El Hassane Ouaalaya1, Laurent Falque2, Jean Michel Dupis3, Marielle Sabatini4, Alain Bernady5, Laurent Nguyen6, Annaig Ozier6, Cécilia Nocent-Ejnaini4, Frédéric Le Guillou7, Mathieu Molimard8, Maéva Zysman9, Chantal Raherison-Semjen10. 1. Bordeaux University, INSERM, Bordeaux Population Health Research Center, team: EPICENE, UMR1219, Bordeaux, France. Electronic address: el-hassane.ouaalaya@u-bordeaux.fr. 2. Polyclinique Bordeaux Rive Droite, Lormont, France. 3. Cabinet Medical Pessac, Pessac, France. 4. CHG Côte Basque, Bayonne, France. 5. Medical Center TOKI EDER, Cambo les bains, France. 6. Polyclinique Saint-Augustin, Bordeaux, France. 7. Cabinet Medical, la Rochelle, France. 8. Bordeaux University, INSERM, Bordeaux Population Health Research Center, team Pharmaco-epidemiology, UMR 1219, Bordeaux, France. 9. Bordeaux University, INSERM, Cardiothoracic Research Center of Bordeaux, team: 2, UMR1045, Bordeaux, France. 10. Bordeaux University, INSERM, Bordeaux Population Health Research Center, team: EPICENE, UMR1219, Bordeaux, France; CHU de Bordeaux, Pole Cardiothoracique, Respiratory Diseases Department, Bordeaux, France.
Abstract
INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: The most important determinants of frequent exacerbations are a history of exacerbations, anxiety and unvaccinated against influenza.
INTRODUCTION: 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. METHODS: Diagnosed COPDpatients 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. RESULTS: 932 COPDpatients 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 obesepatients). 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. CONCLUSIONS: The most important determinants of frequent exacerbations are a history of exacerbations, anxiety and unvaccinated against influenza.