Future exacerbations and mortality rates among patients experiencing COPD exacerbations: a meta-analysis of results from the EXACOS/AVOIDEX programme
Objectives Exacerbations of chronic obstructive pulmonary disease (COPD) can lead to reduced lung function and worse clinical outcomes. Previous studies have reported associations between severe exacerbations and increased risk of hospitalisation and/or mortality. This meta-analysis examined the imp...
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BMJ Publishing Group
2025-07-01
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| Online Access: | https://bmjopen.bmj.com/content/15/7/e097006.full |
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| author | Jennifer K Quint Hana Müllerova Clementine Nordon Deven Patel Juan José Soler-Cataluña Giovanni Sotgiu Jonathan Marshall Kirsty Rhodes Claus F Vogelmeier Barry J Make John Haughney Pierachille Santus Sanjay Sethi My Linh Duong Erika Penz |
| author_facet | Jennifer K Quint Hana Müllerova Clementine Nordon Deven Patel Juan José Soler-Cataluña Giovanni Sotgiu Jonathan Marshall Kirsty Rhodes Claus F Vogelmeier Barry J Make John Haughney Pierachille Santus Sanjay Sethi My Linh Duong Erika Penz |
| author_sort | Jennifer K Quint |
| collection | DOAJ |
| description | Objectives Exacerbations of chronic obstructive pulmonary disease (COPD) can lead to reduced lung function and worse clinical outcomes. Previous studies have reported associations between severe exacerbations and increased risk of hospitalisation and/or mortality. This meta-analysis examined the impact of moderate exacerbations on the risk of future exacerbations and all-cause mortality.Design This meta-analysis included seven observational studies from the EXACOS (EXAcerbations of COPD and their OutcomeS)/AVOIDEX (Impact of AVOIDing EXacerbations of COPD) programme studies.Data sources This meta-analysis used data from regional claims databases or electronic healthcare records from seven countries.Eligibility criteria The individual studies included patients with a diagnosis of COPD and ≥12 months of data availability before (regarded as baseline) and after the index (ie, the date of the first COPD diagnosis), with postindex data considered the follow-up period.Data extraction and synthesis The number of COPD exacerbations experienced during the baseline period (ie, the exposure variable) was used to categorise patients into the following groups: no exacerbations, one moderate exacerbation only or two or more moderate/severe exacerbations. Outcomes assessed included risk of COPD exacerbations and all-cause mortality during follow-up as a function of baseline exacerbations. For meta-analyses, all rate ratios (RRs) were log-transformed, and associations were pooled across studies using random-effects meta-analysis models.Results Among 2 733 162 patients with COPD, one moderate exacerbation was significantly associated with a twofold increased risk of future exacerbations compared with having no exacerbations during baseline, with pooled RRs (95% CIs) of 2.47 (1.47 to 4.14) at 1 year, 2.49 (1.38 to 4.49) at 2 years and 2.38 (1.30 to 4.34) at 3 years postindex. The pooled RR (95% CI) for all-cause mortality was 1.30 (1.05 to 1.62), indicating a 30% increase in risk following one moderate exacerbation versus no exacerbations.Conclusions Preventing moderate exacerbations in patients with COPD should be a priority that may improve patient trajectories and outcomes. |
| format | Article |
| id | doaj-art-1385cf2332cd4a088d43f69e39d8ee2e |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-1385cf2332cd4a088d43f69e39d8ee2e2025-08-20T02:45:42ZengBMJ Publishing GroupBMJ Open2044-60552025-07-0115710.1136/bmjopen-2024-097006Future exacerbations and mortality rates among patients experiencing COPD exacerbations: a meta-analysis of results from the EXACOS/AVOIDEX programmeJennifer K Quint0Hana Müllerova1Clementine Nordon2Deven Patel3Juan José Soler-Cataluña4Giovanni Sotgiu5Jonathan Marshall6Kirsty Rhodes7Claus F Vogelmeier8Barry J Make9John Haughney10Pierachille Santus11Sanjay Sethi12My Linh Duong13Erika Penz14School of Public Health, Imperial College, London, UKRespiratory Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UKRespiratory Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UKRespiratory Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USADepartment of Respiratory, Hospital Arnau de Vilanova-Lliria, Valencia, SpainClinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, ItalyMedical Affairs, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UKReal World Science & Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UKGerman Center for Lung Research (DZL), University of Marburg, Marburg, Hessen, GermanyDivision of Pulmonary Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USAClinical Research Facility, Queen Elizabeth University Hospital, Glasgow, UKDivision of Respiratory Diseases, ‘L. Sacco’ University Hospital, Milano-Università degli Studi di Milano, Milan, ItalyJacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USAThe Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, CanadaDivision of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaObjectives Exacerbations of chronic obstructive pulmonary disease (COPD) can lead to reduced lung function and worse clinical outcomes. Previous studies have reported associations between severe exacerbations and increased risk of hospitalisation and/or mortality. This meta-analysis examined the impact of moderate exacerbations on the risk of future exacerbations and all-cause mortality.Design This meta-analysis included seven observational studies from the EXACOS (EXAcerbations of COPD and their OutcomeS)/AVOIDEX (Impact of AVOIDing EXacerbations of COPD) programme studies.Data sources This meta-analysis used data from regional claims databases or electronic healthcare records from seven countries.Eligibility criteria The individual studies included patients with a diagnosis of COPD and ≥12 months of data availability before (regarded as baseline) and after the index (ie, the date of the first COPD diagnosis), with postindex data considered the follow-up period.Data extraction and synthesis The number of COPD exacerbations experienced during the baseline period (ie, the exposure variable) was used to categorise patients into the following groups: no exacerbations, one moderate exacerbation only or two or more moderate/severe exacerbations. Outcomes assessed included risk of COPD exacerbations and all-cause mortality during follow-up as a function of baseline exacerbations. For meta-analyses, all rate ratios (RRs) were log-transformed, and associations were pooled across studies using random-effects meta-analysis models.Results Among 2 733 162 patients with COPD, one moderate exacerbation was significantly associated with a twofold increased risk of future exacerbations compared with having no exacerbations during baseline, with pooled RRs (95% CIs) of 2.47 (1.47 to 4.14) at 1 year, 2.49 (1.38 to 4.49) at 2 years and 2.38 (1.30 to 4.34) at 3 years postindex. The pooled RR (95% CI) for all-cause mortality was 1.30 (1.05 to 1.62), indicating a 30% increase in risk following one moderate exacerbation versus no exacerbations.Conclusions Preventing moderate exacerbations in patients with COPD should be a priority that may improve patient trajectories and outcomes.https://bmjopen.bmj.com/content/15/7/e097006.full |
| spellingShingle | Jennifer K Quint Hana Müllerova Clementine Nordon Deven Patel Juan José Soler-Cataluña Giovanni Sotgiu Jonathan Marshall Kirsty Rhodes Claus F Vogelmeier Barry J Make John Haughney Pierachille Santus Sanjay Sethi My Linh Duong Erika Penz Future exacerbations and mortality rates among patients experiencing COPD exacerbations: a meta-analysis of results from the EXACOS/AVOIDEX programme BMJ Open |
| title | Future exacerbations and mortality rates among patients experiencing COPD exacerbations: a meta-analysis of results from the EXACOS/AVOIDEX programme |
| title_full | Future exacerbations and mortality rates among patients experiencing COPD exacerbations: a meta-analysis of results from the EXACOS/AVOIDEX programme |
| title_fullStr | Future exacerbations and mortality rates among patients experiencing COPD exacerbations: a meta-analysis of results from the EXACOS/AVOIDEX programme |
| title_full_unstemmed | Future exacerbations and mortality rates among patients experiencing COPD exacerbations: a meta-analysis of results from the EXACOS/AVOIDEX programme |
| title_short | Future exacerbations and mortality rates among patients experiencing COPD exacerbations: a meta-analysis of results from the EXACOS/AVOIDEX programme |
| title_sort | future exacerbations and mortality rates among patients experiencing copd exacerbations a meta analysis of results from the exacos avoidex programme |
| url | https://bmjopen.bmj.com/content/15/7/e097006.full |
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