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RESEARCH PRODUCT

The frequent exacerbator in real-life: an analysis of the DACCORD study

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Introduction: Exacerbation prevention is a major treatment goal in COPD. Hence, exacerbations are a decisive diagnostic and prognostic factor when it comes to therapy. The non-interventional prospective DACCORD study was following COPD patients for 2 years. Here, we compare patients with frequent exacerbations, non-frequent exacerbations and no exacerbations in the 6 months prior to study entry. Methods: DACCORD recruited COPD patients following a change or initiation of COPD maintenance. Data collected at baseline and every 3 months include exacerbations and COPD medication use. COPD Assessment Test (CAT) data were collected anually. Results: Out of 6527 patients, 7.1% were frequent exacerbators (≥ 2 ex), 17.3% were non-frequent exacerbators (1 ex) and 75.6% were non-exacerbators (0 ex). The historic exacerbation frequency correlated with CAT score at baseline (0 ex: 18.2; 1 ex: 21.8; ≥2 ex: 25.3). Annualized exacerbation rates during 2 year follow up were highest for frequent exacerbators (0.857) compared to non-frequent exacerbators (0.502) or non-exacerbators (0.215). Frequent exacerbators, however, showed in a higher proportion a clinically important CAT score improvement (0 ex: 53.6%; 1 ex: 62.0%; ≥2 ex: 77.9%) after 2 years. The percentage of patients treated with LABA and/or LAMA decreased while the proportion of patients receiving an ICS-containing therapy regimen increased, an effect mostly pronounced in frequent exacerbators. Conclusion: Our data confirm previous observations that a history of exacerbations is a key predictor for future exacerbations. The improvement of CAT scores alongside the reduction of exacerbations observed further strengthens the importance of exacerbation prevention.