COPD exacerbation a red flag for lung function decline

The occurrence of an exacerbation, regardless of severity, is associated with accelerated lung function decline in patients with chronic obstructive pulmonary disorder (COPD), according to the Early COPD study.

The 3-year Early COPD (ECOPD) study was conducted in China and included patients with COPD at baseline and had complete annual spirometry and exacerbation data from baseline to 3 years. Exacerbation events were defined as mild (ie, event treated domestically), moderate (ie, treated as an outpatient), or severe (ie, hospitalization treatment). 

A total of 915 patients participated in the ECOPD study, of whom 703 (77 percent) had complete spirometry and exacerbation data each year during the 3-year follow-up and were included in the analysis.

Of the patients, 60 percent experienced at least one mild-to-severe exacerbation event, and more than 40 percent experienced at least one moderate-to-severe exacerbation event during the 3-year follow-up.

Compared with those who had no exacerbation, patients with any mild-to-severe exacerbation showed faster decline in postbronchodilator forced expiratory volume in 1 s (FEV₁) (adjusted difference, 13 mL/year, 95 percent confidence interval [CI], 3–23; p= 0.015) and postbronchodilator FEV₁% predicted (adjusted difference, 0.5 percent per year, 95 percent CI, 0.1–0.9; p=0.012).

Results were generally consistent in patients with mild-to-moderate COPD and GOLD 2025 A.

The findings indicate that any exacerbations in COPD, regardless of severity or baseline disease stage, should prompt a reassessment of long-term management.