December 2010 Pulmonary Journal Club

Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to Exacerbation in Chronic Obstructive Pulmonary Disease (COPD). New Engl J Med 2010;363:1128-38.  

Reference as: Luedy HW, Mathew M. December 2010 pulmonary journal club: Susceptibility to exacerbation in chronic obstructive pulmonary disease (COPD). Southwest J Pulm Crit Care 2010;1:21. (Click here for PDF version)

   This large, observational cohort study tested the hypothesis that there is a frequent-exacerbation phenotype in COPD.  2138 pts were followed for 3 years. The frequency of exacerbations, defined as the prescription of antibiotics, steroids, or both, was noted.  The results demonstrate that the greatest predictor of COPD exacerbations was a previous exacerbation.  The authors noted that patients who experience two or more exacerbations in a year were likely to continue to have frequent exacerbations and this was independent of disease severity.  This was an important study in several regards. First, it shows that collecting data from large COPD sample sizes are possible, which in turn may yield further speciation on what constitutes an exacerbation.  Second, several intangible factors may play a role in exacerbations but these factors remain unknown.  Although the study demonstrates that patients that have COPD exacerbations will likely have more, how this can be modified is unknown.

Prepared by Henry W. Luedy, MD and  Manoj Mathew, MD