ATS 2021: Severe COPD Exacerbations May be Associated with Increased Mortality Risk

Sydney Jennings

Associate Editor of Patient Care Online

The risk of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) may increase among those with moderate exacerbation, and even more so for severe exacerbation, suggests new research being presented at the upcoming American Thoracic Society International Conference, held May 14-19, 2021.

Researchers performed a modeling activity to estimate the risk for mortality and severe COPD exacerbation events over 5 years using data from a real-world observational study of patients with COPD (HERA-II) and applying corresponding death rates from the ETHOS trial.

The HERA-II study examined exacerbations and health care utilization in 1.55 million patients with COPD using commercial, state, and federal insurance databases.

The ETHOS study, whose primary endpoint was annual rate of moderate or severe COPD exacerbations, demonstrated the safety and efficacy of triple combination therapy with budesonide, glycopyrrolate, and formoterol fumarate vs glycopyrrolate/formoterol fumarate and budesonide/formoterol fumarate.

In the current analysis, investigators used data from HERA-II to estimate exacerbation transition matrices over a 5-year study period for 4 categories:

A. No exacerbation
B. 1 moderate exacerbation
C. ≥2 moderate exacerbations, but no severe exacerbation
D. ≥1 severe exacerbation

The results showed that the 5-year mortality risk was highest for patient category D (42.6%), followed by category C (18.1%), category B (15.2%), and category A (9.9%). The risk of severe exacerbation and/or death (composite endpoint) for each category was projected to be 29.3%, 49.0%, 57.3%, and 77.0% at 5 years, respectively.

Researchers also found that compared to category A, the unadjusted mean relative risks of death for categories B-D were 1.53, 1.82, and 4.30; unadjusted mean relative risks for the composite endpoint were 1.68, 1.96, and 2.63, respectively.

“Our models suggest that risk of mortality and morbidity in COPD patients is projected to increase among those with even one moderate exacerbation; more so for patients with ≥1 severe exacerbation,” concluded authors. “Targeting factors associated with exacerbations, such as comorbidities and suboptimal maintenance treatment, may improve patient survival and reduce burden of these events on society and health plans.”


The abstract, Prediction of 5 year severe exacerbation and mortality risk by baseline exacerbation status in the US-application of the ETHOS trial to a real-world analysis of COPD patients, also appears in the Online Abstracts issue of the American Journal of Respiratory and Critical Care Medicine.