Predictive factors for exacerbation and reexacerbation in chronic obstructive pulmonary disease: an extension of the Cox model to analyze data from the Swiss COPD cohort

  • Pascal Urwyler University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Liestal, Switzerland.
  • Nebal Abu Hussein University Hospital Basel, University of Basel, Basel, Switzerland.
  • Pierre O. Bridevaux Hospital of Valais, University of Geneva, Sion, Switzerland.
  • Prashant N. Chhajed University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Liestal, Switzerland.
  • Thomas Geiser University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland.
  • Peter Grendelmeier University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Liestal, Switzerland.
  • Ladina Joos Zellweger St. Clara Hospital, University of Basel, Basel, Switzerland.
  • Malcolm Kohler University Hospital Zurich, University of Zurich, Zürich, Switzerland.
  • Sabrina Maier University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Liestal, Switzerland.
  • David Miedinger University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Liestal, Switzerland.
  • Michael Tamm University Hospital Basel, University of Basel, Basel, Switzerland.
  • Robert Thurnheer Cantonal Hospital of Muensterlingen, Münsterlingen, Switzerland.
  • Thomas Dieterle University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Liestal, Switzerland.
  • Joerg D. Leuppi | joerg.leuppi@ksbl.ch University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Liestal, Switzerland.

Abstract

Background: The Swiss COPD cohort was established in 2006 to collect data in a primary care setting. The objective of this study was to evaluate possible predictive factors for exacerbation and re-exacerbation. Methods: In order to predict exacerbation until the next visit based on the knowledge of exacerbation since the last visit, a multistate model described by Therneau and Grambsch was performed. Results: Data of 1,247 patients (60.4% males, 46.6% current smokers) were analyzed, 268 (21.5%) did not fulfill spirometric diagnostic criteria for COPD. Data of 748 patients (63% males, 44.1% current smokers) were available for model analysis. In order to predict exacerbation an extended Cox Model was performed. Mean FEV1/FVC-ratio was 53.1% (±11.5), with a majority of patients in COPD GOLD classes 2 or 3. Hospitalization for any reason (HR1.7; P = 0.04) and pronounced dyspnea (HR for mMRC grade four 3.0; P < 0.001) at most recent visit as well as prescription of short-acting bronchodilators (HR1.7; P < 0.001), inhaled (HR1.2; P = 0.005) or systemic corticosteroids (HR1.8; P = 0.015) were significantly associated with exacerbation when having had no exacerbation at most recent visit. Higher FEV1/FVC (HR0.9; P = 0.008) and higher FEV1 values (HR0.9; P = 0.001) were protective. When already having had an exacerbation at the most recent visit, pronounced dyspnea (HR for mMRC grade 4 1.9; P = 0.026) and cerebrovascular insult (HR2.1; P = 0.003) were significantly associated with re-exacerbation. Physical activity (HR0.6; P = 0.031) and treatment with long-acting anticholinergics (HR0.7; P = 0.044) seemed to play a significant protective role. In a best subset model for exacerbation, higher FEV1 significantly reduced and occurrence of sputum increased the probability of exacerbation. In the same model for re-exacerbation, coronary heart disease increased and hospitalization at most recent visit seemed to reduce the risk for re-exacerbation. Conclusion: Our data confirmed well-established risk factors for exacerbations whilst analyzing their predictive association with exacerbation and re-exacerbation. This study confirmed the importance of spirometry in primary care, not only for diagnosis but also as a risk evaluation for possible future exacerbations. Trial registration: Our study got approval by local ethical committee in 2006 (EK Nr. 170/06) and was registered retrospectively on ClinicalTrials.gov (NCT02065921, 19th of February 2014).

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Published
2019-02-05
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Original Research Articles
Keywords:
COPD, Exacerbation, Re-exacerbation, Primary health care, Risk factors
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How to Cite
Urwyler, P., Hussein, N. A., Bridevaux, P. O., Chhajed, P. N., Geiser, T., Grendelmeier, P., Zellweger, L. J., Kohler, M., Maier, S., Miedinger, D., Tamm, M., Thurnheer, R., Dieterle, T., & Leuppi, J. D. (2019). Predictive factors for exacerbation and reexacerbation in chronic obstructive pulmonary disease: an extension of the Cox model to analyze data from the Swiss COPD cohort. Multidisciplinary Respiratory Medicine, 14(1). https://doi.org/10.4081/mrm.2019.6