occurrence of exacerbations profile. Diagnosed COPD patients have been included by their pulmonologists, with up to 3 years of follow-up. Data were analyzed using the KmL method designed to cluster longitudinal data and receiver operating characteristic curve analysis to determine the best threshold to allocate patients to identified clusters. 932 COPD patients were included since January 2014, 446 patients (65.68% males, 35.59% current smokers) were followed over a period of 3 years with complete data. 239(28.15%) patients reported two or more exacerbations in the year before enrolment (frequent exacerbations). Among them 142(16.68%) also had frequent exacerbations in the first year of the study, and 69(8.10%) who remained frequent exacerbators in the second year. Based on our hypothesis, we were able to determine four phenotypes: A (infrequent), B (frequent in underweight patients), C (transient), and D (frequent in obese patients). Frequent exacerbators had more airflow limitation and symptoms. Irrespective of cut-offs set to define the optimal number of clusters, a history of exacerbations OR: 3.72[2.53-5.49], presence of anxiety OR: 2.03[1.24-3.31] and absence of the annual influenza vaccination OR: 1.97[1.20-3.24] remained associated with the frequent exacerbator phenotypes. The most important determinants of frequent exacerbations are a history of exacerbations, anxiety and unvaccinated against influenza.

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Déclaration de conflit d'intérêts

Declaration of competing interest All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: Mr. Ouaalaya has nothing to disclose; Dr. Falque has nothing to disclose; Dr. Bernady has nothing to disclose; Dr. Nguyen has nothing to disclose; Dr. Ozier has nothing to disclose; Dr. Nocent-Eijnani has nothing to disclose; Dr. Zysman has nothing to disclose; Dr. Le Guillou reports personal fees from GSK, personal fees from Menarini, personal fees from Pfizer, personal fees from Philips, personal fees from Astra Zeneca, personal fees from Boeringher Ingelheim, personal fees from Chiesi, other from Alize santé, other from SOS oxygène, other from Bastide Médical, other from Boeringher Ingelheim, outside the submitted work; Dr. Molimard report personal fees from University of Bordeaux during the conduct study, other from Novartis Pharma, Boehringer Ingelheim, GSK outside the submitted work; Dr. Raherison reports grants from Bordeaux University Foundation, during the conduct of the study; personal fees from Astra Zeneca, personal fees from ALK, personal fees from Boehringer Ingelheim, personal fees from Glaxo SmithKline, personal fees from MundiPharma, personal fees from Novartis, personal fees from Chiesi, outside the submitted work.