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June 2022

COPD flare-ups increase risk of further exacerbations and death

A new UK study has confirmed that increasing frequency and severity of COPD exacerbations increases the risk of future flare-ups and death.

The EXACOS-UK study (EXAcerbations of COPD and their OutcomeS), funded by AstraZeneca, included 340,515 COPD patients across the UK. Those with a history of exacerbations with increasing frequency and severity at baseline had higher rates of future exacerbations, and were more likely to die from all-cause, COPD-related, and cardiovascular-related mortality compared with those with no exacerbations. Even one moderate exacerbation increased the rate of future exacerbations.

Over 70% of people living with COPD experience at least one moderate or severe flare up within three years of diagnosis. It is the second largest cause of emergency hospital admissions in the UK, and the fifth most common cause of death in the UK, causing nearly 30,000 deaths every year in England alone. However, if best practice was applied, one quarter of these deaths could be avoided.

Despite this, many patients are under-treated and at risk of further disease progression – one third of patients (33.3%) are not reviewed by a respiratory team within 24 hours of hospital admission, and 38% of patients remain undertreated post hospital discharge. Around 40% of patients themselves take no immediate action when having a flare-up.

Carol Stonham, executive chair of the Primary Care Respiratory Society said: ‘This study highlights the importance of each and every COPD exacerbation. Due to existing treatment guidelines, too often we wait for patients to get worse or have a flare-up before we optimise their treatment – this is a failure-based approach and must change. More needs to be done to ensure the system is set up to enable a proactive, preventative approach to allow for more ambitious treatment goals, such as reducing the mortality risk.’

Whittaker H, et al. Int J Chron Pulmon Dis 2022;17:427-437

Practice Nurse 2022;52(5):6